Bolstering institutional delivery and an increased focus on maternal health is crucial to bring down neonatal mortality
Terming India the 12th riskiest nation—among 52 lower-middle income ones—for newborns with a neonatal mortality rate of 25.4 per 1,000, Unicef has kicked off a storm. Over 6 lakh neonates died within a month of birth in 2016. What’s worse, newborn girls have a higher mortality than boys because parents are less likely to seek treatment for a sick female newborn than a male one, Unicef reasons. The trends vary widely between states—while Kerala and Goa have neonatal mortality rates of 10 per 1,000 live births, Bihar has a much bleaker 44 deaths per 1,000 live births. Bihar, Uttar Pradesh, Rajasthan and Madhya Pradesh account for 46% of all births in the country and 57% of its neonatal deaths. The latest figure mean that India is not on track to the Sustainable Development Goal of neonatal mortality of less than 12 by 2030. The neonatal death rate in low-income countries is 27—though India is below this, it is far from matching the levels in neighbours like Sri Lanka, Bangladesh, Bhutan and even Nepal—while it is as low as 3 in developed countries.
The country has managed to bring down neonatal mortality from 57 in 2005-06 to 41 in 2015-16. The gain has been on the back of increased public health of spending, owing in part to high growth years, the roll-out of the National Rural Health Mission and the community-healthworkers-based ASHA programme that is focussed on driving up institutional delivery and maternal and neonatal health.
Most of the neonatal deaths happen due to premature birth, followed by labour and delivery complications and infections such as sepsis, meningitis and pneumonia. This bolsters the case for institutional delivery—this has been going up, from 39% in 2005-06 to 79% in 2015-16, but there still is a significant gap that must be bridged.
The other focus has to be ante-natal maternal health to bring down the possibility of premature birth and maternal malnutrition, that, in turn, affects the neonate’s birth weight and chances of survival as also lactation by the mother. Given how crucial breast-feeding is to the neonatal immunity and nutrition, maternal nutrition and health thus becomes a key factor for bringing down neonatal mortality rates.