India accounts for 29 percent of all the first-day deaths globally, the highest for any country, according to the ‘State of the World’s Mothers’ report released by ‘Save the Children’ on May 6th 2013. This dismal rank puts a question mark over claims made by the Union government in regard to have taken concrete steps to improve child mortality in the country.
The health ministry does not independently estimate the number of day old child deaths but had in 2011 estimated the early neo-natal mortality rate (number of infant deaths less than seven days of life per thousand live births) to be 24. The ‘Save the Children’ report identified three key factors for alarming number of day old children deaths in the country: preterm birth, severe infections and complications during childbirth.
On its part, the Union government claims to have initiated several ambitious projects to mitigate the problem.
Janani Suraksha Yojana (JSY) is one of the most important programmes under the umbrella of NRHM aimed at reducing ‘Maternal Mortality Ratio’ and ‘Neo-natal Mortality Rate’ by promoting institutional deliveries. Mothers availing financial assistance under JSY ranged from 14.6 percent in Jharkhand to 61.6 percent in Odisha according to Annual Health Survey 2011. The overall success of this scheme has been a mixed bag.
According to the Coverage Evaluation Survey (CES) (2009), at the national level, 72.9 percent of the deliveries were institutionalized. 85.6 percent of the women in urban areas delivered in an institution as compared to 68.0 percent in rural areas. The proportion of deliveries attended by skilled health personnel was less in rural areas (71.1 percent) as compared to urban areas (87.9 percent). Overall at the national level, 76.2 percent of the deliveries were reportedly attended by skilled health personnel.
Identifying the causes behind the deaths of newborns in India, Dr Anjali Mathur, consultant, neonatology at Moolchand Children Hospital says, ‘Lack of skilled healthcare professionals, unavailability of proper birthing centers, premature deliveries and infections are the reasons behind the current situation.’
At the national level, 68.7 percent women received three or more checkups during the antenatal period. The proportion of women who received three or more antenatal check-ups was higher in urban (82.7 percent) than rural areas (63.3 percent) according to CES Survey 2009.
Rural women are the sufferers of the lot. Dr Vandana Kent, senior consultant, paediatrics at Rockland Hospital, concurs, ‘Most of the girls in rural India are unaware of the facts pertaining to pregnancy and child birth due to illiteracy, hence they miss the required checkups as mandated which gives rise to complications during child birth and results in deaths of new born.’
The latest Comptroller & Auditor General of India (CAG) report on malnutrition levels in India has raised hope as the report shows an improvement in the figures as compared to the National Family Health Survey (NFHS-III) (2005-06) report. According to CAG as on March 2011, 41.16 percent of children in India are malnourished, an improvement of 0.89 percent over 2007.
However, the medical fraternity is of opinion that India is way behind its target to achieve proper nourishment level for children across India.
Suggesting recommendations to address the worrisome situation of deaths of the new borns, Dr Kent at Rockland Hospital, advises, ‘Awareness at the grassroots level is required to address the situation. The first requirement is that all pregnancies should be registered. In order to reach to the illiterate and poor people, the health workers should regularly visit them and should make use of audio –visual aids to make them aware of matters related to pregnancy and post pregnancy.’