It cannot get any worse than this. Over three lakh newborns in India die on the very first day of their birth. With this the country ranks as number one in terms of first day of birth mortality; its share in global first-day deaths stands at 29 per cent. The appalling state of Indian health care to which this speaks is further highlighted by the fact that the next worst performer, Nigeria, is a distant second with less than 90,000 deaths a year and a nine per cent share of global deaths. These are some of the statistics in the “State of the World’s Mothers” report released by Save the Children recently. With 28,000 deaths a year, Bangladesh is not only better off than India, but is also one of the 12 developing countries that have made the greatest strides in achieving a significant decline in deaths between 1990 and 2011. As one of the most populous countries, it is inevitable that India may continue to register a greater number of deaths even if it achieves an appreciable decline in percentage mortality. Hence it must simultaneously adopt multiple strategies, and with greater immediacy, for a large reduction in the number of newborn deaths. Tremendous gain can be achieved by preventing childhood marriages as teenage pregnancy greatly contributes to first-day deaths.
Poor mothers living in rural areas are another at-risk group that needs undivided focus. If poor health before and during pregnancy is already a big risk factor, lack of good medical care during delivery exacerbates it. This brings to the spotlight the need to have a greater percentage of institutional deliveries. Forty-six per cent of mothers deliver at health-care facilities in sub-Saharan Africa. Though India’s national average of 73 per cent is much higher than sub-Saharan Africa’s, why is neonatal mortality still high in many States? For instance, Madhya Pradesh, Uttar Pradesh and Odisha have high newborn (0-7 days) deaths despite having high institutional deliveries of 63 per cent, 46 per cent and 53 per cent respectively. The uncomfortable truth is the questionable quality of care at many of these facilities. The personnel attending to deliveries are very often not properly trained and hence not fully proficient in labour-room protocols. Labour rooms are not always fully equipped with essential medicines, equipment and electricity. All these result in the incongruity between more facilities but poor outcome. States must therefore emulate the Tamil Nadu model where women-friendly public services are provided by fully equipped health-centres with a well-trained nurse round the clock to ensure safe deliveries.