India, which has taken proactive steps to reduce neonatal mortality, is likely to achieve the Sustainable Development Goal (SDG) targets in this key area by 2030, a top WHO official has said, citing data on the annual rate of reduction for newborn deaths in the country between 2016 and 2021.
"India has taken important steps to improve the quality of care during labour and childbirth, leading to reductions in maternal deaths. This will also bring better outcomes for new-borns," Dr. Anshu Banerjee, Director, Department of Maternal, Newborn, Child and Adolescent Health and Ageing at the World Health Organisation, Geneva, told PTI , in Cape Town.
"If we use the annual rate of reduction for newborn deaths between 2016–2021 and apply it to 2022–2030, it is likely that India will be able to achieve the Sustainable Development Goal targets," Dr. Banerjee, who was here last week to attend the 'International Maternal Newborn Health Conference' (IMNHC 2023), said.
“India has been proactive in taking action to accelerate neonatal mortality reductions, including strengthening policy and planning for newborn health,” Dr. Banerjee said. Dr. Banerjee addressed several sessions during the four-day conference which was held from May 8-11.
The IMNHC 2023 was hosted by the government of South Africa and AlignMNH – a global initiative funded by the Bill and Melinda Gates Foundation in collaboration with the United States Agency for International Development (USAID), and in partnership with UNFPA, UNICEF, and the World Bank.
India has an established newborn care programme at both the health facility and community levels.
Essential newborn care is given through dedicated Newborn Care Corners in health facilities, Newborn Stabilisation Units have been established in primary health facilities to take care of simple newborn illnesses, and a large network of about 1,000 newborn care units covers nearly every district in the country has been established in hospitals to take care of sick and preterm newborns.
India also has one of the largest "home-based care for newborns" programmes where six to seven visits are made by frontline health workers (ASHAs) to provide health services and counselling at home after birth.
"In order to bring further gains, it will be important to continue improving the quality of care available to newborns, especially those that are born early, small or sick," he said.
On being asked about the learnings from the 'Born too soon: decade of action on preterm birth' report by the WHO, UNICEF and PMNCH — the world’s largest alliance for women, children, and adolescents, which was also launched here last week, Dr. Banerjee said that complications relating to premature births are now the leading cause of under-five child deaths globally, and as such, its is one of the most pressing issues for child survival. Preterm birth is when a baby is born before 37 weeks of pregnancy.
"We simply can’t achieve global newborn health and survival targets without moving on this big issue. And yet, there has been very little progress in reducing rates of preterm births globally over the last decade," he said.
"There is now no excuse for inaction – we have so many solutions and innovations that we didn’t have a decade ago. What we need is a big focus on investment and implementation for both prevention of preterm birth – in particular, this means ensuring high-quality care during pregnancy for every woman, including early ultrasound – and better care for small and sick newborns and their families," he stressed.
“Next week, the WHO will be launching new resources for countries to support the wider roll-out of kangaroo mother care, a lifesaving technique involving both skin-to-skin contact between a mother and a baby and exclusive breastfeeding,” Dr. Banerjee said.
“This needs to be available to preterm babies everywhere to ensure they have the best possible chance of survival.”
On countries facing twin problems of obesity and malnutrition with urbanisation, Dr. Banerjee said while the problem of undernutrition in women and children (manifested as wasting, stunting, and micronutrient deficiencies) continues to be a major contributor to sickness and mortality throughout the world, rising rates of obesity are contributing to increases in non-communicable diseases. This has been called “the double burden of malnutrition”.
“This means that health programmes and healthcare workers must simultaneously scale up interventions to address both ends of the spectrum at the same time – and ensure they are screening for and managing both undernutrition and obesity,” he said.
“This can be a huge challenge, but we are finding that there are achievable “double-duty actions” that are important to reduce both undernutrition and obesity. “For example, protection and support of continued breastfeeding – including through maternity protections, for instance - supports better child growth and protects against the later development of obesity.”
“Delivering supplemental food products that are highly nutritious without containing unhealthy fats and sugars can also be a double-duty action,” he said.
On what are some best practices that India can emulate from other countries for improving maternal and newborn health, Dr. Banerjee said, "India does not have to look far." There are success stories within India - for example, the State of Kerala has achieved a maternal mortality rate of 19 per 100,000 live births, followed closely by a few other States.
“Implementation of quality standards in obstetric care helped address the common causes of maternal death, complemented by improvements in the response to childbirth-related emergencies,” he stated.
“In South Asia, Sri Lanka has achieved remarkable success and that too with limited financial resources by focussing on universal health coverage, deploying professional midwives for skilled birth attendance and ensuring quality of care.”
On what learnings others can derive from India's policies to reduce MMR, he said leadership and commitment at the highest level to reduce maternal and neonatal mortality are instrumental in driving change.
“In addition, India has several unique policies and schemes that have focussed on reducing inequities in access to quality care in public and private healthcare facilities.”
In particular: India has adopted a policy to provide every woman and newborn with assured, dignified, respectful and quality healthcare, free of cost and with zero tolerance for denial of services under SUMAN.
Another scheme guarantees pregnant women a minimum package of antenatal care services, including ultrasound, in the second and third trimesters of pregnancy at designated public health facilities.
India is supporting monitoring and safe delivery for all high-risk pregnant women through additional extra antenatal visits for them.
Interventions during labour and childbirth are estimated to have the greatest impact on reducing preventable maternal and newborn deaths, and India has focussed hard on improving care at this point.
The Ministry of Health has undertaken quality certification of hundreds of labour rooms and maternity operation theatres under the “LaQshya” programme. Standardisation of labour rooms, adherence to critical (clinical and non-clinical) practices around childbirth and creation of a conducive environment for “respectful maternity care” has fostered more confidence in the public health system.
Competencies of the health care providers in these labour rooms have been strengthened through a programme called “Dakshta” which focusses on improving essential skills.
India has introduced several IT initiatives to leverage digital platforms to support health service provision for pregnant women and children. Several states are using innovative mobile technology to support health status monitoring and response.