In what is not a surprise any longer, India leads a group of high-burden countries with respect to one more health indicator — neonatal (0-27 days of age) deaths. Of the three million neonatal deaths globally in 2012, some 779,000 were in India. Nigeria comes second with about one-third of India’s figure. Also, globally there were 2.6 million stillbirths in the same year, of which 600,000 were in India. Since about half of all stillbirths occur close to delivery and could potentially be prevented, the story becomes even more poignant. The first 24 hours after birth represent the most critical period for the survival of a neonate. Of the one million newborns dying globally on the first day of birth, nearly one-third are in India. That 56 per cent of all under-five deaths in India happen during the neonatal period reveals how vulnerable the neonatal period is. Besides bearing the ignominy of being the highest neonatal burden country, for India what is worrying is its inability to achieve death toll reduction. The country, which had a neonatal mortality rate of 29 per 1,000 live births in 2012, recorded an average annual rate of reduction of just 2.6 per cent during 1990-2012. According to papers published recently in The Lancet , India, Nigeria and Pakistan registered the “slowest rates of progress” in reducing neonatal mortality.
According to a 2012 WHO report, India is one of the 10 countries with an estimated 100,000 to 250,000 preterm births, as in 2010. The high number of preterm births is one of the reasons for the very high numbers of newborn deaths in the country — preterm births cause about 50 per cent of neonatal mortality. Though very little is known about what causes preterm births, poverty, adolescent pregnancy, inadequate spacing of deliveries, and lack of medical care are some of the risk factors. Starting 2006, over 500 special-care newborn units have been set up in district hospitals, and about 600,000 admissions take place a year. Thanks to initiatives such as cash transfer, institutional deliveries have increased since 2006. Yet, a concomitant reduction in infant mortality has not been achieved; many deliveries still take place at home, especially in the States of Uttar Pradesh and Bihar. Hence, there is a dire need to increase the number of well-trained birth attendants. Also, the lack of well-trained healthcare workers and well-equipped healthcare centres has proved to be a “barrier” to improving newborn survival. There is, hence, an urgent need to improve the quality of care. What must be borne in mind is that many of the initiatives taken to save neonates’ lives would also help in reducing maternal mortality. With 50,000 deaths, India has the highest maternal mortality in the world.