Many readers of this newspaper are likely to be concerned about shedding a few kilograms brought on by age and a sedentary lifestyle. But weight—or the lack of it—is a major problem for a large number of newborns in India. Birthweight is a strong indicator not only of a mother’s health and nutritional status but also of a newborn’s chances for survival, growth, long-term health and development.
According to UNICEF, low birthweight (less than 2,500g) raises grave health risks for children. Low birthweight is a public health problem in many countries; globally an estimated 15% of births (over 20 million newborns) result in low birthweight babies. Babies who are undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and an elevated risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and face a higher incidence of diabetes and heart disease. Children born underweight also tend to have cognitive disabilities and a lower IQ, affecting their performance in school and their job opportunities as adults. More than half of low birthweight infants are born in South Asia, where more than one in four infants are born with low birthweight. India, one of the countries with the highest incidence of low birthweight, adds nearly 7.5 million such babies annually—the highest in any country.
Existing literature clearly shows that there appears to be a permanent effect of low birthweight on socio-economic and health outcomes. A recent paper by David N. Figlio and others (The Effects of Poor Neonatal Health on Children’s Cognitive Development, National Bureau of Economic Research working paper 18846) uses birthweight of twin children in Florida as a proxy for neonatal health. The paper suggests that effects of birthweight on cognitive development are roughly constant across a child’s schooling career. These appear to be the same across a wide range of demographic and socio-economic groups. These results suggest that the gaps observed in adulthood associated with poor neonatal health are largely fixed at least by third grade or even kindergarten, indicating that some biological factors may be very difficult to overcome by subsequent interventions.
Many such studies are carried out in a developed world context and so must be applied to India with caution. In the absence of rigorous studies (or, for that matter, credible, robust data), the common sense conclusion in India has to be that in addition to desirable health outcomes, a major economic boost will arise if we were to focus on the health of the newborn baby and the pregnant mother. In aggregate, if the median birthweight of newborns in India were to rise by 100 or 200g and the percentage of low birthweight babies were to fall (from 28% to 20% or lower), a meaningful productivity boost to the economy is likely.
The percentage of low birthweight babies has decreased only very gradually in India over many decades to 28% in 2005-10. Nearly two-thirds of birthweights are not even recorded. With the primary mission to improve the health of women and children, the government of India set up the ministry of women and child development nearly four decades ago. That effort has had a mixed record. The ministry oversees the government-managed and community-run creches and day care centres called anganwadis and coordinates several nutritional and immunization initiatives. It is also responsible for an innovative conditional cash transfer scheme related to maternal health—the Indira Gandhi Matritva Sahyog Yojana, modelled on the successful Janani Suraksha Yojana—that is reasonably effective even though not fully scaled across the country.
What more can be done? Low birthweight stems primarily from poor maternal health and nutrition—poor nutritional status before conception, short stature (mostly due to under-nutrition and infections during childhood) and poor nutrition during pregnancy. Key interventions to prevent low birthweight include improved food intake for pregnant and lactating mothers, micronutrient supplementation, preventing and treating diseases such as malaria and HIV/AIDS, educating girls and expectant mothers, deworming primary school girls (future mothers) and preventing teenage pregnancies (underage mothers result in underweight babies).
In conjunction with the total sanitation programme, a large-scale awareness campaign involving cinema and cricket stars should focus on the importance of the antenatal health of the mother and the neonatal health of the newborn. For it to be effective, the message has to be simple and persistent. The two maternal health programmes run by two different ministries should be merged. An explicit cash transfer for recording birthweight must be incorporated into the conditional transfer, and national and state-wise goals for improving median birthweights must be set.
PS: “The entire man is, so to speak, seen in the cradle of the child,” said Alexis de Tocqueville.
Narayan Ramachandran is chairman, InKlude Labs, which helps state governments implement large-scale school-based deworming in India. Comments are welcome at email@example.com
To read Narayan Ramachandran’s previous columns, go to www.livemint.com/avisiblehand