A healthy future for mothers and babies
Despite the remarkable global progress made in maternal and newborn survival over the last decade, 4.6 million babies still die in their first year of life—nearly three million in the first 28 days. India loses more children under age 5 each year than any other country. Countrywide, more than half of these deaths occur in the neonatal period, most often because babies are born prematurely, suffer from birth asphyxia, or have neonatal infections. Of the 27 million babies born in India annually, approximately 13% (3.5 million) are born preterm and 28% (7.6 million) with low birth weight, increasing their risk of dying in the neonatal period. The maternal mortality for India continues to be high, with 167 maternal deaths per 100,000 live births.
The good news is that there is an upsurge in collective efforts in India to improve neonatal and maternal health in line with the UN’s Sustainable Development Goals. However, major challenges remain, especially around ensuring that small and isolated populations, women and children in particular, in vulnerable locations can access the healthcare they need.
Role of socio-economic and environmental factors
To solve these challenges successfully, we need urgent and more coordinated collaborative efforts that address the complex socio-economic factors leading to ill health in children and women in India. Neonates born to vulnerable populations, such as the urban and rural poor, and traditionally marginalized and excluded communities, such as Adivasis and Dalits, have a higher probability of being excluded from health services and are at high risk of morbidity and mortality.
In addition, as compared to males, newborn deaths among females are higher at the district level—newborn care units typically admit approximately 30% fewer female neonates than male neonates. Studies show that the average expenditure on healthcare during the neonatal period is nearly four times higher in households with male newborns than those with female newborns.
These socio-economic factors continue to persist in spite of numerous efforts by governments and civil society to address them. We need better oversight and governance through the engagement of civil society organizations and information technology (IT)-enabled platforms, which can lead to the generation of real-time data for better decision making.
Germs are not the only cause of disease; environmental factors, such as lack of nutrition, safe water, sanitation and hygiene, can also play a role. Without addressing these environmental factors, we will be stuck forever in the reactive treatment mode. Instead, we need to adopt the more proactive and preventive mode, which requires long-term planning and commitment of resources, both human and material.
Moving from reactive to preventive
Many state governments in India are making efforts to address public health challenges in their states. Maharashtra has a home-based newborn care programme in Gadchiroli to reach women in settings where public health infrastructure may be limited. In Odisha, the government is using self-help groups and community participation to address the equity and quality of delivery of public health programmes.
The Union government’s safety net programmes, such as the public distribution system, integrated child development services, and midday meal schemes, while challenged by inefficiency, play an important role in offering social protection and ensuring that poor families do not go hungry. The training and posting of auxiliary nurse midwives in newly built health sub-centres, under the supervision of block medical officers, is another positive step to improve access to health services in rural areas.
The recent decline in maternal and infant mortality rates is a positive example of public health intervention in India. Several initiatives, such as the Janani Suraksha Yojana and Janani Shishu Suraksha Karyakram, are paying increasing attention to scaling up through institutional delivery, which has a greater impact. Efforts are under way to implement both facility-based newborn care (FBNC) and home-based newborn care (HBNC) programmes to further reduce maternal and infant mortality.
By ensuring better nutrition for mothers and newborns during the first 1,000 days after birth, we can greatly reduce malnutrition and help infants survive and stay healthy. A simple step like promoting early exclusive breastfeeding has the potential to prevent 13% of global deaths annually for children under five years. The government of India is moving in the right direction with the recent release of guidelines for comprehensive lactation management centres, kangaroo mother care, and for FBNC.
However, there are still gaps in impact, and these interventions remain inadequate due to limited coverage, governance challenges, and the shortage of health workers in primary healthcare facilities.
India’s march towards more development will be faster only if all its current and future citizens have an equal chance to lead a healthy life.
This article is the third in a series on public health in India.
Rajiv Tandon is technical director at PATH India country programme.
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