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The Magnitude of Neonatal Mortality

The Sustainable Development Goals (SDGs), otherwise known as the Global Goals, are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity. The SDGs provide clear guidelines and targets for all countries to adopt in accordance with their own priorities. SDG 3 clearly states- Ensure healthy lives and promote wellbeing for all at all ages. The target within SDG 3 on neonatal mortality further states – By 2030, end preventable deaths of newborns and children under five years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births.

The status of newborn and infant mortality in the world

UNICEF released a report on February 20, 2018 on infant mortality rate, according to which every year 26 lakh children in the world die within one month of birth and about 26 lakh children are still born. In the report, Japan is said to be the safest country for infants and Pakistan is the most unsafe country. Newborn mortality rate is less than one (0.9 percent) per 1000 newborns in Japan followed by Iceland 1/1000 (1 percent), Singapore 1.1 (1.1 percent) and Finland 1/833 (1.2 percent). According to the report, 8 of the 10 most unsafe countries are sub-Saharan Africa. The birth of children is the most unsafe in Pakistan, where one in every 22 newborn dies before completing 28 days, similarly in Central Africa (42.3 percent), Afghanistan (40.2 percent) and Somalia (38.8 percent) of newborns die.

The report also says that globally, in low-income countries, the average newborn mortality rate is 27 deaths per 1000 births. In high-income countries, that rate is 3 deaths per 1000. In the list of unsafe births in 52 countries with low-income, India ranked 12th in 2017. According to the World Health Organization, of these 26 lakh infant deaths, 10 lakh have died on the first day of birth and 10 lakh children have died within 6 days of birth. In the report ‘The Story Behind the Data 2017’, released by the Bill and Melinda Gates Foundation, more than 100 million children have been saved since 1990 due to immunization and improved newborn care, and if efforts are further intensified then global mortality rate can be 11 in 2030. 80 percent of new born children die due to premature birth and complex infections such as pneumonia and sepsis.

Availability of quality health facilities, trained doctors, nurses, midwives, breastfeeding within one hour, cleanliness, clean water, proper pre and post-natal care, can prevent these deaths from taking place. If every country takes good care of their newborns then 16 lakh lives can be saved. WHOs report ‘The World Health Statistics 2017’ includes statistics of life expectancy as well as data on sustainable development goals. According to this report, newborns and infant mortality rates are declining year after year and all the countries are making efforts to reduce it. Newborn mortality rate of 19 per 1000 live births in 2015 is 37 percent less than it was in the year 2000. But in spite of these efforts, there are 60 countries that cannot achieve the required newborn mortality rate of 12/1000 live births by 2030, and half of these countries cannot even meet this target by 2050.

The struggle for the life of the newborn in India

Newborn infant mortality rate in India is 25.4/1000 births. Out of the total infant mortality rate globally, one fourth, i.e. 24 percent deaths, are in India alone. According to the Sample Registration System (SRS Bulletin September 2017) of the Registrar General of India, in the year 2016, there has been a three digit decline (8 percent) in the newborn mortality rate and 90,000 fewer infants have died in 2016 compared to 2015. This decrease was recorded in Bihar, Assam, Madhya Pradesh, Uttar Pradesh, Jharkhand, Chhattisgarh, Odisha and Rajasthan. In the case of infant mortality, inequalities are seen in the states of India whereas in Kerala and Goa the rate is 10 per 1000, in Bihar and Uttarakhand it is 44/1000. The deaths of newborn children are also higher in the states where the birth rate is high, 46 percent of the total children born in the country are born in Madhya Pradesh, Rajasthan, Uttar Pradesh and Bihar and 57 percent of the total number of new born infant mortality is from these states.

A Look at the Causes of Death

Delay and complex deliveries, infections such as pneumonia, sepsis and diarrhea, congenital abnormalities are major causes of the death of the newborn. According to the Sample Registration System (SRS) of the Registrar General of India, 35.9 percent of the total infant deaths in India are of babies born before time and the weight of children is lower at birth, 16.9 percent pneumonia, 9.9 percent Asphyxia and birth trauma, 7.9 percent Other non-communicable diseases, 6.7 percent of diarrheal diseases and 4.6 percent are due to birth defects and 4.2 percent due to infections. There is a huge lack of institutional health infrastructure and facilities. The condition of health services in villages is shabby. According to NFHS-IV, only 21 percent of women can get all pre-delivery services. When the child is growing in the womb, the inability to detect any problems causes a large number of new born deaths.

Children have the highest risk of infections like pneumonia, blood infection and diarrhea. According to the World Health Organization (May 2017 Factsheet), diarrhea is the second largest cause of death among Indian children. According to the report of the Johns Hopkins Bloomberg School of Public Health 2017, if India gives more attention to pneumonia and diarrhea, then the life of 90 thousand children under five years of age can be saved every year. Apart from this, not having proper eating habits in adolescence, child marriage, getting pregnant before the full development of the body, not getting rest during pregnancy and subsequent hard work, mental / emotional problems, social beliefs about pregnancy, pollution, violence etc. are also causes contributing to the death of newborns.

Some efforts and strategies to achieve the SDG goals

Awareness is being brought about by the government through television, radio and newspapers about the various schemes like Navjaat Shishu Yojana, Baal aur Kishoravastha Swasth Yojana, Pradhan Mantri Maatritva Vandana Yojana. Special Neonatal Treatment and Nutrition Rehabilitation Centers are also being opened across the country. If the government wants to achieve the SDG target of the newborn infant mortality in the right way then more budget allocation will be have to be made for health services. A mass awareness campaign needs to be run at the grassroots level, in which volunteers, organizations, media; social workers and students can help. Every citizen has been given the right to life in the Constitution of India. This right is not available to the newborn children due to which a large number of new born children are dying. There is a need to make serious socio-economic-political efforts to reduce infant mortality. The views expressed in the above article are that of Upasana Behar of Charkha Development Communication Network. – Business Standard