Infant mortality: South Asia
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India tops global list of 1st-day deaths of infants
Jayashree Nandi 2013/05/07
More newborns die on the first day in India than in any other country, according to the latest ‘State Of The World’s Mothers ’ report. Every year, over 3,09,300 children (29% of the global share) in India don’t live beyond the first day because of complications associated with preterm birth, hygiene and maternal health, the report says.
The report by the United States-based Save the Children, which ranks 176 countries on maternal and child mortality, will release globally on Tuesday.
Despite being more populated, China ranks 4th and accounts for only 5% of the global share of first-day deaths. Nearly two-thirds of all first-day deaths occur in just 10 countries and most of these countries have very large populations like India and Indonesia.
Others high up on the list are Pakistan, Afghanistan and African nations like Nigeria and Ethiopia. Predictably, just 1% of the global first-day deaths occur in developed countries.
South Asia is particularly vulnerable because the region has only 14 doctors or nurses per 10,000 people, the report says. Other reasons include preterm deliveries, low birth weight (28% of babies in India are underweight) and stunting among women. Stunting refers to a height of less than 4ft 7. Early marriage and childbearing heightens the risk for babies further. In India 47% girls are married off by the age of 18.
India also fares very poorly in maternal health, with 56,000 maternal deaths per year. Pakistan, with 12,000 maternal deaths, is ranked right above India. Overall, India ranks 142 among 176 countries.
South Asia is particularly vulnerable because the region has only 14 doctors or nurses per 10,000 people according to the report. Other reasons include pre-term deliveries, low birth weight (28% of babies in India are underweight) and stunting among women. Stunting refers to a height of less than 145 cm. The report says that in Bangladesh, India and Nepal close to 13% of women are stunted and at a higher risk for complications of having smaller babies. In these countries, 20% to 40% of women are also very thin. Early marriage and childbearing heightens the risk for babies further. In India 47% girls marry by the age of 18, in Bangladesh child marriage and early childbearing is most prevalent with 66 % of young women getting married and 40% giving birth by before 18 years.
Dr Rajiv Tandon, senior adviser for health and nutrition at Save the Children, feels that India suffers from systemic problems. "We don't just lack resources but also training of frontline workers, supportive supervision and data for decision making. We need to find out whether our auxiliary nurse midwife (ANMs), Accredited Social Health Activist (ASHA) workers and anganwadi workers are motivated? In most districts they lack the supplies required and don't have the skill-sets to deal with such emergency situations," he says.
Tandon also points to cultural issues that most often risk the lives of both baby and mother. "In rural areas there is a culture of applying absolutely anything to the umbilical chord, from cow dung to oils. This can cause acute local infection and even neonatal sepsis. Another such misunderstanding is that in many parts of India people think that colostrum (first breast milk rich in anti-bodies) is not suitable for feeding. These have tremendous effect on the morbidity of newborns," he adds.
The report recommends using simple and effective techniques by frontline workers like when a mother is in preterm labor the attendant can administer an injection of corticosteroids to accelerate lung development of the fetus while the baby is still in the womb. Or, for birth asphyxia when babies don't breathe after birth (kills about 717,000 babies each year), the practice of drying the baby and gently rubbing to stimulate breathing can prevent death.
India is faring very poorly even in maternal health with 56,000 maternal deaths per year followed by Pakistan which has 12,000 maternal deaths per years. India ranks 142 among 176 countries where the first rank goes to Finland and the last rank to Democratic Republic of the Congo for maternal health and well-being. The index for this ranking was developed on the basis of five indicators—maternal health, children's wellbeing, educational status, economic status and political status of women in their country.
Infant mortality in Delhi and the other metros
Goal missed, city infant mortality capital
Even Large States Like TN And Maharashtra Score Higher
INSIGHT GROUP [1]
New Delhi: The bad news is that Delhi has the highest infant mortality rate (IMR) among all the metros and at the current sluggish pace at which the figure is being reduced the capital would achieve its goal of reaching an IMR of 15 only in 2030. The good news is that the utilization of public health facilities is over 60%, much higher than in most states.
From an IMR—a measure of how many die within the first year for every 1,000 live births—of 33 in 2004-09, Delhi has progressed at a crawl to touch the current IMR of 28. The Delhi Human Development Report (DHDR) 2013 pointed out that much larger states like Maharashtra and Tamil Nadu had achieved IMRs of 25 and 22 respectively despite having substantial rural populations, higher levels of poverty and a less intensive network of public health infrastructure. In the Delhi Development Goals set in 2006, the target was to achieve an IMR of 15 by 2015.
Segregating infant deaths shows that most happen in the early neonatal period (up to seven days after birth). The decline in postneonatal (28 days to one year) deaths, has been cut by 62%, compared to declines in neonatal (less than one year) and early neonatal deaths of 35% and 26% respectively. The major reasons for this scenario have been identified as inadequate neonatal care in health facilities and the significant proportion of deliveries still happening at home-—about 20%—which kept women out of the coverage of essential maternal health services. The report argued for urgent efforts to ensure improved coverage of maternal and child health services in Delhi.
Yet, the Perception Survey carried out for the DHDR revealed that across different socio-economic groups a large chunk used the public health system, the proportion varying from over 75% in low income groups to 45% in high income groups.
