India is worst on infant mortality
Nothing can be worse than this. Upwards three lakh newborns in India take their last birth on the very first day of their arrival into this planet in which we all dwell. With this the country ranks as number one in terms of birth mortality; its share in global first day deaths stands at 29%. The sorrowful and appalling state of Indian healthcare to which this speaks is further highlighted by the stark fact that the next worst performer - Nigeria is a distant second with less than 90,000 deaths a year and a 9% share of global deaths. These are some of the statistics in the “State of the World’s Mothers” report released by “Save the children” in recent times. With 20,000 deaths a year ago (1917), Bangladesh is not only better off then India, but is also dozen nations that are developing which have made the greatest strides in achieving a significant decline in deaths between 1990 and 2012. As one of the most populous countries, next only to China it is inevitable India may continue to register greater number of deaths even if it achieves an appreciable decline in percentage mortality. Hence it must simultaneously adopt multiple strategies and with greater urgency, for a substantial reduction in the number of newborn demises. Wonderful gain can be achieved by preventing childhood marriages as teenage pregnancies immensely contribute to first day deaths.
Power stricken mothers in rural areas are another at risk group that calls for undivided focus. If poor health before and during pregnancy is already a huge risk factor, paucity of good medical care during pregnancy exacerbates it. This brings to spotlight the dire necessity to have a greater percentage of institutional deliveries. 40% of mothers deliver at healthcare facilities in subSarahan Africa.
Why itʼs on high?
Albeit India’s national average of 73% is much higher than sub-Saharan Africa’s why is neo-national mortality high in many states? For example Madhya Pradesh, Uttar Pradesh and Odisha have high newborn (0-7 days) deaths, in spite of having high institutional deliveries of 63% and 53% respectively. This unpalatable fact is the questionable quality of care of host of these facilities.
The personnel attending to these deliveries are quite often not well trained and hence not proficient in labour-room protocols. Instances are not rare when newly appointed nurses attending to deliveries culminating not only in the deaths of the still to be born children but also the deaths of mothers. Labour rooms are not always fully equipped with essential medicines, equipment and electricity. All these occasion in the incongruity between more facilities but poor out come. States must therefore emulate the Tamil Nadu model where women friendly public services are provided by fully equipped health centres with well trained nurse round the clock to ensure safe deliveries.
India loses 4200 children under the age of five daily, this figure still alarming and unacceptable. A string of these deaths is preventable. Added to this is the wide prevalence of child marriages, anaemia among young women and total lack of focus on adolescent sanitation, all impacting child death rates.
Its share in global first day deaths stands at 29%.
Whereas India in recent years has made notable achievements in bringing down deaths per 1000 live births (infant mortality) deaths in less than 4 weeks of birth (neonatal) and under five mortality are the areas that can doubtless do with some more attention.
U5 MR and Indian states, In recent times Under Five Mortality Rate (U5MR) had come down drastically, faster than world average. India had registered a fall of 48 between 1990 and 2011. In terms of numbers 2011 saw U5MR decline precipitously by roughly half to 60% live births.
This should be a welcome improvement for the battling infant deaths in the country. But given the enormous size of the nation accomplishments in slashing down mortality are not regrettably uniform. While some states had faired extremely there are others which have fallen far behind. While Kerala is in the forefront in reducing the infant mortality; Tamil Nadu, Maharashtra, Karnataka, Andhra Pradesh including Telangana have bucked the national fall of 7.25% between 2008 and 2014. Haryana and Bihar with a dwindling rate of 7% have to just touch the national average.
Among the bigger States that fare badly are Jharkhand and Madhya Pradesh with Assam keeping company to them. West Bengal and Punjab, Jammu & Kashmir, Uttar Pradesh, Rajasthan and Chhatisgarh are just below the national average.
Just as there are variations among States in cutting down child deaths, there are wide disparities within the States as well. For example in Assam, the U5MR in Kokrajhar is twice that of Dhemaji district. In Chhatisgarh, U5MR in Durg is half that of the tribal dominated Surguja. Ditto is the story in Patna and Sitamarhi in Bihar. While 53 children per 1000 live births die in Patna, the figure is 106 for Sitamarhi. These disparities are even worse in Rajasthan and Jharkhand. There are stand-alone districts in many States where deaths are rampant like Kandhamal (145) in Odisha, Shrawasti (142) in Uttar Pradesh and Patna (140).
To sustain high rate of annual decline it cannot be things as usual. Each State will have to identify a specific goal to meet the target like sanitation, hygiene and water supply.
As per the national survey, adolescents (15-19 years) contribute about a sixth of the aggregate fertility in the nation. With the large unmet requirement of contraception nearly a quarter of the adolescents (15-19 years) and low condom use by them in general, girls age band are at high risk contraction of sexually transmitted infections, HIV and unintended and unplanned pregnancies. All these impact child mortality rate.
Affordable life saving treatments remains inaccessible to a large majority of Indian kids and especially in the poorest of the poor bracket. All these challenges can only met by the respective state governments.
Therefore universalisation of maternal health and child services which include special newborn care, dexterous delivery, immunization and management of diarrhea appears to be the only answer if India has to accomplish the high goals of reducing child mortality.
With the large unmet requirement of contraception nearly a quarter of the adolescents (15-19 years) and low condom use by them in general, girls age band are at high risk contraction of sexually transmitted infections, HIV and unintended and unplanned pregnancies. All these impact child mortality rate. Affordable life saving treatments remains inaccessible to a large majority of Indian kids.
Healthcare is a basic right for the new born as well as the mother.
Universalisation of maternal health and child services are need of thehour in India.