Nargis Yadav was lucky. Not because she was handpicked as one of the world’s seven billionth babies, who hogged the limelight for a day, but because she and her mother Vineeta received the critical and correct medical attention soon after her birth that ensured little Nargis kept her date with life.
Thousands of infants like her are not so lucky.
Every year, close to 12 lakh newborn babies die in India and 45 per cent of deaths occur within the first two days of their life. India bears the burden of the world’s largest share of neonatal deaths, which constitutes two-thirds of infant deaths in India. Majority of the neonatal deaths occur at home within the first few days of the births due to rural poverty, unskilled neonatal care and absence of adequate referral health care centres across the country.
India contributes about 20 per cent of global births with 27 million live births each year. With about 2 million under-five annual deaths, India also accounts for a quarter of the global child mortality. According to 2008 estimates, out of the annual 1,829,826 under-five deaths, 1,003,767 (54.8%) occurred in the neonatal stage.
“With 1.8 million deaths of children below five years and 52 million stunted children, India’s burden of poor child health is greater than that of any other country. Under-nutrition is the cause of a third to half of deaths among children below five years,” a group of public health researchers led by Vinod Kumar Paul at All India Institute of Medical Sciences, Delhi said in a paper published in the Lancet.
Roughly, a third of infants (7.8 million) are born with low birth weight (less than 2.5 kg) every year, accounting for 26 per cent of the global burden. Close to 60 per cent are born at term after fetal growth restrictions. The first two years of life, particularly the earliest months are crucial for addressing the under-nutrition that arises as a result of a combination of low birth weight, suboptimum feeding and infections such as diarrhoea.
Early under-nutrition is pre-disposed to irreversible effects on educational attainment, adult height, income and the birth weight of subsequent offspring, Paul said.
Add lack of public health infrastructure to it and you know why Nargis was lucky to get her 15 minutes of fame, which ensured proper medical attention. Bereft of the special focus, the infants who died in hospitals in West Bengal recently, and in Andhra Pradesh in September last, are symbolic of the tragic welcome majority of infants across India receive on arrival into this world. The infants who died in B C Roy Hospital had travelled the last mile from remote corners in a critical condition, to reach a referral centre in Kolkata. Similar was the fate of babies who died in Burdwan Medical College and Jangipur hospital in Murshidabad of the State.
Deaths of 30 babies within a few days rocked West Bengal. A bigger jolt came within days when a hospital attendant in yet another hospital in Murshidabad used acid in place of anti-septic to clean up a new-born, killing the child. While the state government suspended the nurse, it gave a clean chit to the B C Roy Hospital staff, who cited lack of infrastructure and the critical state in which the infants were brought to the hospital, leading to the crib deaths.
After the deaths, Union Health Minister Ghulam Nabi Azad announced that all district hospitals will have a sick new born care unit, within the next five years. A study conducted by Public Health Foundation of India and UNICEF shows it is possible to set up and manage quality special care newborn units in rural India to improve the survival of newborns with low birth weight and sepsis. About 10-15 per cent of all newborns have some complication requiring level-II care provided by these special units. Infants who survive the first two days of their lives have a much better chance of staying alive.
But access to healthcare alone is not sufficient. The underlying causes behind child death include malnutrition, absence of clean drinking water and sanitation. There are other social determinants too. “India lags behind both in terms of health services and socio-economic indicators. Till the time these issues are addressed, baby deaths will continue to be a grim reality,” said Amit Sengupta, a doctor from People’s Health Movement.
Over the years, the Infant Mortality Rate (IMR) has improved from 139 per 1000 live births in 1972 to 50 per 1000 births in 2009. But it is still far lower than the UN Millennium Development Goal of 28 per 1000 by 2015. Under-five mortality rate stands at 64 per 1000 births in 2009 as against the MDG target of 42 per 1000 births by 2015. Close to 45 per cent of deaths occur between 1 year and 59 months mainly due to pneumonia and diarrhoea. “It’s impossible to reach the MDG targets,” said Sengupta. Ironically, West Bengal is one of the states which has achieved the MDG target in under-five mortality rate.
While Sengupta claims there is hardly any data available to evaluate the impact of National Rural Health Mission that targets to bring down the IMR to 30 per 1000 live births by 2012, paediatricians point out that proper training of the community health workers under NRHM is absolutely necessary to improve the child mortality scenario. An analysis of 1,92,000 births by a group of Indian and UNICEF experts suggest that a significant decrease in neonatal mortality rate is possible by ensuring home visit by properly trained community health workers within the first two days.