No country for new born
A recent report by Save the Children reveals that 3,09,00 babies die on the first day of their birth in India and almost one every minute in South Asia
In a major new report launched globally today, Save the Children has revealed how 4,20,000 babies across South Asia die on their first day of life – that’s almost one every minute. The agency’s 14th annual State of the World’s Mothers report indicates that chronic malnourishment which leads to mental or physical impairment or ‘stunting’ is particularly severe in the region. The report’s Birth Day Risk Index shows that of the one million babies who die each year on the day they are born, almost 40 per cent of these are in India, Pakistan and Bangladesh. This statistic makes the first 24 hours by far the riskiest day of a human life, not just in the region but in almost every country in the world.
Stunting amongst mothers in South Asia is one of the major factors contributing to newborn baby deaths in the region, according to the report. Mothers, who suffer from stunting, run a higher risk of complications during birth – both for themselves and their babies. In the same countries, between 20 and 40 per cent of women are excessively thin, compounding the risks of poor pregnancy outcomes. The relatively common practice across South Asia for women to have babies at a young age, before their bodies have fully matured, also contributes to health issues of newborns, according to the report.
Where Does India Stand?
Today, the world is on the brink of a major breakthrough to ensure newborn babies everywhere survive. If there's one place to trace the seeds of this brewing revolution, it's India. Yet today, India also represents some of the greatest challenges in seeing this revolution through. It has persistently high rates of newborn mortality, and accounts for 29 per cent of all first day deaths globally –309,000 a year. But although some countries are making progress, the State of the World’s Mothers report shows that inequality is growing both between and within nations. If all newborns in India, for example, experienced the same survival opportunities as newborns from the richest Indian families, nearly 3,60,000 more babies would survive each year.
India: Where are NEWBORNS dying?
According to Government of India's Sample Registration Survey (SRS 2011) Madhya Pradesh has the highest burden of early newborn deaths (0-7 days) at 32, followed closely by Uttar Pradesh and Odisha (30). Other states with high burden are Rajasthan, Chhattisgarh, Bihar, Jharkhand and J&K.
Kerala is the leader in reducing neonatal mortality by a wide margin, while Tamil Nadu, Delhi and Maharashtra too have bucked the national rate.
Thomas Chandy, CEO of Save the Children in India, added, “For the first time in history, putting an end to this crisis is within our reach, but to achieve this will require unprecedented focus on saving babies in their first day and month of life. Save the Children recognizes the immense efforts being made in India and the government’s commitment to end child mortality in a generation. Although many challenges remain, India has mobilized the most important ingredient to long term success: political will.”
Neonatal Mortality in Selected Indian States
Save the Children commends the efforts the efforts of countries like Bangladesh and Nepal, which have demonstrated that effective solutions to this challenge exist and are affordable, even in the poorest communities. The report also acclaims the work of Dr Abhay Bang, whose pioneering model of home based neonatal care in rural districts of India that has been rolled out across the region and, according to the report, “likely prevented hundreds of thousands of newborn deaths”.
Overall, however, the report says that progress in South Asia, while “significant” has, along with sub-Saharan Africa, “lagged behind the rest of the world”. Two thirds of all newborn deaths occur in just ten countries, four of which are in the region: Nigeria, DR Congo, Tanzania, Ethiopia, Pakistan, India, Afghanistan, Bangladesh, Indonesia and China.
Also in the report, Save the Children reveals the worst place in the world to be a mother. The ranking, which compares 176 countries around the globe, shows the countries that are succeeding – and failing – in saving the lives of mothers and their newborn babies. The report weighs up factors such as mothers’ health, education and economic status, as well as critical child indicators such as health and nutrition. This year, the Democratic Republic of the Congo comes bottom of the pile, while Finland comes out on top. Save the Children recognizes the progress made although not sufficient, has been ‘significant’. Among those countries making big strides:
Bangladesh has reduced newborn mortality by 49 per cent since 1990. Community health workers reaching mothers and babies at home, and training birth attendants and medical staff in resuscitation device to help babies breathe are factors in this progress
Nepal has reduced newborn mortality by 47 per cent since 1990. Community-based care and a world-leading use in low-cost antiseptic chlorhexidine to prevent umbilical cord infection, is contributing to progress.
Also in the State of the World’s Mothers report is a Mothers’ Index, a unique ranking of 176 countries around the globe, showing how effective governments are in supporting mothers. It assesses mothers’ well-being looking at levels of women’s health, children’s health, educational attainment, economic well-being and female political participation. This year, the Democratic Republic of the Congo is bottom of the list, while Finland is top.
In South Asia, there are striking differences between countries in the case of maternal risk to life. In Afghanistan, a mother has a one in 32 risk of maternal death, in India it is 1 in 170, but in Nepal it is one in 190. But when it comes to education there is less disparity with children in Pakistan having an expected 7.5 years of education, Nepal nearly nine years and nearly 11 years in India. This compares with nearly 17 years in top ranked Finland.
Other key findings of the annual report include:
The top 5 countries in the South Asian mothers’ ranking are: Maldives, Sri Lanka and Bhutan. The bottoms 5 are (in descending order) Pakistan, India and Afghanistan.
The top 5 countries in the global mothers’ ranking are: Finland, Sweden, Norway, Iceland and the Netherlands. The bottom five (in descending order) are: Niger, Mali, Sierra Leone, Somalia and the DRC
In the industrialized world, the United States has by far the most first-day deaths. There, 50 per cent more first-day deaths occur than in all other industrialized countries combined.
Two thirds of all newborn deaths occur in just 10 countries: India, Nigeria, Pakistan, China, DR Congo, Ethiopia, Bangladesh, Indonesia, Afghanistan and Tanzania.
With 98 per cent of all newborn deaths occurring in developing countries, a gap between the health of the world’s rich and poor is persistent and widening.
In many countries, the mortality gap between rich and poor has widened despite falling national rates.
Newborn health funding doesn’t match the need. While overseas development assistance for maternal and child health doubled between 2003 and 2008, only six per cent of the funding in 2008 went to activities specifically focused on newborns and only 0.1 per cent targeted newborns exclusively.
Save the Children calls on world leaders to:
Invest in low-cost solutions that can dramatically reduce newborn mortality. Proper cord care and newborn/paediatric doses of antibiotics can prevent and treat simple but deadly infections. Exclusive breastfeeding and “kangaroo mother care” should be encouraged which cost nothing but can save hundreds of thousands of babies’ lives each year. Additionally, birth attendants should be trained and given proper support and supplies.
Strengthen health systems so women have greater access to skilled birth attendants. They can provide lifesaving interventions to all mothers and children, in addition to providing more funding for maternal, newborn and child health programmes. More should be invested in frontline healthcare workers and community health workers to reach the most vulnerable mothers and babies.
Fight the underlying causes of newborn mortality, especially gender inequality and malnutrition. Helping mothers become strong and stable – physically, financially and socially – make their children stronger and more likely to survive and thrive.