RSTV: THE BIG PICTURE- TACKLING INFANT MORTALITY
The death toll of infants at the JK Lon Hospital in Rajasthan’s Kota has reached 110 in the past 36 days. In Gujarat the State run civil hospitals in Rajkot and Ahmedabad witnessed death of 134 and 85 infants respectively in the month of December, 2019. Death of children under the age of 1 is measured by Infant Mortality Rate which is the number of deaths per 1000 live births. While Rajasthan’s Infant Mortality Rate in 2017 stood at 38 which is higher than the national average of 33, this figure for Gujarat was below the national average in 2017 at 30.
- It is the death of young children under the age of 1.
- This death toll is measured by the infant mortality rate (IMR), which is the number of deaths of children under one year of age per 1000 live births.
- The under-five mortality rate, which is referred to as the child mortality rate, is also an important statistic, considering the infant mortality rate focuses only on children under one year of age
- In 1990 9 million infants younger than 1 year died globally. Until 2015 this number has almost halved to 4.6 million infant deaths. Over the same period, the infant mortality rate declined from 65 deaths per 1,000 live births to 29 deaths per 1,000.
- Child mortality is the death of a child before the child’s fifth birthday, measured as the under-5 child mortality rate (U5MR).
- The child mortality rate, but not the infant mortality rate, was an indicator used to monitor progress towards the Fourth Goal of the Millennium Development Goals of the United Nations for the year 2015.
- A reduction of the child mortality is now a target in the Sustainable Development Goals for Goal Number 3 (“Ensure healthy lives and promote well-being for all at all ages”).
- Every day, India witnesses the death of an estimated 2,350 babies aged less than one year.
- Among them, an average 172 are from Rajasthan and 98 from Gujarat.
- India has the most child deaths in the world.
- The infant mortality rate (IMR) in the country currently stands at 33 per 1,000 live births.
- India’s IMR remained worse than that of Nepal (28), Bangladesh (27), Bhutan (26), Sri Lanka (8) and China (8).
- The problem remains severe in the northern Indian states of Madhya Pradesh, Rajasthan, Bihar, Assam and Uttar Pradesh.
- Forms of infant mortality:
- Perinatal mortality is late fetal death (22 weeks gestation to birth), or death of a newborn up to one week postpartum.
- Neonatal mortality is newborn death occurring within 28 days postpartum. Neonatal death is often attributed to inadequate access to basic medical care, during pregnancy and after delivery. This accounts for 40–60% of infant mortality in developing countries.
- Postneonatal mortality is the death of children aged 29 days to one year. The major contributors to postneonatal death are malnutrition, infectious disease, troubled pregnancy, Sudden Infant Death Syndrome and problems with the home environment
Why India is not able to reduce new born mortality rate:
- Premature birth. Premature births counts for over 80% of newborn deaths.
- Complications like asphyxia during delivery. Due to lack of institutionalisation of births and lack of health infrastructure in rural areas.
- Complications during labour and delivery as well as infections like sepsis, meningitis and pneumonia are also major contributors
- Female literacy rates are less leading to less awareness regarding nutrition needed.
- Babies born to mothers with no education face nearly twice the risk of early death as babies whose mothers have at least a secondary education
- Prevalence of child marriages, anaemia among young women and a lack of focus on adolescent sanitation, all of which impact child death rates.
- With the substantial unmet need of contraception nearly a quarter of married adolescents (15–19 years) and low contraception use by them in general, girls in this age band are at a high risk of contracting sexually transmitted infections, HIV and unintended and unplanned pregnancies. All these impact the mortality rate.
- Shortage of properly trained health workers and midwives:-
- Also the large reproductive population of 2.6 crore remains bereft of care during the critical phases of pregnancy
- Babies born to the poorest families are 40 per cent more likely to die than those who are born to the least poor
- The absence of steps to propagate basic healthy practices relating to breast feeding and immunisation.
- Part of the reason is that in the last two decades, efforts to tackle the problem were not as well funded as HIV and AIDS prevention.
India’s Per capita spending on health:
- Per capita spending on health in the Budget in India is Rs.458 (Rs.61,398 crore/ 134 crore, which is the population).
- The S. spends $10,224 per capita on healthcare per year (2017 data).
- A comparison between two large democracies is telling the U.S.’s health expenditure is 18% of GDP, while India’s is still under 1.2%.
- US Budget spending per capita on health in the U.S. is therefore $3,150 ($1.04 trillion/ 330 million, the population). Adjusting for purchasing power parity, this is about $30, one-hundredth of the U.S.
- Yet, the $4,000-$5,000 per capita spending in other OECD countries is not comparable with India’s dismal per capita health expenditure.
- The rate of growth in U.S. expenditure has slowed in the last decade, in line with other comparable nations.
- Paying attention to the mother’s health during pregnancy and ensuring she delivers in a hospital attended by trained doctors or midwives. India has programmes such as the Janani Suraksha Yojana for this, but must expand its reach in laggard States like Uttar Pradesh and Madhya Pradesh.
- Each State will have to identify a specific goal to meet the target. These could be enhanced coverage of health and nutrition, water, sanitation and hygiene which can prevent pneumonia and diarrhoea.
- Inexpensive lifesaving treatments remain inaccessible to a vast majority of Indian children, and especially those in the poorest groups within the country. All these challenges can only be met by State intervention.
- It is also equally important to forge interlinkages and package different interventions at various levels like linking child survival to reproductive health, family planning, and maternal health
- In addition to focusing attention to addressing disparities within States and among regions, there is an urgent need to bring health and child services under universal health coverage with a focus on special requirements of vulnerable and marginalised groups.
- Universalisation of maternal health and child services, which includes special newborn care, skilled delivery, immunisation and management of diarrhoea, need to be effectively implemented if India is to achieve the high goals of reducing child deaths.
- To lower neonatal deaths, India needs to strengthen mother and newborn health services, including home-based care by health workers, promoting breastfeeding, treating underweight babies, keeping the mother healthy, preventing early marriage and reducing malnutrition in adolescent girls.
- More than 80 per cent of newborn deaths can be saved with:
- Provide clean water, disinfectants
- Breastfeeding within the first hour
- Good nutrition
- The Central and State governments have introduced several innovations in the healthcare sector in recent times, in line with India’s relentless pursuit of reforms.
- However, while the government’s goal is to increase public health spending to 2.5% of GDP, health spending is only 1.15-1.5% of GDP.
- Since a major innovation in universal healthcare, Ayushman Bharat, is being rolled out, it must be matched with a quantum leap in funding. Only if we invest more for the long-term health of the nation will there be a similar rise in GDP.
- To reach its target, the government should increase funding for health by 20-25% every year for the next five years or more.