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EDITORIAL ANALYSIS : Reducing preterm births and stillbirths


Source: The Hindu

  • Prelims: Current events of national importance(child mortality, under-five mortality, Sample Registration System (SRS), National Health Policy etc
  • Mains GS Paper I & II: Social empowerment, development and management of social sectors/services related to Health, poverty and hunger etc


  • Nelson Mandela: There can be no keener revelation of a society’s soul than the way in which it treats its children”.
    • Global reports released on child mortality and on stillbirths: depict whether India is doing enough for ensuring the health and survival of every child.




Child mortality rate(under-five mortality rate):

  • It refers to the probability of dying between birth and exactly five years of age expressed per 1,000 live births.


  • It is the death or loss of a baby before or during delivery.
  • Both miscarriage and stillbirth describe pregnancy loss, but they differ according to when the loss occurs.
  • World Health Organization’s Classification : A baby who dies after 28 weeks of pregnancy, but before or during birth, is classified as a stillbirth.


The report on child mortality — Levels and Trends in Child Mortality(by the United Nations Inter-agency Group for Child Mortality Estimation (UNIGME)):

  • Globally, five million children died before their fifth birthday (under-five mortality) in 2021.


India’s share:

  • Estimated around:
    • 7 lakh under-five deaths
    • 5 lakh 86 thousand infant deaths (death before first birthday)
    • 4 Lakh 40 thousand neonatal deaths.


Sample Registration System (SRS)-released in 2022:

  • Wide inter-State variations in child mortality in India.
  • For every 1,000 live births: Infant mortality rate in Madhya Pradesh was six-fold of the rate in Kerala.
  • The children in rural parts in any age subgroup have much higher mortality rates than their urban counterparts.


Neglected challenges:

  • Children being ‘born too early’ (preterm births): ‘preterm babies’ are two to four times at higher risk of death after birth in comparison to those born after 37 weeks of gestation.
    • Globally: one in every 10 births is preterm
  • India:
    • one in every six to seven births is preterm.
    • India has a high burden of preterm births
  • Stillbirths-the subject of the second report titled ‘Never Forgotten(UNIGME):
    • Globally, an estimated 1.9(one point nine)million stillbirths happened in 2021.
    • India: around two lakh eighty thousand.


Reasons preterm births and stillbirths do not get due attention:

  • Lack of granular and reliable data: While countries have strengthened the mechanisms for tracking child mortality, the data on stillbirths and preterm births are scarce.
  • At the global level, the first-ever report on stillbirths was released only in October 2020.
  • lack of timely, granular data on stillbirths from the block, district and State levels.


Known and proven Solutions:

  • Scaling up known and proven interventions and improving the quality of health services.
  • The focus must be on increasing access to family planning services
  • Improving antepartum services such as health and nutrition, including the intake of iron folic acid by pregnant mothers
  • Providing counseling on the importance of a healthy diet, and optimal nutrition
  • Identification and management of risk factors.
  • Preventing, detecting and managing diseases which put mothers at high risk, such as diabetes, hypertension, obesity and infections.
  • Reduce future neurological complications for preterm babies by ensuring the Kangaroo mother care and early initiation of exclusive breastfeeding.
  • Monitoring labor and functional referral linkages and improving the quality of health care services will prevent stillbirths.


Way Forward

  • Studies: Preterm births contribute to one in every six under-five child deaths.
    • However, three out of every four deaths due to preterm birth-related complications are preventable.
  • The rates and number of both preterm births and stillbirths are unacceptably high and drive the neonatal, infant and child mortalities upwards in India.
    • They demand urgent interventions
  • The maternal and perinatal deaths surveillance guidelines need to be effectively implemented.
  • International Classification of Diseases’ definition for perinatal mortality must be adopted.
    • The use of this classification will help standardize the causes of stillbirth reporting.
  • India needs to identify the hot spot clusters of stillbirths and preterm births for local and targeted interventions.
  • In the National Health Policy of 2017: the government had committed to investing 5(two point five) % of the GDP on health by 2025.
    • The government’s allocation for health has increased only marginally.
  • It is time for all stakeholders to work together and for health policymakers to take note of these challenges and start interventions.



Q. Can the vicious cycle of gender inequality, poverty and malnutrition be broken through microfinancing of women SHGs? Explain with examples.(UPSC 2021) (200 WORDS, 10 MARKS)