India today accounts for nearly one third of all newborn deaths worldwide but fortunately the Indian govt agrees that saving newborn lives should be a national priority, writes Dr Rajiv Tandon.
Before you finish reading this, another baby in India will be born who does not live to see tomorrow.
Every day, on average, more than 800 babies die on the day they are born in India. The toll of first-day deaths in India exceeds 300,000 each year. The numbers are truly staggering, even considering that India has the highest number of births worldwide.
In fact, India today accounts for nearly one third of all newborn deaths worldwide. And, of all the children under 5 who die each year in India, more than half are babies less than a month old.
Clearly, saving newborn lives should be a national priority, and fortunately the national government of India agrees. In recent months, the government has made key policy decisions that focus on several major causes of newborn death including babies with severe infections, babies born too soon (premature) and babies born at full term but at very low birth weight.
Consider the treatment of infections, which alone account for more than a third of deaths in the first month of life. While effective, low-cost injectable antibiotics have been available for decades to treat t infections among newborns and their mothers, only physicians have been allowed to use them. That has caused many babies to die without treatment. The reason: their families could not get access to timely and adequate care from a doctor.
In April, the government reversed this long-standing policy and authorized Auxiliary Nurse Midwives (ANMs) to administer the first pre-referral dose of medicines. Doctors will still play an important role, but ANMs, who are at the frontlines of India’s child survival battle, can now continue to administer these injectable antibiotics for a full course treatment in specific situations when referrals are not possible.
The new policy will also help ensure that newborns who develop severe infections are identified as early as possible and provided the care they need to survive. Armed with the ability to administer the first dose of antibiotic treatment, ANMs will be able to reach many more newborns with life-saving treatment.
And there is more good news. ANMs have also been authorized to administer a pre-referral dose of antenatal corticosteroids to women in preterm labor. This drug helps premature lung development, often the case with babies born too soon, and reduces risk of death. Once administered, ANMs then refer cases to a higher level of facility for further management of preterm labor.
The administration of antenatal corticosteroids to women at high risk of preterm birth is a powerful intervention that has been proven to reduce neonatal mortality in resource-rich environments. The effect of antenatal steroids to reduce mortality among preterm babies in hospital settings in developed countries with high utilization is well established, yet until now this lifesaving intervention has not been routinely used in India.
The government, in collaboration with non-governmental organizations, is working to help mothers help themselves in caring for their babies. One new practice is encouraging and supporting participation of pregnant mothers in rural communities in support groups. The latest evidence shows pregnant mothers who join such groups are much more likely to provide improved home care during and after delivery, including clean cord care, warming and drying the newborn, and exclusive breastfeeding than women who are not members of support groups. The findings suggest that supporting such groups is a cost-effective way of reduce newborn deaths.
In addition, the government is supporting Kangaroo Mother Care, a proven and cost-effective practice that encourages mothers to keep their babies warm through skin-to-skin contact. Such care is now considered “essential” for premature and low birth weight babies, both in health facilities and for post-discharge care at home. Guidelines, protocols and educational tools are being developed by the government for wide dissemination. The government also plans to offer counseling and additional support for mothers so they can become more familiar with the practice.
Taken together, these decisions are directly supportive of recent events and commitments by the Government of India to accelerate progress towards Millennium Development Goals to reduce maternal and child mortality, including:
In February India’s Government convened a high-level Child Survival and Development Call to Action Summit, organized in collaboration with USAID and UNICEF, which brought together representatives from ministries, states, private sector, civil society, media, and other stakeholders to recommit themselves to address challenges in reducing newborn mortality.
That same month, the ministry launched a strategic roadmap to engage all partners to arrive at actionable goals and commitments for high-burden states. Largely supported by India’s Reproductive Maternal Newborn Child and Adolescent Health coalition (RMNCH-A), this strategic plan embodies the country’s vision for comprehensive and integrated health services with a special focus adolescents, mothers and children.
In March, at Lucknow, Save the Children organized a Leadership Summit on Child Survival, in partnership with the Hindustan Times, where the state Chief Minister and other senior leaders actively participated. Soon after this, the government announced 2013 as the Year of the Newborn.
In April, India sent a high-level delegation of Ministry of Health officials led by Dr. Rakesh Kumar, Joint Secretary of the Reproductive and Child Health Program, and in-country partners to attend the world’s first-ever Global Newborn Health Conference in Johannesburg. This meeting enabled Indian health experts to confer with the peers from many other countries to review various low-cost interventions proven to reduce newborn mortality. Indian officials are now actively engaged in consulting with other government health officials on the development of India’s Every Newborn Action Plan.
In April and early May, advocates for newborn health in India continue to reinforce the government’s recent policy decisions by singling out the country’s high number of newborn deaths. Save the Children’s State of the World’s Mothers: Surviving the First Day report, for example, received widespread coverage in Indian media outlets across the country. The report documented for the first time the high number of first-day deaths in India.
In late May, at the Women Deliver Conference in Kuala Lumpur, Ms Anuradha Gupta, Additional Secretary of the Ministry of Health & Family Welfare, Government of India, spoke at a special side event introducing the Every Newborn Action Plan. Ms. Gupta acknowledged that the country had previously focused on addressing preventable deaths for children older than a year because interventions for newborn health did not appear to be easily achieved. She applauded the recent policy changes for newborn survival and highlighted some of the government’s more recent broader health actions that have helped to improve newborn health outcomes. One example: the government now exempts all user fees for pregnant mothers and includes free transfers from home to facilities and back for new mothers and their babies.
Putting these policies into practice in a country as vast and complex as India is no easy task. Progress won’t be immediate, and many challenges remain as India seeks to save newborn lives. Still, the government’s renewed commitment to addressing newborn mortality, coupled with the strong support of health advocates across the broad spectrum of maternal, child, newborn and reproductive health, serve as an example to other countries faced with similar challenge. The government is offering every mother-to-be reason to hope that their baby won’t be part of India’s staggering daily death toll of newborns.
No child is born to die. That should be our mantra as we move forward.
Dr Rajiv Tandon is senior adviser for maternal, newborn, child health and nutrition at Save the Children India.