Bill & Melinda Gates Foundation

An Equal Chance for India's Most Vulnerable Newborns

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August 31, 2011

Join the global conversation on Impatient Optimists and Healthy Newborn Network as we explore the pressing need — and what our partners are doing to address the need — to save the lives of women and newborns in India. This is the second post in a multi-week series.

One of every four newborn deaths around the world is an Indian child, according to new numbers released this week by the World Health Organization (WHO), Save the Children, and partners.

In India in the year 2009, over 900,000 babies died during their first four weeks of life — but this risk of dying is not equal. The poorest families are more than twice as likely to mourn the loss of their newborn baby compared to the wealthiest families. If all of India’s newborns had the same risk of death as the richest fifth of the population, 900 fewer newborns would die each day, reducing newborn deaths by one third. A rural family has a 30 percent higher risk of newborn death than an urban one, despite the increasing challenge of urban poverty in India.

A woman’s chance of her baby dying varies dramatically between the different Indian states. A baby born to a family in the small western state of Goa has a risk of newborn death similar to a baby born in Argentina (9 per 1000 births). A baby born in Chhattisgarh state in central India has a risk similar to an Afghani baby (51 per 1000 births). This is a six fold difference within one country.

Overall, India ranks highest in the world for the number of newborn deaths, and 166 out of 193 countries for newborn mortality risk. While India is not currently on track to achieve its Millennium Development Goal (MDG) 4 target, to reduce child mortality, by the year 2015, the nation has made progress in reducing child deaths and that pace has increased in recent years.

Progress in reducing deaths for children under five years of age is good news. The bad news, however, is that due to slower progress in reducing newborn deaths, a staggering 52 percent of deaths of children under age 5 in India are in newborns.

Accelerating progress to reach MDG 4 requires concerted action to reduce these deaths. India has reduced the national neonatal death rate by one third since 1990 while other countries, such as Nepal and Bangladesh, have more than halved this rate in the same time period.

Reduction in newborn deaths in the 1950s and '60s in Europe and North America was achieved prior to the introduction of hi-tech, expensive, and intensive care. Progress is possible, even in the most challenging circumstances.

Three “killers” account for over three quarters of newborn deaths: childbirth complications, preterm birth, and infections. For each of these there are highly effective interventions that work as long as there are frontline health workers available with information, simple medicines, and basic equipment.

The strategies to reduce newborn deaths vary in different settings, but involve community empowerment, demand creation and bringing care closer to homes, improving care at health facilities, and engaging civil society and policy makers to ensure effective implementation.

India’s poorest families have the highest risk of newborn deaths – yet as these deaths are due to the most preventable causes such as neonatal tetanus and infections. Paradoxically these are the deaths that can be reduced most quickly with even basic care at birth, and newborn care that should be the right of every citizen.

As Gandhi once advised, we should prioritize our next step based on the effect it will have for the “most vulnerable human being we ever saw." Who can be more vulnerable and voiceless than a newborn baby?

 
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