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Issue Briefs- Neonatal Mortality in India |
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- Control of deaths due to diarrhoeal diseases:
Education and use of Oral Rehydration Salts are
advocated for early treatment of diarrhoea and
to prevent deaths due to this disease. ORS was
introduced in India in 2004.
- Supplementation with micronutrients such as
Vitamin A and iron.
- Universal Immunization Programme: Children are
immunized against six vaccine preventable diseases.
They include polio, measles, DPT and BCG.
Integrated Management of Neonatal and
Childhood Illnesses
Integrated Management of Neonatal and Childhood
Illnesses (IMNCI) was started on a pilot basis in 2004
through UNICEF. It has been incorporated into RCH
since 2005. By 2007, the initiative has been launched
in all districts. Its strategy encompasses a range of
interventions to prevent and manage five major childhood
illnesses. They are: Acute Respiratory Infections,
diarrhoea, measles, malaria and malnutrition and the
major cause of neonatal mortality, sepsis. It also teaches
about nutrition including breastfeeding promotion,
complementary feeding and micronutrients.
The major components of this strategy are:
• Strengthening the skills of the health care workers
• Strengthening the health care initiative
• Involvement of the community
According to latest government data, 37,337 health
personnel have been trained in IMNCI. 7
Table 6: Statewise Breakup of Personnel
trained
StatesNo. of personnel trained
Madhya Pradesh
2243
Rajasthan
1108
Bihar
1367
Chhattisgarh
88
Uttar Pradesh
1167
Orissa
5196
Jammu & Kashmir
5
Arunachal Pradesh
60
Tripura
6
Punjab
2107
Haryana
607
Karnataka
1210
Gujarat
14002
Tamil Nadu
1438
Maharashtra
6580
Andaman Island
150
Source: Annual Report: 2007-08, Ministry of Health and Family Welfare, Govt of India
Home Based New Born Care
The government has approved the implementation
of Home Based New Born Care. Accredited Social
Health Activists (ASHAs) will be trained in identified
aspects of newborn care during the second year of
their training.
The programme shall be launched in the five high
focus states of Madhya Pradesh, Rajasthan, Bihar,
Chhattisgarh and Uttar Pradesh. In addition, facility
based assessment of the needs for newborn care is
being carried out in 10 states so that an appropriate
facility based newborn care model can be initiated.7
The eleventh Five Year Plan (2007-2012) aims to develop
specific interventions to address malnutrition, neonatal,
and infant mortality. Home based neonatal care will be
provided, including emergency life saving measures.
Traditional Birth Attendants shall be trained to turn
them into Skilled Birth Attendants. They would ensure
proper deliveries, whether at home or an institution.
Immunization programmes shall be strengthened to
eliminate neonatal tetanus and emphasis shall be given
to breastfeeding and reduction of anaemia.8
Endnotes
1. “Health Status Statistics: Mortality,” World Health Organization (see
http://www.who.int/healthinfo/statistics/ indneonatalmortality/en/).
2. “Annual Report: 2005-06,” Ministry of Health and Family Welfare,
Govt of India.
3. “Report of the Steering Committee of Family Welfare,” Steering
Committees for 10th Five Year Plan, Planning Commission, Govt of
India.
4. “Neonatal and Perinatal Mortality: Country, Regional and Global
Estimates,” World Health Organization, 2006.
5. “Student’s Handbook for Integrated Management of Neonatal and
Childhood Illnesses,” World Health Organization and Ministry of
Health and Family Welfare, Govt of India, 2003.
6. “The State of the World’s Children,” United Nations Children’s Fund,
Dec 2007.
7. “Annual Report: 2007-08,” Ministry of Health and Family Welfare,
Govt of India.
8. Eleventh Five Year Plan 2007-12, Social Sector, Volume II, Planning
Commission, Govt of India.
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Population Foundation of India
B-28, Qutab Institutional Area, New Delhi-110016
Tel.:+91-11-43894100, Fax: +91-11-43894199,
E-mail: popfound@sify.com, Website: www.popfound.org
nEONATAL mORTALITY IN iNDIA
Issue Brief
Highlights
• Mortality during neonatal period (0-28 days) is considered a key indicator of both
maternal and newborn health. In India, about two-thirds of all deaths during infancy
take place during the neonatal period.
• Although improved access to immunization, health care and nutrition programme have
resulted in substantial decline in infant mortality rate, decline in neonatal mortality rate
has been very slow.
• The major causes of neonatal mortality are pre-term births, severe infections such as
sepsis, birth asyphixia, tetanus, and diarrhoea.
• The neonatal mortality rate is measured by the National Family Health Survey (NFHS)
and the Sample Registration System (SRS). India’s neonatal mortality rate is measured
as 39 according to NFHS while it is 37 according to SRS.
• Infant mortality rates are sensitive indicators of inequity and poverty. Therefore,
neonatal mortality rates vary based on differences in socio-economic characteristics
such as religion, caste, and wealth.
• The largest absolute number of new born deaths occurs in South Asia but the highest
national rates of neonatal mortality occur in sub-Saharan Africa.
• The government has initiated various measures to tackle the problem of neonatal
mortality. Some of the important measures are the Integrated Management of Neonatal
and Childhood Illnesses and Home Based New Born Care.
• The Eleventh Five Year Plan aims to develop specific interventions to address
malnutrition, neonatal, and infant mortality.
Prepared By
PRS Legislative Research • Centre for Policy Research • Dharma Marg • Chanakyapuri • New Delhi – 110021
Tel: (011) 2611 5273-76, Fax: 2687 2746, www.prsindia.org
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Issue
Mortality during neonatal period (0-28 days after birth)
is considered a key indicator of both maternal and
newborn health. Neonatal mortality is defined as the
number of deaths during the first 28 days of life per
1,000 live births in a given year.1 Neonatal deaths may be
sub-divided into early neonatal deaths, occurring during
the first seven days of life and late neonatal deaths,
occurring after the seventh day but before the child
completes 28 days.
In preparing child mortality reduction strategies it
is important for countries to know the magnitude of
neonatal mortality. In India, about two-thirds of all
deaths during infancy take place during the first month
of life. About 50% of these are accounted for during
the first week of life.2
Improved access to immunization, health care and
nutrition programmes have resulted in substantial decline
in infant mortality rate (IMR). However, the decline in
neonatal mortality has been very slow.3
Figure 1: Trends in Neonatal Mortality Rates
(NMR)
80
79
70
60
50
49
40
68
43
57
39
30
20
10
0
NFHS-I ‘92-’93 NFHS-II ‘98-’99 NFHS-III ‘ 05 -’06
Neonatal Mortaily Rate
Infant Mortality Rate
Source: National Family Health Survey 3, 2005-06
Figure 2: Causes of neo-natal mortality
Pre-term birth
27%
Other 7%
Diarrhoea 3%
Tetanus 7%
Congenital
anomalies 8%
Birth asphyxia
23%
Severe
infections 25%
Sources: Child and Adolescent Health and Development, Progress Report 2006-07, World Health
Organization
Causes and determinants of neonatal deaths and
stillbirths differ from those causing postneonatal and
child deaths. The major causes of NMR are pre-term
births, severe infections (mainly sepsis/pneumonia),
birth asphyxia, etc. They also stem from poor maternal
health, inadequate care during pregnancy, inappropriate
management of complications during pregnancy and
delivery, poor hygiene during delivery and the first
critical hours after birth, and lack of newborn care.4
Goals
Many countries, including India, have set under-five
mortality reduction as their key development goal, as
suggested by various international conferences.
Table 1: Goals for reducing IMR and NMR
Current StatusNational Rural Millennium Development
Health Mission 2012 Goals 2015
IMR 58
30
27
NMR 37
<20*
<19*
*Estimated
Source: Annual Report 2007-08, Ministry of Health and Family Welfare,
Govt of India
Trends in neonatal mortality deaths
The NFHS and the Sample Registration System (SRS)
are the two sources of data regarding NMR in India.
NMR varies across states.
Table 2: Statewise Neonatal Mortality Rate
State
Chhattisgarh
Jharkhand
Uttar Pradesh
Assam
Orissa
Madhya Pradesh
Rajasthan
Andhra Pradesh
Bihar
West Bengal
Arunachal Pradesh
Gujarat
Tripura
Maharashtra
Jammu and Kashmir
Delhi
Karnataka
Punjab
Uttarakhand
Himachal Pradesh
Harayana
Meghalaya
Nagaland
Sikkim
Tamil Nadu
Manipur
Mizoram
Kerala
Goa
All-India
NFHS-III
51
49
48
45
45
45
44
40
40
38
34
33
33
32
30
29
29
28
28
27
24
24
20
19
19
19
16
11
9
39
SRS 2006
43
29
48
35
52
51
45
33
32
28
-
38
-
27
39
22
28
30
-
30
34
-
-
-
24
-
-
10
-
37
Sources: NFHS-III (2005-06) and “Statewise progress as of Dec 31, 2008,” National Rural Health
Mission, Govt of India.
Infant and childhood mortality are sensitive indicators
of inequity and poverty. Thus, children who are most
commonly and severely ill, who are malnourished and
who are most likely to die of their illness belong to the
most vulnerable and underprivileged populations of
society.5 In India, these children mostly reside in rural
areas, are minorities or from a backward caste. The
following tables and figures highlight the differences in
NMR based on socio-economic categories.
Table 3: Trends in NMR by Place of Residence
Rural
Urban
NFHS-III
42
28
NFHS-II
54
36
Source: National Family Health Survey-III, 2005-06
NFHS-I
57
35
Figure 3: Trends in NMR by Religion
Other
43
Buddhist
43
Sikh
Christian
Muslim
Hindu
36
31
34
40
0
10
20
30
40
50
Source: National Family Health Survey-III, 2005-06
Figure 4: Trends in NMR by Caste
35
35
30
29
26
27
25
20
15
10
5
0
Scheduled Scheduled Other
Caste Tribes Backward
Classes
Source: National Family Health Survey-III, 2005-06
Other
Table 4: Trends in NMR by Wealth Index
Lowest Second Middle
Fourth Highest
39
41
32
31
21
Source: National Family Health Survey-III, 2005-06
Table 5: Trends in NMR by Gender
NMR
Male
41
Female
37
Source: National Family Health Survey-III, 2005-06
International Comparison
Although the global neonatal mortality rate has
decreased slightly since 1980, neonatal deaths have
become proportionally much more significant. This is
because the reduction of neonatal mortality has been
slower than that of under-five mortality. Between 1980
and 2000, deaths in the first month of life declined by a
quarter, while deaths between one month and five years
declined by a third. According to latest estimates, four
million babies die each year in their first month of life.
The largest absolute number of new born deaths occurs
in South Asia but the highest national rates of neonatal
mortality occur in sub-Saharan Africa.6
Table 6: Global Rates of Neonatal Mortality
CountryNeonatal Mortality Rate
Pakistan
53
Botsowana
46
Ethiopia
41
Nepal
32
China
18
Sri Lanka
08
USA
04
Switzerland
03
United Kingdom
03
Source: World Health Organization Statistical Information System
Government Initiatives
Significant improvements in the early neonatal period
will depend on essential interventions for mothers and
babies before, during and immediately after birth. An
estimated 3 to 4 million deaths could be prevented
each year if high coverage is achieved for a package of
proven, cost-effective interventions that are delivered
through outreach, families and communities, and facility
based clinical care across a range of neonatal care.
The Ministry of Health and Family Welfare has
implemented several programmes to address the issue of
high infant and child mortality in the country. National
Rural Health Mission’s Reproductive and Child Health
Care (RCH) Programme focuses on reducing neonatal,
infant and child mortality.7
Strategies
- Integrated management of neonatal and childhood
illnesses.
- Home based new born care.
- Promotion of breastfeeding and complementary
feeding.
- Control of deaths due to acute respiratory infections:
Healthcare workers are trained to recognise signs
and symptoms of pneumonia. Co-trimoxazole,
an antibiotic used for treatment is being supplied
throughout the country to all healthcare units.