India: A growing country needs to tend to its newborns
More children die on their first day of life in India than anywhere else in the world: over 300,000 every year, according to Save the Children’s latest ‘State of the World’s Mothers’ report. This is hardly the kind of list that any country wants to top. The report also looks at government support for mothers, and India doesn’t do well there, either: 142 in a ranking of 176.
Yet it is not that the world’s second-most populous country is complacent: far from it. In 1993, a married couple of social activists and health-care workers, Doctors Abhay and Rani Bang, began training community volunteers to provide home-based newborn care in the villages of a troubled rural district of Gadchiroli in central India, an area where poor mothers had no access to health clinics or hospitals.
Their efforts produced dramatic local improvements; since then, countries including Nepal, Bangladesh and Malawi have adapted their model and achieved remarkable results.
But the problem of newborn and child mortality remains, and it is large-scale and complex. Nonetheless, India is committed to addressing it: in June 2012, along with the United States and Ethiopia, the country convened A Promise Renewed, a Child Survival Call to Action aimed at preventing child deaths.
Where in India are newborns dying?
According to the Indian government’s 2011 Sample Registration Survey, Madhya Pradesh has the highest number of early newborn deaths, followed closely by Uttar Pradesh and Odisha. Other states with high figures are Rajasthan, Chhattisgarh, Bihar, Jharkhand and Jammu and Kashmir. When it comes to reducing these numbers, Kerala is leading the way; Tamil Nadu, Delhi and Maharashtra too have bucked this grim national trend.
Similarly, there are broad variations within individual states: for example, cities do better at keeping babies alive than rural areas do. So it makes more sense to concentrate on percentage changes rather than compare numbers from one state to another.
Closing the inequity gap
Clearly, babies born in India do not all get an equal chance of survival: family income is crucial, and inequities are persistent and widening. If all newborns in India had the same chance of survival as those in the richest Indian families, nearly 360,000 more babies would survive each year. Children from poor households are more likely to be exposed to diseases; when they are, their resistance is lower due to malnutrition and their families have limited resources to cope.
So there is a lot to do to make India a safer and healthier place to be a mother or a newborn. But the will is there, and so is the capacity, and if pioneering grassroots healthcare could happen here 20 years ago, how much more, given India’s rapid economic development, should we be able to accomplish now?