- 82% of neonatal deaths in 3 UP districts were within 7 days of birth: CRY
- Doctors conducted only 14% of the childbirths in these 3 districts
- 28% mothers reported their children received post-natal check-up
8 in every 10 neonatal deaths in three districts of Uttar Pradesh occurred within 7 days of birth, revealed a study conducted by non-profit organisation Child Rights and You (CRY). WHO defines neonatal death as deaths among live births during the first 28 completed days of life. According to the study titled ‘An In-depth Study on Neo-Natal Health in three districts of Uttar Pradesh’, 82 per cent of deaths of newborns were reported to be early neonatal deaths that took place within a week of childbirth. The three districts of UP where the study was conducted include the rural areas of Kaushambi, Sonbhadra and Varanasi, which are among the backward districts in terms of neonatal health in the state, CRY report said. The study was conducted between July 2019 to July 2020, and the data was gathered using case studies of 55 neonatal deaths, chosen at random and the in-depth interviews of their mothers.
Here are the main findings of the report:
- 8 in every 10 or 82 per cent of neonatal deaths in three districts of Uttar Pradesh occurred within 7 days of births
- The majority of neonatal deaths in these districts, 58 per cent, occurred at home and 38 per cent occurred in health facilities – private facilities: 20 per cent and public facilities: 18 per cent. The trend was similar in all the 3 districts, it said.
- Neo-natal Pneumonia and Respiratory Distress Syndrome emerged as the two highest probable causes accounting for 27 per cent and 24 per cent of neonatal deaths overall.
- Even though the majority of deliveries (78 per cent) were institutional, 69 per cent of the women who delivered in an institution, were discharged on the same day of the delivery, increasing worries for receiving care post birth for both mother and child.
- Among the women who had institutional delivery, only one in every ten deliveries or 14 per cent were assisted by a doctor and 86 per cent of them were conducted by an Auxiliary nurse midwife (ANM). This figure was the highest in Kaushambi where 88 per cent of delivering mothers were assisted by an Auxiliary nurse midwife and only 12 per cent by a Doctor. 17 per cent of the deliveries were not assisted by any skilled or trained birth attendant and were attended to by Dais and relatives.
- 28 per cent mothers reported that their children did not receive any post-natal check-up in the first week of birth.
- 93 per cent of women were registered with Anganwadi centres and 88 per cent got counselling by Anganwadi worker or ASHA but 11.2 per cent got full Ante Natal Care check-ups. Four in every 10 respondents or 39 per cent received benefits provisioned under central/state maternity benefit schemes though most of them were registered at Anganwadi centres.
- 89 per cent of women had a normal delivery, and approximately half of them (44 per cent) had high-risk pregnancy in terms of low Haemoglobin counts and low weight of women etc. Out of the high-risk pregnancies, 29 per cent of cases reported home delivery.
- 93 per cent of the women reported receiving Take-Home-Ration (THR), but 22 per cent did not use it to supplement their own dietary needs. One in ten also stated that they did not have 3 times meal in a day during pregnancy.
Explaining the need to conduct the study, Soha Moitra, Regional Director of CRY- North explains,
CRY has been working in 60 villages of Kaushambi, 50 villages of Varanasi (Rural) and 28 villages of Sonbhadra district through various program initiatives to provide holistic care and protection to infants. We felt the need to conduct this research to delve deep into the causal factors leading to neo-natal deaths, and the required actions at the system, community and personal level.
The study recommends adopting state-specific strategies and multi-sectoral approaches to bring down neonatal mortality, and move closer towards achieving the targets and goals of India Newborn Action Plan (INAP), National Health Mission (NHM), NAPC and Sustainable Development Goals.
Policy Options for the survival of the new-borns should include community awareness, adopting preventive strategies, enhancing local health infrastructure and increasing investment in child health and related maternal and adolescent health policies and schemes, it reads.
Talking about the findings of the study, Ritu Priya, Professor of the Centre of Social Medicine and Community Health (JNU) and a member of the board of trustees at CRY, said,
India contributes to one-fifth of global live births and more than a quarter of neonatal deaths. In India, the NMR stood at 23 deaths per thousand live births in 2018 (average global rate as per UNICEF is 17 deaths per 1,000 live births). Around 72 per cent of total infant deaths and more than half of under-five deaths fall in the neonatal period; deaths in the first week alone account for 55 per cent of total infant deaths.
Underscoring that the study reflects the socio-cultural, economic and healthcare determinants of neonatal health, Professor Priya added,
The study highlights the on-ground reality in CRY intervention areas in rural Uttar Pradesh, with a focus on the community’s beliefs and practices, access, availability, affordability and utilisation of health services. Two major findings emerge from this study – first, the state of maternal health with high anaemia and poverty generated conditions leading to over 30% Low Birth Weight (LBW) babies with acute respiratory diseases as the immediate cause of death. Secondly, the limitations of the government health services that lead to lack of trust between the service providers and the community members adding to the detriment of neonatal health. Lack of availability of adequate infrastructure and well-trained staff and lack of cordial interaction with patients has emerged as chief barriers in the study. Most of these challenges would have got further pronounced due to the COVID pandemic and therefore ensuring that maternal and child health services continue to function with greater vigilance is required during this period.
Dr Ved Prakash, General Manager Medical and Health, National Health Mission, Uttar Pradesh said that the Sample Registration System (SRS) 2018 data suggests that the state is doing considerably well in reducing under-5 mortality of children and infant mortality.
The immunisation coverage in the state is also showing constant improvement leading to lesser deaths. However, to curb neonatal deaths specifically early neonatal deaths there is a need to address abate-natal care and nutrition issues during pregnancy and also delivery complications. Civil society organisations play a relevant role in effectively implementing government interventions at the grass-root level and are a great medium of feedback and redressal.
On the other hand, emphasising on the need of extended ante-natal care , Dr Neelam Singh, Managing Trustee of Jan Mitra Nyas -UP said,
As the data suggests most of the neonatal deaths are taking place within 7 days of childbirth, thus, there is a need to see maternal and child health together in one frame especially at district and block level to effectively address neonatal mortality. To end neonatal mortality there is a need for extended ANC.
Ms Moitra lastly highlights that this study comes at a crucial time when the system is already struggling to deliver due to constraints brought in by the COVID-19.
The ongoing pandemic has directly impacted child survival, health and nutrition significantly with the access to health care facilities and nutritional meals being limited to the poor and vulnerable children. We hope this study serves as a critical resource to inform and guide programming and policy interventions working towards the cause of child survival, she signed off.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.