New Delhi: “India still has 25 million births every year. We make one mini-Australia every year,” said Padma Bhushan Dr Neelam Kler, a neonatologist at Delhi’s Sir Ganga Ram Hospital, while discussing the status of neonatal mortality rate in India, on Banega Swasth India Season 9 finale. Dr Kler said that India has dramatically reduced the neonatal mortality rate (probability of dying during the first 28 days of life) to 24 per 1,000 live births in 2019-2021 from 29 per 1,000 live births in 2015-2016. She added,
We started with very high numbers, and now we have reduced the number to a large extent. We have come down to 24 per thousand live births, which is almost a 60 per cent reduction to date from 1990 if we observe, and for this, we must congratulate ourselves.
Though there has been a decline in neonatal mortality rate at the national level, a disparity exists among states. Dr Kler explained,
We have seen the reduction in neonatal mortality rates, but there are certain disparities we need to look at if we want to successfully work towards our aim of ‘Sabka Saath, Sabka Vikas’. There are states like Kerala that have a single-digit neonatal mortality rate, while some other states are still reporting double digits like Madhya Pradesh. Further, looking at the rural and urban populations, the former has higher numbers of neonatal mortality cases.
Improving India’s Neonatal Mortality Rate
Dr Kler said that if India needs to reduce the neonatal mortality rate and achieve its Sustainable Development Goal (SDG) of 12 per 1,000 live births, healthcare needs to become more holistic. She said,
Holistic healthcare includes maintaining personal hygiene and providing a hygienic environment in hospitals for mothers and newborns. We have to prioritise hygiene at all levels – teach handwashing techniques and hygiene and sanitation measures to people and maintain water, sanitation, and hygiene (WASH) services in hospitals as it contributes to lower neonatal mortality rates. Unfortunately, most of the hospitals in India are not equipped with proper WASH services and lack 24×7 supply of water, among others.
It is essential to maintain hygiene and sanitation services at hospitals, as it would reduce the chances of contracting infections such as Sepsis, Dr. Kler said. According to UNICEF, Sepsis is spread in health facilities and contributes to 15 per cent of overall neonatal mortality and 11 per cent of maternal deaths.
Dr Kler believes that if the above lapses are taken care of, India will be able to achieve the goal of ‘Sabka Saath, Sabka Vikas’ and ‘Lakshya Sampoorn Swasthya Ka’ (Health For All).
As a neonatologist, Dr Neelam Kler is known for improving the survival chances of premature babies weighing less than 1,000 grams. She has also worked in close tandem with the National Neonatology Forum as secretary and later as President (2009-2010). The Government of India conferred Dr Kler with Padma Bhushan in 2014, the third highest civilian award, for her exemplary work in neonatology.
Maternal Mortality Rate In India
The Padma awardee said that India has seen a significant decline in maternal mortality rates (MMR) in the last few years. According to the Union Ministry of Health and Family Welfare, the country’s Maternal Mortality Rate has come down from 130 (2015-17) to 97 per lakh live births (2018-20).
Improving India’s Maternal Mortality Rate
Most maternal and newborn mortalities occur around delivery, within 24 to 48 hours, Dr Kler said. In order to reduce the maternal mortality rates in India, Dr Kler suggests:
- Increase the number of institutional deliveries, by providing access to healthcare services to the marginalised communities and people residing in the far-flung hilly regions.
- Break any social or cultural stigma around institutional deliveries among the rural communities.
- Increase the skilled medical workforce in remote areas in maternal and neonatal care.
- Deploy skilled birth attendants, either nurses or ANMs (Auxiliary Nurses And Midwives) at public health centres, who can assist pregnant women and new mothers at home and educate them about institutional deliveries and other queries related to pregnancy and delivery. Dr Kler gave the example of Sri Lanka, a country which is not as developed as in India, but has significantly reduced the maternal mortality much earlier by training the local community members about deliveries or guide new mothers.
- Establish a public health cadre consisting of public health professionals that would help the government implement healthcare policies.
- Use artificial intelligence (AI) in healthcare to reach the unreachable. The ANMs or nurses deployed in the health centres in remote areas can be provided with the algorithms, which can help them get the symptoms or pattern of the disease.
The Importance Of Gut Health Among Newborns
Dr Kler also discussed the importance of gut health among newborns. She highlighted three factors that determine a child’s gut health, including vaginal delivery, breastfeeding, and zero use of antibiotics.
Dr Kler said that children conceived through vaginal delivery over caesarean delivery have a better gut microbiome. Talking about the benefits of breastfeeding, the neonatologist said that it establishes a healthy microbiome in babies. Additionally, a child is less likely to become obese and develop any kind of lifestyle disease. The Padma Bhushan awardee said that saying ‘NO’ to non-essential antibiotics will also help a child to have strong gut health. They should only be used when needed, not for viral infections like cold.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – theLGBTQ population,indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the currentCOVID-19 pandemic, the need for WASH (Water,SanitationandHygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fightmalnutrition, mental wellbeing, self care, science and health,adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues likeair pollution,waste management,plastic ban,manual scavengingand sanitation workers andmenstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India wheretoiletsare used andopen defecation free (ODF)status achieved as part of the Swachh Bharat Abhiyan launched byPrime Minister Narendra Modiin 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.