Push to lower India’s infant death rate

India, which accounts for 29 per cent of global first-day deaths, may finally be making progress.
An Indian nurse holds a newborn baby girl as she explains the importance of breast feeding to her mother and grandmother at a hospital in Shivpuri, central Madhya Pradesh.  Roberto Schmidt / AFP
An Indian nurse holds a newborn baby girl as she explains the importance of breast feeding to her mother and grandmother at a hospital in Shivpuri, central Madhya Pradesh. Roberto Schmidt / AFP

SHIVPURI // Suman Chandel, 25, lay on a bed in a clinic in remote northern India with a smile of relief on her face.

She had just given birth to her fourth child, a seemingly healthy baby boy weighing three kilograms and, having already lost two babies – to diarrhoea and dysentery – is optimistic that this time the chances of survival are good.

“I was very worried beforehand. I was having more and more problems with each delivery, but he seems fine and I’m happy,” said Ms Chandel as she breastfed her newborn.

Married at 15 and pregnant three years later, Ms Chandel’s struggles to keep her babies alive are a familiar story for millions of women battling disease, caste discrimination, powerlessness and poverty in rural India.

India has a dismal record of deaths from preventable illness. For example, it accounts for 29 per cent of global first-day deaths and 309,000 newborn deaths a year, said the non-profit group Save the Children.

But figures published in October suggest that after 15 years of booming economic growth and explosive modernisation, India may finally be turning the corner.

“There’s a long way to go and traditional practices are still there,” said Karin Hulshof, the regional director for the United Nation’s children’s fund, Unicef. “But there has been great progress, a great call to action.”

This has come with investments by the government and non-government organisations, she said.

Initiatives have focused on issues such as encouraging women to give birth in hospitals instead of at home, and increasing health centres and immunisation drives.

Education into, for example, the importance of breastfeeding, improved nutrition and using clean water for hand washing and toilets to prevent episodes of life-threatening diarrhoea, has also been a priority.

Paul Vinod, the head of paediatrics at one of India’s most prestigious teaching hospitals, said the figures spoke for themselves: infant mortality rates have dropped from 80 deaths per 1,000 live births in 1990 to 42 deaths in 2012.

Despite the improvements, India still has that high newborn deaths tally, as well as accounting for 22 per cent of the world’s deaths of children under five, according to a joint report this year from the UN, the World Health Organisation and World Bank.

Public expenditure on health remains woeful and accounts for just 1.2 per cent of gross domestic product, said Dr Vinod.

“Some developed countries spend 8 to 10 per cent,” he said. “We should be close to 3 per cent or 5 per cent. Anything less than three is poor.”

A child’s chances of survival were also skewed depending on where a family resided. The mortality rate in southern Kerala state was 12 in every 1,000, the new figures showed, but jumped to 56 in Madhya Pradesh, where Ms Chandel lives.

This postcode lottery is blamed by experts on population density and the priority state governments have placed on child health, among other reasons.

Deep cultural issues, including the powerlessness of women and accepted attitudes about their role in society, remained a huge battle.

“These girls are unable to make independent decisions about their own reproductive choices or fertility,” said Anuradha Gupta, an Indian health ministry official.

“We have a huge battle ahead to change societal attitudes and norms towards adolescents, particularly girls.”

Pale with anaemia, Radha Bagnele, 20, lay in a bed in Shivpuri District Hospital in Madhya Pradesh and listened to her mother-in-law despair about Ms Bagnele’s newborn twin daughters.

“We wanted boys, so we are not happy, we are just OK,” said Ramkunar Bagnele. “Of course she will keep trying until we get them.”

Married at 13, Radha already has two daughters and worries her husband does not earn enough as a farm labourer to feed and care for their expanding family.

“I’m worried, but we need a boy,” she said softly.

Shivpuri hospital, together with Unicef, has developed a 24/7 call centre and a fleet of 35 ambulances so that women throughout the district can reach a hospital or clinic in time for a safer delivery.

The number of infant deaths has fallen dramatically since its introduction but problems still exist.

In the hospital’s special newborn care unit, also funded by Unicef, Sunil Gautam hovered over rake-thin babies.

He pointed to a boy in an incubator born days earlier who weighed 600 grams – less than half the minimum healthy weight of a newborn.

“Eight hundred grams today!” the paediatrician said.

Asked why the 17 babies in the unit were born underweight, premature or sick, he reeled off problems that had improved steadily in the five years he had worked there.

“Poverty, illiteracy, nutrition deficiency, early marriage and no spacing between births,” he said of the circumstances of the mothers.

“Things are working, are improving. But it’s slow.”

* Agence France-Presse

Published: December 15, 2013 04:00 AM


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