Fortunately, newborn health has now come to the attention of policymakers and UNICEF is joining their efforts to address these preventable deaths. The Indian government has introduced two landmark programmes, the National Rural Health Mission (NRHM) and the Reproductive, Maternal, Newborn, Child and Adolescent Strategy (RMNCH+A Strategy). The NRHM has provided an unprecedented focus and resources for newborn health, while the RMNCH+A strategy marks a significant shift in approach, basing services on a continuum-of-care model and on strengthening health systems.
The government has also now developed the India Newborn Action Plan (INAP) in response to the global Every Newborn Action Plan (ENAP) launched at the World Health Assembly in June 2014. INAP, in which UNICEF is a key partner, aims to significantly reduce preventable newborn deaths and stillbirths and to bring down the Neonatal Mortality Rate and Still Born Rate to “single digits” by 2030.
The plan includes clear timelines to implement, monitor and evaluate, and scale up interventions and is built on six types of intervention package: Pre-conception and antenatal care; Care during labour and child birth; Immediate newborn care; Care of healthy newborn; Care of small and sick newborns; and Care beyond newborn survival.
Challenges to better Newborn Survival and Child Health
Though India accounts for highest burden of under-5 deaths, it has shown faster decline in under-5 mortality reduction compared with the global fall. Worldwide, the under-5 mortality rate reduced by 49 per cent from 90 per 1000 live births in 1990 to 46 per 1000 live births in 2013, while India achieved a reduction of 59 per cent in under-5 mortality from 126 in 1990 to 52 in 2012.
However the decline in neonatal mortality has been much slower compared with under-5 mortality. In order to accelerate progress it is important that preventing neonatal deaths has been prioritized. Undernutrition is an underlying factor in 45 per cent of under-5 deaths and breaking the intergenerational cycle of malnutrition needs to focus on nutrition of adolescent girls and pregnant women. It is also important to focus on improving breastfeeding rates, Water, Sanitation and Hygiene (WASH) practices at both facility and household level.
Other challenges to maternal, neonatal and child survival:
• Mothers and children in the lowest economic bracket have about a two and a half times higher mortality rate.
• Social norms and socio-cultural factors often affect accessibility to healthcare and nutrition as well as water and sanitation services and facilities in many regions.
• Groups such as rural communities, Scheduled Castes and Scheduled Tribes and minorities have a higher IMR and U5MR. The IMR in rural India is 44 while in urban areas it is 278.
• Families have little access to accurate and comprehensive information about healthy maternal, neonatal and child health practices, social services entitlements and how to use them. These keys to child survival include: the age of a mother at childbirth and her education level, spacing between children, gender-discriminatory child rearing practices (more girls die than boys, with the IMR for boys 39 and for girls 428), access to improved sanitation, drinking water quality and maternal and child nutrition.
• There aren’t enough skilled personnel and specialists in child healthcare, leading to a lack of demand for health services and the promotion of healthy practices and care-seeking behaviours among families.