The sixth position from the bottom among eight South Asian countries when it comes to newborn deaths suggests that there are serious gaps in both the health system and political commitment on this issue in India.
A staggering 700,000 of the one million babies who died within 28 days of birth in South Asia in 2015 was in India, according to a recent Unicef report. Only Pakistan and Afghanistan ranked lower than India. This figure means that India accounts for 26% of newborn deaths in the world. The high number of births due to a young population means that newborn mortality rates are high, but there are several interventions that can help bring down these figures.
Nepal, Bangladesh and Bhutan have really beefed up their immunisation programme. For example, the DTP3 (diphtheria, pertussis and tetanus) vaccine coverage for Bhutan is 99% and for Bangladesh 94% while for India it is 87%. This suggests if India builds on its routine immunisation, it could turn the corner on newborn mortality. Besides this, there is a number of low-cost interventions that could be scaled up. Among these are early breastfeeding and medical assistance at birth.
The problem with India is that the public health system, which is the only option for the majority of women in India. Through this women can get the medical care they need for childbirth and natal care in the form of oral rehydration and prevention of infections.
Our public health system has long been in a shambles and this is where India needs to put in much more investment. The panchayati raj system could be an effective vehicle for spreading awareness about basic hygience practices which can save the life of a newborn. Under the public health system, health workers are meant to attend to births in rural areas and clinics are supposed to be equipped with appropriate kits. But most of them do not even have basic medicines.
India conducted a very successful polio immunisation campaign, which became a benchmark for many developing countries. Given that curative care is either unavailable or expensive for the most part, the prevention route is best for a country like India. For immunisation to work, the cold chain needs to be improved and the public health system used to push immunisation in infancy much more aggressively.
Countries which are economically much poorer like Nepal and Bhutan have been able to fare better because there seems to have been a serious effort made by the authorities. Unfortunately, both commitment to health and investment in it have not been the priorities they should be in India. This latest report should serve as a wake-up call if India is to begin the fight to save its children with greater seriousness.