India’s neonatal burden and the challenges ahead

While it is heartening to witness India move on the right track towards holistic growth of children, there remains one area that warrants our immediate attention – to reduce the country’s neonatal burden. As per a recent United Nations report, nearly one lakh children die annually in the country from diseases that could have been prevented via breastfeeding, accounting for nearly $14 billion in economic losses – or 0.70% of its Gross National Income.

It has been promising to witness the consistent efforts made by the Government of India over the past two decades, as India braces itself to reduce the country’s global burden of neonatal mortality rates and meet the Sustainable Development Goal (SDG) Target 3.2 to reduce all preventable deaths of newborns and children under 5 years to as low as 12 per 1,000 live births by 2030. Furthermore, India’s National Health Mission (NHM) targets to reduce the maternal mortality rate (MMR) to 90, the infant mortality rate (IMR) to 23, and under-5 mortality rate (U5MR) to 23 by 2025.

Collaborative efforts at both state and central levels have made a tremendous impact--with the neonatal mortality rates decreasing from 37 deaths per 1,000 live births in 2003, to 25 deaths per 1,000 live births in 2021.

Through extensive research and development programmes, the amalgamation of initiatives focusing on maternal and child health indicators has significantly improved the landscape over the past two decades. Systematic implementation of policies, such as the National Rural Health Mission, introduced in 2005 (now subsumed under the National Health Mission, 2013), has been a commendable effort to improve the country’s health care system by emphasising infrastructural and wellbeing reforms through efficient monitoring programmes, capacity building, and flexible financing.

Simultaneously, the implementation of initiatives undertaken by the ministry of health and family welfare, such as the Integrated Management of Neonatal and Childhood Illness (2003) and Newborn Stabilisation Unit (2011) in identifying “at risk” and “sick” newborns to prevent infections proved pivotal to improving the health indicators for neonates. Infrastructural and free/subsidised distribution of necessary drugs and free regular check-ups through policies such as Facility Based-Integrated Management of Neonatal and Childhood Illness (2009) and Pradhan Mantri Matru Vandana Yojana (2017) have facilitated in both reducing India’s maternal and neonatal/infant mortality rates and eliminating out-of-pocket expenses, particularly in remote areas. Mission Indradhanush, which aims to achieve 90% full immunisation coverage across the country, has so far vaccinated over 5 crore children and 1.25 crore pregnant women since its inception in 2014.

The role of nutrition and hygiene are strong contenders in improving the overall health of a mother, thereby reducing postnatal complications and neonatal and maternal mortality rates. Nationwide policies, including the Saksham Anganwadi and POSHAN 2.0 (with the inclusion of the umbrella Integrated Child Development Scheme – Anganwadi Services, Poshan Abhiyan, Scheme for Adolescent Girls, and National Creche Scheme), and Pradhan Mantri Matru Vandana Yojana (subsumed under Mission Shakti in 2022), have proven to be critical in not only providing tertiary healthcare and nutrition but also raising awareness on the importance of nutrition, education, and hygiene in the holistic development of women and children.

As per a comprehensive study conducted based on the previous rounds of the National Family Health Surveys (1992-93, 2005-06, and 2015-16), it was concluded that “70 per cent of the decline in neonatal mortality from 1992-2016 is due to changes in utilisation of maternal- and child-care program factors and distribution of household, mother's, and child's characteristics”, while mother’s educational background, the utilisation of the immunisation programmes, improved access to clean drinking water, and frequent antenatal care visits further aided in significantly reducing neonatal mortality.

While we see remarkable progress in maternal and child health indicators, there remains a scope for improvement that would further accelerate India’s journey in achieving its SDG and NHM targets.

In a country as populous as ours, it becomes imperative to recognise the need for a harmonised approach between quality and quantity – addressing the challenges in the logistics and supply and demand to cater to the increasing population across the country becomes imminent to identify risk factors unique to a community, thereby formulating priority interventions.

Moreover, while we see substantial efforts at the national/administrative level, increased community engagement is the key, through collaborative efforts amongst government stakeholders, non-government organisations, and civil society organisations, to ensure robust execution of the existing policies and further brainstorm innovative strategies to reduce the country’s neonatal burden.

India’s immense efforts in bringing about a change in its maternal and child healthcare are laudable, and although there is a long road ahead of the country, heightened community involvement remains pertinent in bridging the gaps between a young, healthy population and the country’s determination to reduce its global disease/mortality burden. Quick adoption of and receptiveness to innovative strategies and increased investments for institutionalisation are of paramount importance in accelerating the nation’s ambitious goals of a universal health care system.

This article is authored by B. K. Agarwal, retired, IAS and former Chief Secretary, Government of Himachal Pradesh and Shubhangi Misra, associate, research and content, Ardent Co.