One of the major contributors to the problem of pediatric deaths are the neonatal deaths globally. Neonatal healthcare pertains to a newborn’s condition from birth to four weeks of age. It is important to note that the neonatal mortality rate is a key indicator of socio-economic development of a country. As neonatal mortality is an outcome and not a cause therefore it sensitively measures the use of resources by the government. Studies show that the above problem is intrinsically linked to mother’s education status, child’s sex, urbanization level and birth order etc. India becomes a unique illustration of the same, for though there has been rapid economic growth, it continues to have the largest number of child deaths compared to any country in the world, and has wide local variations in under-5 mortality.


Neonatal Mortality Rate: Where do we stand?


Every year in India almost one million newborns die before they complete their first month of life, which is 30% of the world’s neonatal deaths. In India, the present day sees almost 1.2 million children dying each day that translates into a neonatal mortality rate of 44 per 1000 live births. One also sees that the neonatal mortality is greater much greater in rural areas at 49 per 1000 live births (vis-a-vis 27 per 1000 in urban areas).


Surprisingly, one can witness a marked disparity in the neonatal mortality rate among the various Indian states. While Orissa and Madhya Pradesh record the highest rates of neonatal mortality  – 61 (rural 63, urban 42) and 59 (rural 63, urban 40) per 1000 live births, respectively; Uttar Pradesh exhibits a rate of 53/1000 (rural 56, urban 39), West Bengal 31/1000 (rural 33, urban 21) with Kerala recording the lowest neonatal mortality with 10/1000 (rural 10, urban 9). Following closely, comes Punjab with 29/1000 (rural 32, urban 19).


This disparity can be attributed to the diverse demographic conditions and variations in the social development of the different states. Undoubtedly, it doesn’t come as a surprise that a child born to a Scheduled Tribe family is 19 per cent more at risk of dying in the neonatal period and 45 per cent higher risk of dying in the post-neonatal period in contrast to with other social classes.


Such statistics should be appreciated in correlation with the condition of doctors at the health centers.  In contrast with the requirement for an existing infrastructure, there is a shortage of 62.6% of specialists at the CHCs, 55.2% of obstetricians and gynecologists and 69.5% of pediatricians. Hence this seems to be one of the reasons of the non-improvement of neonatal mortality rate.


However, overall it would not be wrong to say that the whole scenario seems to be improving. Deaths in children younger than 5 years has fallen in India from about 2·5 million in 2001 to 1·5 million in 2012.  The Millennium Development Goals of UN in India for under-5 mortality was pegged at 38 deaths per 1000 livebirths by 2015. The Indian government decided to emphasize on nine poorer states of Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh, and Uttarakhand and though the goal has been not met completely, every new initiative is moving the efforts a step further in the right direction.


Causes for neonatal deaths


Several causes are instrumental in bringing about such high neonatal deaths with the reasons behind this grave situation ranging from the sex of the child to other basic living factors such as availability and use of clean cooking fuel, access to a clean and indoor toilet facility, safe drinking water, and the like that also affects the mortality rate. In addition, biological factors such as order of birth and the interval between two deliveries, mother’s age at the time of birth, availability and quality of professional antenatal and delivery care, and the facility to fully immunize the child, all play an important role. In addition to these, social factors such as mother’s education, urban vs. rural residence, mothers’ ethnicity and religion is also associated with infant and child mortality.


In fact, community awareness catering to the need for addressing socio-cultural standards towards eliminating gender-based discrimination among Scheduled tribes, too plays an important role in regulating and curbing neonatal and pediatric deaths.


Another important factor for the increased neonatal death rates also stem from lack of trained healthcare personnel in rural as well as urban government hospitals. These factors lead to neonatal illnesses ranging from acute respiratory infections, diarrhoea, measles, malaria, and malnutrition and ultimately death.


Economic factors like income of the parents also affects the mortality rate as a recent World Bank report states that there is an inverse relationship between per capita income and infant mortality rate in India. This may be because the increase in per capita actually does not trickle down.


The causes can, hence be categorized into three groupings as follows and each have their bearing on the rate of neonatal deaths in varying weightages:

  1. biological factors
  2. socio-economic factors
  3. environmental factors


Governments Initiatives for Neonatal Mortality


The government of India has taken several policies with respect to neonatal health. It launched the National Rural Health Mission (NHRM) which provides for establishment of Sick New Born Care Units at District Hospitals, newborn stabilization Units at Community Health Centres (CHCs) and New Born Care corners at 24×7 Primary Health Centres (PHCs) to provide new born and child care services. Further a safe motherhood initiative called “Janani Suraksha Yojana (JSY)” has also to be executed under the NRHM to increase the institutional delivery rates and provide skilled care at birth for the newborn. Under the NHRM, a Home Based New Born Care (HBNC) through ASHAs with series of home visits have also been provided for so that in rural areas where most of the deliveries are done by midwifes, the mothers are under constant observation.


The recently launched Pradhan Mantri Matritva Suraksha Yojna also provides for a healthy life of a pregnant women and aims to ensure a safe delivery and healthy life of the baby. Further, it paves way for regular checkups of the mother on the 9th day of every month and tests conducted accordingly at government and private hospitals and private clinics across the country. This in turn envisages to help in detecting the health issue relating to both the fetus and the mother.


The Reproductive and Child Health program (RCH-II) uses integrated management of neonatal and childhood illness (IMNCI) protocols to ensure that the quality and reach of antenatal care is targeted towards expansion as well as availability of home-based newborn care.  This provides for higher skilled nurses and doctors as well as strengthen the infrastructure of hospitals throughout the country.


For care and resuscitation, a new basic program known as Navjaat Shishu Suraksha Karyakram (NSSK) has been launched. The initiative makes important interventions with regards to prevention of hypothermia and infections as well as early initiation of breastfeeding. Stipulations regarding Comprehensive Emergency Obstetric and New born Care (CEmONC) Services and Basic Emergency Obstetric and Newborn Care (BEmONC) have also been provided for in this scheme.




Neonatal mortality seems to be a priority agenda for government which gets reflected in their policies and initiatives. However, it has a long way to go as it is still great and completely skewed towards the rural areas. The basic problem lies in the lack of trained manpower which influences the quality of care the neonates receive. Also, it is further important to focus on the rural sector and therefore training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, encouraging and promoting community awareness towards the basic neonatal and maternal health concerns, and mobilization of the local community to bring about the exploration and strengthening of the public-private partnerships.


It is only through better healthcare services both in rural as well as the urban slums that this disparity between the high level of economic growth and the rate of child mortality can be reduced. It must be appreciated that the so called economic growth is only for the upper section of the society and not for the poor. The divide between the have and have nots has to decrease for this development to percolate. Such measures will go a long way to giving birth to a healthy future generation.


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