Though there is a decline in the Infant Mortality Rate in India, the reduction is at a slower pace when compared to the global average. Discuss the challenges India has been facing in reduction of Infant Mortality Rate. What are the measures taken by Government to Reduce Infant Mortality Rate? Suggest measures to achieve India’s’ target of Single Digit Neonatal Mortality Rate by 2030.
Infant mortality is the number of deaths per 1,000 live births of children under one year of age, whereas, A neonatal death is defined as a death during the first 28 days of life (0-27 days).
Infant and neonatal mortality in India has declined substantially over the past 15–20 years. Infant deaths are more a symptom of deeper social problems such as malnutrition, sanitation, and immunization, rather than just medical aspects.
Challenges in reducing infant mortality rate:
- Infrastructure:
- Due to lack of institutionalization of births and lack of health infrastructure in rural areas complications like asphyxia during delivery has been increasing.
- Complications during labour and delivery as well as infections like sepsis, meningitis and pneumonia are also major contributors to child mortality.
- Lack of education in the mother:
- Maternal education increases the chances of mothers being aware of different health issues and thus taking the correct and appropriate steps towards preventing such issues.
- Less Female literacy rates leading to less awareness regarding nutrition needed.
- Babies born to mothers with no education face nearly twice the risk of early death than babies whose mothers have at least a secondary education
- Prevalence of child marriages, anaemia among young women and a lack of focus on adolescent sanitation, all of which impact child death rates.
- Shortage of properly trained health workers and midwives: A large reproductive population of 2.6 crore remains bereft of care during the critical phases of pregnancy leading to mortality.
- Unidentified Causes: Sometimes the causes of child death are unknown.
- Type of Delivery: Whether the child is born at home or in a facility also determines the infant survival rate. Infection risks are high in case of a non-institutional birth.
- Environmental factors such as air pollution are consistently associated with post-neonatal mortality due to respiratory effects and sudden infant death syndrome. The additional presence of carbon monoxide in the air causes greater harm to the infants as their respiratory system is not developed yet.
- Malnutrition was the predominant risk factor for death among children under five years of age in every Indian state
- Community health centres in all 13 states except Kerala and Maharashtra had a shortage of specialists making most parents to seek care at tertiary care units such as district hospitals, which leads to overcrowding at intensive care units for neonates and infants. This increases the risk of infections.
Government measures to reduce infant mortality:
- The National Rural Health Mission (NRHM) was launched by the Government of India to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The scheme covers a wide range of aspects under its umbrella.
- Navjat Shishu Suraksha Karyakram (NSSK) aims to train healthcare personnel in newborn care and resuscitation.
- Nutritional Rehabilitation Centres (NRC): These centres are set up with the aim of reducing the fatality rate of Severe Acute Malnutrition (SAM) children through standard case management protocol like specialized treatment and prevention interventions at NRCs (Nutritional Rehabilitation Centres).
- Rashtriya Bal Swasthya Karyakram (RBSK): is set up to provide quality health screening, early detection of birth defects, diseases, deficiencies, development delays and early intervention services.
- India Newborn Action Plan (INAP): It was launched in 2014. It aims to make concerted efforts towards the attainment of the goals of “Single Digit Neonatal Mortality Rate” and “Single Digit Stillbirth Rate,” by 2030.
- Schemes like Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK), Pradhan Mantri Matru Vandana Yojana (PMMVY) etc. were started to promote institutional deliveries so as to reduce the prevalence of IMR.
Measures to handle Neonatal Mortality:
- Enhanced coverage of health and nutrition, water, sanitation and hygiene which can prevent pneumonia and diarrhoea.
- Paying attention to the mother’s health during pregnancy and ensuring she delivers in a hospital attended by trained doctors or midwives.
- To lower neonatal deaths, India needs to strengthen mother and newborn health services, including
- home-based care by health workers
- promoting breastfeeding
- treating underweight babies
- keeping the mother healthy
- preventing early marriage and
- Reducing malnutrition in adolescent girls.
- Universalisation of maternal health and child services, which includes special newborn care, skilled delivery, immunization and management of diarrhea, need to be effectively implemented to achieve the high goals of reducing child deaths.
- Increase in Budgetary allocations: The budget allocations for the health sector has to be improved. This would help enhance the socio-economic conditions. An increase in the budgetary allocations would also permit the hospitals and medical centres to buy the necessary equipment and upgrade their facilities and thus the quality of care provided.
- Newborn deaths’ can be prevented by reaching higher coverage of good quality antenatal care, skilled care at birth, postnatal care for the mother and the baby, and care of small and sick newborns.