- Low Birth Weight, Pre-Term Delivery are top cases of newborn deaths
- Infants have low birth weight when they are under 2.5 kg at birth
- At 28%, India had the third highest percentage of low birth weight
By Devanik Saha
The death of every other newborn in India can be traced to either low birth weight or premature delivery – a reflection of poor maternal health and an inadequate healthcare system – according to an IndiaSpend analysis of census data.
Neo-natal mortality is defined as death during the first 28 days of life. And India reports the highest numbers in the world: As many as 7,00,000 newborns die in India each year – 29 per 1,000 births.
This accounts for 26 per cent of neo-natal deaths in the world, according to UNICEF. Thirteen African countries have better infant mortality rates than India, IndiaSpend reported in May 2016.
The figures for child mortality, 0-5 years of age, are equally high. Between 1990 and 2015, more children in this age group died in India than anywhere in the world. Despite a 62 per cent reduction in child mortality over these years, the number stands at 1.3 million every year.
The deadly 28 post-birth days
Infants are said to have low birth weight when they are under 2.5 kg at birth. A premature or pre-term baby is one born alive before the completion of 37 weeks of pregnancy, according to the World Health Organisation.
In India, of all infants who died before they completed 29 days post-birth, 48.1 per cent suffered from low birth weight and premature birth, according to the Causes of Death Statistics, 2010-13 report by the census office. This figure was 35.9 per cent for children under one year of age, and 29.8 per cent for those in the 0-4 age group.
These two causes led to the most deaths of children between 0-4 years of age. But between 1 and 4 years, they did not even figure in the top 10 factors, indicating that 0-1 year is the most vulnerable period in childhood.
Poor maternal health
Low birth weight is a complex syndrome caused by two factors – preterm birth and a foetus too small for his/her gestational age. However, the overlap between these two situations has the worst outcomes.
These points are corroborated by research involving 350 mothers – conducted by the Rohilkhand Medical College in Uttar Pradesh – to find the epidemiological factors associated with low birth weight among institutional deliveries.
The study revealed the following: 40 per cent of expectant mothers delivered low birth weight babies and 76.5 per cent of them had a gestational age lower than 37 weeks; 58.5 per cent of these mothers were less than 20 years of age and 76.1 per cent of them weighed less than 50 kg.
Incidence of low birth weight highest in South Asia, India second highest in the world
In 2013, as many as 22 million newborns – an estimated 16 per cent of babies born globally – had low birth weight, according to UNICEF.
In terms of regional variations, South Asia had the highest incidence of low birth weight, with 28 per cent newborns weighing less than 2.5 kg. This region also had the highest percentage of infants (66 per cent) not weighed at birth. Sub-Saharan Africa’s incidence of low birth weight among newborns is estimated to be 13 per cent; and 54 per cent newborns are not weighed at birth.
At 28 per cent, India had the third highest percentage of low birth weight newborns, behind only Mauritania (35 per cent), Pakistan and Yemen (32 per cent each). Except for Pakistan, India performed worse than all its South Asian neighbours. Unicef, however, has cautioned that the data maybe inaccurate because of under-reporting.
India has most preterm births in the world
There are an estimated 15 million preterm births across the world each year, according to latest available data released by the WHO in 2012. Over 60 per cent of preterm births occur in Africa and South Asia. At 3.5 million, India accounted for the most preterm births in the world, followed by China (1.17 million) and Nigeria (0.77 million).
India’s Newborn Action Plan and how it works
The India Newborn Action Plan (INAP) was launched in September 2014 with the aim of ending preventable newborn deaths and stillbirths by 2030. The plan aims to attain single-digit neo-natal mortality and stillbirth rate by 2030.
India Newborn Action Plan’s main strategy is called Kangaroo Mother Care. It creates a womb-like environment for the newborn that provides the four basic needs of the baby – warmth, food, love and protection – and significantly benefits all newborns, especially those who are preterm or suffer from low birth weight.
Generally, Kangaroo Mother Care is advocated for all newborns weighing less than 2.5 kg at birth. However, in India, because of the huge burden of low birth weight, India Newborn Action Plan has recommended facility-based Kangaroo Mother Care for newborns with birth weight less than 2 kg on priority basis.
India has already cut neonatal tetanus mortality by 99.76 per cent and was declared as maternal and neonatal tetanus-free by the World Health Organisation, as IndiaSpend reported in October 2015.
(In arrangement with IndiaSpend.org, a data-driven, non-profit, public interest journalism platform. Devanik Saha is an MA Gender and Development student at Institute of Development Studies, University of Sussex. The views expressed are those of IndiaSpend. Feedback at email@example.com. Read the report on IndiaSpend: http://www.indiaspend.com/cover-story/low-birth-weight-preterm-delivery-cause-most-newborn-deaths-in-india-45376)