The year 2016 holds special significance for children in India since this is the first year of the new development framework- Sustainable Development Goals. The new global targets will influence the lives of children for the next 15 years until 2030.
Save the Children is certain that equitable access to quality pre-natal care, safe delivery, and expert post-natal care can substantially reduce maternal, neonatal and child mortality – a priority for us as we seek to support the government to achieve their own development targets. Family Planning is not only limited to the control of birth but is also important for improvement of life as a whole, for improving the social condition of a family and for better health of the mother and her children.
India was the first country in the world to have launched a National Programme for Family Planning way back in 1952. One of the goals enunciated in its National Population Policy 2000 was to stabilize the population at a level consistent with the requirement of national economy. The programme has since come a long way and currently it has been repositioned to not only achieve population stabilization but also to reduce maternal, infant and child mortality and morbidity.
Despite significant improvements in maternal and child health over the last decade or so, which is evident in the reductions in their mortality in the country, an estimated 47,000 mothers and 7.3 lakhs neonates continue to die every year due to causes related to pregnancy, childbirth and during the post-partum period. The major medical causes of the maternal deaths are hemorrhage (38%), sepsis (11%), abortion (8%), hypertensive disorders (5%), obstructed labour (5%) and ‘other’ causes including anaemia (34%), according to SRS 2011-03. A large proportion of newborn deaths are still due to preventable causes. According to the Lancet 2012, neonatal causes contribute to more than half (56%) of the total under-5 deaths in the country. The three major causes of newborn deaths in India are pre-maturity (35%), neonatal infections (33%), and intra-partum related complications (20%).
The rate of institutional deliveries in India have increased from 47 per cent as reported in the District Level Health Survey (DLHS-3, 2007-08) to 73 per cent in the Coverage Evaluation Survey (CES 2009). Yet, about 17 per cent births continue to take place at home, and even those women who come into the fold of institutional delivery are many a time deprived of quality services. Institutional deliveries aim to bring all women during pregnancy and childbirth into the institutional fold so that delivery care services of good quality can be provided to them at the time of delivery.
For reduction of Maternal Mortality Rate and Infant Mortality Rate including Neonatal Mortality Rate, strategies and interventions have to be tailored to specific needs and situations and implemented as a continuum of care; hence service packages have to be designed to provide care to both mother and newborn from antenatal to postnatal period. Essential newborn care should start soon after delivery and continue thereafter in the rest of the newborn period.
Maternal and child health are important aspects for the development of any country in terms of increasing equity & reducing poverty. The survival and well-being of mothers and their children is not only important in their own right but are also central to solving large broader, economic, social and developmental challenges.
In February 2012, India moved from its earlier focus on Reproductive and Child Health (RCH) to a new strategic approach, the RMNCH+A (Reproductive, Maternal, Newborn, Child and Adolescent health), bringing focus on all the life stages notably the adolescents. It links maternal and child survival to other components (family planning, adolescent health, gender & PC & PNDT) and connects community and facility-based services.
India has one of the lowest health spends as a proportion of the gross domestic product (GDP). Public expenditure on health in India was 1.3% of GDP in 2013, ranking well below the OECD average of 6.7%. In the Budget for 2016, Save the Children recommends a significant raise in the spending for health from 1.3% to 5% of GDP.
Towards the realization of the India Newborn Action Plan, it is important that Frontline Health Workers, namely Auxiliary Nurse Midwives and ASHAs are have skills to practice Essential Newborn Care, and Home Based Newborn Care. It is recommended that the Union Budget allocate funds for at least refresher courses of the Navjaat Shishu Suraksha Karyakram, and ASHA Modules 6 and 7, for all Frontline Health Workers. In a study done by Save the Children in five States, an estimated 50% of these Frontline Health Workers lack these essential skills.
Since the availability of pediatricians are limited at the community level, we recommend the 2016-17 budget allocate adequate funds for training and capacity building of health workers, especially the ANMs on new born health care,
India shoulders the biggest responsibility, globally, to ensure that newborns and infants have a healthy life, along with their mothers. With proper family and reproductive healthcare built, India can bring about results to make the nation proud and build a healthy profile of young citizens who can lead the nation to greater glory in the times to come.
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