The United Nations children's agency UNICEF's recent report on the Neonatal Mortality Rate (the number of deaths per 1000 live births) has revealed some interesting facts about the chances of survival of the newborns in different nations in the world. According to the report, Pakistan is the riskiest country to be born in, with one in 22 babies born there dying before they turn one month old. India’s neonatal mortality rate is 25.4, which ranks it at 12 among 52 lower middle-income countries in terms of risk for newborns. While this is better than Pakistan, it is far behind India’s less prosperous neighbours like Sri Lanka, Bangladesh, Nepal and Bhutan. While Sri Lanka has the lowest neonatal mortality rate of 5.2, which is comparable with high-income countries, Bangladesh, Nepal and Bhutan are also ahead of India in neonatal survival. As per the report, babies born in Japan, Iceland and Singapore have the best chance of survival, while newborns in Pakistan, the Central African Republic and Afghanistan face the worst odds. However, the silver lining in the report is that India has done better than the world in reducing under-five mortality, reducing it by 66% between 1990 and 2015 against the world average of 55%. Globally, in low-income countries, the average newborn mortality rate is 27 deaths per 1,000 births, while in high-income countries, that rate is 3 deaths per 1,000.
What is noteworthy in the report is the fact that more than 80 per cent of newborn deaths are because of premature birth, complications during labour and delivery, and infections such as sepsis, meningitis and pneumonia. This clearly means these deaths can be prevented with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition. However, a shortage of well-trained health workers and midwives means that thousands don’t receive the life-saving support they need to survive. For example, while in Norway there are 218 doctors, nurses and midwives to serve 10,000 people, that ratio is 1 per 10,000 in Somalia. Though India has shown some progress in reducing under-five mortality, the progress has been slower in saving babies during the neonatal period when they are the most vulnerable. In India, there is massive disparity between states on neonatal mortality rate. While Kerala and Goa have neonatal mortality rates of 10, the figure for Bihar and Uttarakhand is 44 per 1000 live births. Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan account for 46% of all births and 57% of India’s neonatal deaths. Experts have already aired their opinion that vaccination doesn’t reduce neonatal or infant deaths much, it lowers under-five mortality. To lower neonatal deaths, India should strengthen mother and newborn health services, including home-based care by health workers, institutional care for sick newborns, promoting breastfeeding, treating underweight babies, keeping the mother healthy, preventing early marriage and reducing malnutrition in adolescent girls. Besides, the government should take note of the massive disparities between different states in neonatal mortality rates and initiate some urgent corrective measures.