Despite 33% drop, India records highest newborn deaths in world

NEW DELHI: First the good news: India has recorded a 33% drop in newborn deaths between 1990 and 2009. Now, the bad news. Despite the sharp drop, over 9 lakh newborns died in 2009, the highest in the world. The most comprehensive newborn death estimates so far - covering all 193 countries and spanning 20 years released by the World Health Organization, Save the Children and the London School of Hygiene and Tropical Medicine on Tuesday - says newborns account for 41% of all child deaths.
India's neonatal mortality rate (NMR) in 1990 (deaths per 1,000 live births) was 49. In absolute numbers, the nation recorded 13.49 neonatal deaths. In 2009, the neonatal mortality rate stood at 34, which worked out to 9.07 lakhs. Only five countries account for more than half of the world's 3.3 million newborn deaths - India, Nigeria, Pakistan, China and Democratic Republic of Congo.
Dr Joy Lawn of Save the Children's Saving Newborn Lives programme said, "Newborns are barely on the global health agenda and this study reveals the tragic results of that neglect. Each year 3.3 million babies still die in the first four weeks of life, despite proven, cost-effective interventions that could save these newborns.
The study found that newborn deaths dropped from 4.6 million to 3.3 million between 1990 and 2009.
But while the newborn mortality rate dropped 28% during that period, it lagged progress on maternal mortality (34% reduction) and mortality of older children (37% reduction for children between 1 month and 5 years).
Consequently, the share of child deaths that occur in the newborn period (the first four weeks of life) rose from an already high 37% to 41% and is likely to be on the rise, the authors said.
The three leading causes of newborn death - preterm delivery, asphyxia and severe infections - are preventable with proper care.
"We know that solutions are simple as keeping newborns warm, clean and properly breastfed can keep them alive, but many countries are in dire need of more and better trained frontline health workers to teach these basic lifesaving practices, said Thomas Chandy of Save the Children.
"The global health worker crisis is the biggest factor in the deaths of mothers and children, and particularly the 3.3 million newborns dying needlessly each year. Training more midwives and more community health workers will allow many more lives to be saved, the study added.
The first four weeks of life - the neonatal period - carries one of the highest risks of death of any four-week period in the human lifespan.
In high-income countries (HIC), now neonates are a major focus of child health both for reducing mortality and morbidity. Globally, the average annual reduction in NMR appears to be accelerating and was twice as high during 1999-2009 (2.3%) as compared to that experienced from 1990 to 1999 (1.1%). Only high-income countries experienced lower average reduction in NMR during 1999-2009 (1.7%) as compared to that between 1990 and 1999 (3.7%), which may reflect the challenge of reducing mortality in very preterm babies.
However, while progress appears to be increasing, the average annual rate of NMR reduction is well below the MDG-4 goal (of 4.4%) at 1.7% per year globally during 1990-2009, and less than for under-five mortality at 2.1% per year in the same period and maternal mortality between 1990 and 2008 at 2.3% per year.