Reducing preterm births and stillbirths

(MainsGS2:Government policies and interventions for development in various sectors and issues arising out of their design and implementation.)

Context:

The recent report on child mortality i.e. Levels and Trends in Child Mortality by the United Nations Inter-agency Group for Child Mortality Estimation (UNIGME) estimates that globally, five million children died before their fifth birthday (under-five mortality) in 2021.
Over half of these (2.7 million) occurred among children aged 1-59 months, while the remainder (2.3 million) occurred in just the first month of life (neonatal deaths).

Indian scenario:

India’s share in these child mortalities was estimated at 7,09,366 under-five deaths; 5,86,787 infant deaths (death before first birthday); and 4,41,801 neonatal deaths.
In addition, the Sample Registration System (SRS), released in September 2022, showed wide inter-State variations in child mortality in India.
For every 1,000 live births, the infant mortality rate in Madhya Pradesh was six-fold of the rate in Kerala.
Further, the children in rural parts in any age subgroup have much higher mortality rates than their urban counterparts.

Neglected challenges:

Preterm births:

The first challenge is of children being ‘born too early’ (preterm births), which means they are born alive before 37 weeks of pregnancy are completed.
This is a challenge because these ‘preterm babies’ are two to four times at higher risk of death after birth in comparison to those born after 37 weeks of gestation.
Globally, one in every 10 births is preterm; in India, one in every six to seven births is preterm.
India has a high burden of preterm births, which means newborns in the country are at greater risk of complications and mortality.

Stillbirths:

A baby who dies any time after 22 weeks of pregnancy, but before or during the birth, is classified as a stillborn.
Globally, an estimated 1.9 million stillbirths happened in 2021 and in 2021, the absolute estimated number of stillbirths in India (2,86,482) was greater than the death amongst children in 1-59 months of age (2,67,565).
The rates and number of both preterm births and stillbirths are unacceptably high and drive the neonatal, infant and child mortalities upwards in India.

Lack of granular and reliable data:

One of the reasons preterm births and stillbirths do not get due attention is lack of granular and reliable data.
Over decades, while countries have strengthened the mechanisms for tracking child mortality, the data on stillbirths and preterm births are scarce.
Even at the global level, the first-ever report on stillbirths was released only in October 2020.
In India, the SRS report on stillbirths fails the ‘smell test’. Its stillbirth estimates are less than even the lower end of the confidence interval by all other reliable estimates, including a recent peer-reviewed analysis with the use of government data from the Health Management Information System.
Experts believe that the problem is the lack of timely, granular data on stillbirths from the block, district and State levels.

Way ahead:

The majority of stillbirths and preterm births can be prevented by scaling up known and proven interventions and improving the quality of health services.
For reducing both stillbirths and preterm births, the focus must be on: increasing access to family planning services; improving antepartum services such as health and nutrition, including the intake of iron folic acid by pregnant mothers, providing counselling on the importance of a healthy diet, and optimal nutrition; and identification and management of risk factors.
The measures to prevent, detect early and manage diseases which put mothers at high risk, such as diabetes, hypertension, obesity and infections, will also help in reducing preterm births and stillbirths.
And it is possible to reduce future neurological complications for preterm babies by ensuring the Kangaroo mother care and early initiation of exclusive breastfeeding, among others.
In the National Health Policy of 2017, the government had committed to investing 2.5% of the GDP on health by 2025 but six years since then, the government’s allocation for health has increased only marginally, which needs to be tackled urgently.

Conclusion:

There are multiple reasons why India’s health system needs more government funding: children continue to die from preventable causes; pregnant women do not receive good quality care; aggregate mortality hides the inequities in health outcomes and the brunt of those inequities is borne by the poorest and marginalized families.