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Why does India have the most newborn deaths in the world?

A mother and her newborn in Madhya Pradesh. By DFID – UK Department for International Development (The importance of breastfeeding from birth) [CC BY 2.0 (], via Wikimedia Commons

Every year, 2.6 million newborns in the world die within a month of their birth. Twenty-four percent of these deaths happen in India.

India has a neonatal mortality rate (NMR) of 25.4 deaths per 1,000 live births, according to a new UNICEF report on neonatal mortality. This translates to 600,000 newborn deaths in the country every year, more than any other country.

India is not necessarily the worst performing country on neonatal mortality, despite having the most deaths. Its NMR is the twelfth highest among lower middle income countries and the 28th highest overall. Of the 184 countries indexed, Pakistan has the highest NMR, of 45.6. Japan has the lowest, of just 0.9.

‘Newborn deaths are difficult to address’

India has made significant progress on its under-five mortality rate. This has fallen by two thirds since 1990 and now stands at 39 deaths per 1,000 live births. This places the Sustainable Development Goal (SDG) target of reducing under-five mortality to 25 deaths per 1,000 live births within reach for India, if the current trend of decline continues.

This, however, is true of the world at large. ‘Deaths among children aged 1 month to 5 years old have fallen dramatically in recent decades,’ the report says, but ‘progress in reducing the deaths of newborn babies…has been less impressive.’  

The report says this is because,  ‘newborn deaths are difficult to address with a single drug or intervention – they require a system-wide approach.’ It identifies ‘increasing access to affordable healthcare’ and ‘improving the quality of that care’ as being ‘critical’ to bringing down NMR.

Modicare a step in the right direction?

The Indian government recently made a significant healthcare commitment in the form of the National Health Protection Scheme (NHPS), or Modicare. The NHPS seeks to provide healthcare coverage to around 100 million economically vulnerable households.

Modicare represents a significant step towards making healthcare affordable for those it may not have been until now. However, the scheme contains few provisions to strengthen the public health system in India which suffers from crippling shortages of facilities and personnel.

This makes accessing quality healthcare a challenge for many patients. It has also led to a number of high-profile cases of medical negligence. At a hospital in Madhya Pradesh last year, rats gnawed at the fingers of a newborn girl after hospital staff put her on the floor due to a lack of available beds. Similar instances had occurred before. In August last year, scores of children – mostly newborns – died in a hospital in Gorakhpur due to oxygen shortages.

UNICEF makes it clear that most deaths during the newborn period are preventable. As such, it places the onus on governments to prevent them.

The UNICEF report can be accessed here.

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