Reducing preterm births and stillbirths (GS Paper 2, Health)
Why in news?
Report on child mortality:
- The report on child mortality, ‘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).
- 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. Many of these are preventable.
SRS report:
Preterm babies:
- At the root of many child deaths are two neglected challenges. 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. Studies have shown that preterm births contribute to one in every six under-five child deaths. However, three out of every four deaths due to preterm birth-related complications are preventable.
Stillbirths:
- The second challenge is of stillbirths, the subject of the second report titled ‘Never Forgotten’, also by the UNIGME.
- 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. 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. Thus, they demand urgent interventions.
Lack of data:
- 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.
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.
- Half the stillbirths happen before delivery due to antepartum causes and the remaining during delivery (intrapartum). Monitoring labour and functional referral linkages and improving the quality of health care services will prevent stillbirths.
Focus on record & report:
- However, the interventions can be best delivered if data on preterm births and stillbirths are better recorded and reported.
- The maternal and perinatal deaths surveillance guidelines need to be effectively implemented and the International Classification of Diseases’ definition for perinatal mortality must be adopted.
- The use of this classification will help standardise the causes of stillbirth reporting. Alongside, India needs to identify the hot spot clusters of stillbirths and preterm births for local and targeted interventions.
Policy solutions:
- Stillbirths and preterm births are highly sensitive ‘tracer indicators’ of the quality of maternal and child health services in particular, and overall health services in general.
- In the National Health Policy of 2017, the government had committed to investing 2.5% of the GDP on health by 2025. Six years since then, the government’s allocation for health has increased only marginally. Even by the best estimate, it is around 1.5% of the GDP.
- The Indian government’s investment on health is among the lowest in the world. Yet, there does not seem any urgency on its part to increase funding for health.
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 marginalised families; and
- the primary healthcare system is underfunded, and some cosmetic changes along are not be enough to improve health outcomes; among others.
Way Forward:
- The two recent reports are reminders that it is time for the government to allocate more funds for health, starting with the upcoming Budget.
