Maternal Health in India
India continues to contribute about a quarter of all global maternal deaths. WHO defines maternal mortality as the death of a woman during pregnancy or in the first 42 days after the birth of the child due to causes directly or indirectly linked with pregnancy.
Globally, every year over 500,000 women die of pregnancy related causes and 99 percent of these occur in developing countries.
• The Maternal Mortality Ratio (MMR) in India is 254 per 100,000 live births according to Sample Registration System (SRS) Report for 2004-2006. This is a decline from the earlier ratio of 301 during 2001-2003.
• In the region, the MMR in China stands at 45, Sri Lanka at 58, Bangladesh at 570, Nepal at 830 and Pakistan at 320 in 2006.
• Wide disparities exist across states in India. The MMR ranges from 95 in Kerala to 480 in Assam.
• MMR has a direct impact on infant mortality Babies whose mothers die during the first 6 weeks of their lives are far more likely to die in the first two years of life than babies whose mothers survive.
• Only 47 per cent of women likely in India have an institutional delivery and 53 percent had their births assisted by a skilled birth attendant. As many as 49 percent of pregnant women still do not have three antenatal visits during pregnancy. Only 46.6 percent of mothers receive iron and folic acid for at least 100 days during pregnancy.
• About half of the total maternal deaths occur because of hemorrhage and sepsis. A large number of deaths are preventable through safe deliveries and adequate maternal care.
• More than half of all married women are anaemic and one-third of them are malnourished (have a body index below normal).
UNICEF in Action
• Building on the achievements of the Government of India’s National Rural Health Mission (NRHM), UNICEF continues to support health programs such as the Village Health and Nutrition Days (VHND), to reach out to pregnant women in underserved areas, ensuring that they receive the three essential antenatal check-ups and sensitizing them about the importance of institutional deliveries.
• UNICEF is working closely with National Rural Health Mission programs such as Janani Suraksha Yojna to encourage women to have institutional deliveries.
• UNICEF follows the continuum of care approach to ensure that both mother and newborn receive necessary services.
This involves a chain of interventions that begin with complete and comprehensive antenatal care, increasing skilled attendance at birth, ensuring that first referral units are equipped to deal with emergency obstetric care and ensuring that both the mother and newborn are followed up post partum.
Neonatal Health In India
Child mortality is a sensitive indicator of a country’s development. In India, the Infant Mortality Rate (IMR) (under one year) has shown a modest decline in recent years.
The average decline of IMR per year between the years 2004 to 2008 has been about 1 per cent per year.
In 2008, the IMR was 53/1,000 live births. Eight states contribute to 75 per cent of infant mortality: Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Andhra Pradesh, Orissa, Gujarat and Assam.
At the current rate of decline, India will miss the XI plan goal of reduction in IMR and the Millennium Development Goal-4 on child survival.
About 70 per cent of the childhood under-five is caused by perinatal conditions (33.1 per cent), respiratory infections (22 per cent) and diarrhea (13.8 per cent). Malnutrition is an underlying cause responsible for about one third of all deaths in childhood.
• Averting neonatal deaths is pivotal to reducing child mortality. The Newborn period is the period starting from birth and continues throughout 28 days of life.
• Neonatal mortality rate (mortality in the newborn period) stands at 35/1000 lives births, and contributes to 65 per cent of all deaths in the first year of life.
• Between 2004-2008, neonatal mortality has moved from 37/1000 live births to 35/1000 only.
• 56 per cent of all newborn deaths occur in five states: UP, Rajasthan, Orissa, MP and Andhra Pradesh.
• Three major causes contribute to about 60 per cent of all deaths in the newborn period: pre-maturity and low birth weight, birth asphyxia and infections.
• Most of the causes of deaths in the newborn period can be prevented or managed by households, communities and health facilities. But they often are unable to provide the required care.
• Inappropriate practices such as delayed initiation of breastfeeding, delayed clothing and early bathing, not seeking care when newborns are sick and applying harmful material on cord-stump increase the risk of newborn deaths.
• Health facilities are often ill equipped to provide essential newborn care to all newborn and special newborn care to sick newborns.
UNICEF in Action
UNICEF partners with the Government of India, state governments and communities, promote simple interventions which can significantly improve newborn survival:
• UNICEF encourages home-based care of all newborns through its support to the Integrated Management of Newborn and Childhood Illnesses (IMNCI) program.
The program equips frontline workers with the required skills and supplies. Following training on IMNCI, frontline workers (ASHAs and AWWs) visit newborns at their households three times in the first week of life. During the visits, the workers assess the newborns, promote healthy practices, manage simple problems and refer those with serious illnesses.
• UNICEF supports intensive behavior change communication efforts through all channels to promote key practices that improve survival of newborns.
• UNICEF raises awareness of media and elected representatives on issues related to newborn and child survival.
• UNICEF supports setting up and managing of Special Care Newborn Units (SCNUs) that provide state-of-the-art care for newborns in some of the least developed districts of the country.
Measles in India
The respiratory disease measles remains a leading cause of death among young children, despite the fact that a safe and effective vaccine has been available for 40 years. Measles is an acute illness caused by a virus of the paramyxovirus family.
It is one of the most contagious diseases and many children who do not have sufficient immunity contract measles if exposed. During the first few weeks after contracting measles, a child’s immune system becomes weakened, and a normal cold or diarrhoea can become a life threatening illness.
- Globally, an estimated 450 people, mostly children, die every day from measles despite the fact that an effective and safe vaccine is available at low cost.
- It costs less than $1 to vaccinate a child against measles.
- A global goal to reduce measles deaths by 90 per cent by 2010 was set at the World Health Assembly in May 2005.
- Despite global successes in reducing measles deaths, an estimated 164,000 people died from measles in 2008, the latest year for which figures are available.
- In November 2010, the Government of India introduced a second dose of measles vaccination drive in 14 high-risk states, targeting 134 million children, to prevent an estimated 60,000 to 100,000 child deaths annually.
UNICEF / WHO Action
The global reduction in death from measles reflects support and commitment by the Measles Initiative to boosting immunization coverage and by national governments to following the World Health Organization (WHO ) / UNICEF comprehensive strategy for reducing measles mortality. This strategy consists of four key components:
• Providing at least one dose of measles vaccine at routine vaccination coverage of at least 90 per cent of children, administered at nine months of age or shortly after
• Giving all children a second opportunity for measles vaccination
• Establishing effective surveillance
• Improving clinical management of complicated cases – including vitamin A supplementation
For more information and interviews, please contact:
Caroline den Dulk Chief of Communication, UNICEF India
Tel: +91-98-1810-6093; E-mail: firstname.lastname@example.org
Geetanjali Master, Communication Specialist, UNICEF India
Tel: +91-98-1810-5861; E-mail: email@example.com
Sonia Sarkar, Communication Officer- Media, UNICEF India
Tel: +91-98-101-70289; E-mail: firstname.lastname@example.org