We work to improve maternal, newborn, child and adolescent health through collaboration with communities, governments and partners in India.
Ending preventable maternal, newborn and child deaths
India has made significant progress in reducing maternal mortality, neonatal mortality and under-5 child deaths. In 2020, maternal mortality was reduced to 97 per one lakh live births, neonatal mortality to 20 per 1000 live births and under-5 mortality to 32 per 1000 live births.
These are crucial gains. Nearly 40 per cent of newborn deaths and half of maternal deaths happen on the day a child is born. Reducing these preventable deaths has poised India to accelerate toward chasing the SDG 2030 targets in all three parameters.
It has now converged its focus to reach the most vulnerable and marginalized populations living in hard-to-reach areas. The aim is to ensure equitable availability and access to quality Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCHA) services.
However, despite these impressive gains, challenges remain. India shoulders the burden of nearly one-sixth of the world's under-5 deaths and around a quarter of neonatal deaths. Every day, 67,385 babies are born in India—every minute, one of these newborns dies.
Concerted efforts, however, can save precious lives. Neonatal deaths, which occur within the first 28 days of life, were reduced significantly from one-third of the global deaths to below a quarter of the same through such efforts.
One of the critical solutions to address the challenge of both maternal and newborn deaths is encouraging institutional delivery. Nearly five million newborns are delivered at home in India every year. Institutional delivery, wherein a woman delivers in a health facility, assisted by a skilled birth attendant, provides access to obstetric care, which can avert risks and prevent these deaths.
The National Family Health Survey (NFHS-5), 2019-21 for India revealed that 89 per cent of newborns in the country are delivered in institutions. Even then, 24,000 women maternal and 468,000 neonatal deaths were reported in India in 2020.
Among the prime causes of maternal deaths were obstetric hemorrhage (47 per cent), pregnancy-related infection (12 per cent) and hypertensive disorders of pregnancy (7 per cent). In newborn deaths, the major causes were prematurity and low birth weight (48 per cent), birth asphyxia and birth trauma (13 per cent), neonatal pneumonia (12 per cent) and non-communicable diseases (7 per cent), along with diarrhoea and pneumonia.
Teenage pregnancy, which poses a high risk to both mother and child, is yet another challenge. According to official data, almost one-fourth of women (23.3 per cent) in the 20-24 age group in India get married before they turn 18 and 6.8 per cent of girls bear children while still in their teens.
In India more girl babies die than boy babies and the gender differential in child mortality is currently 3 per cent. This discrimination begins even before birth with an adverse sex ratio for the female child, meaning more boys are born than girls and continues across all stages of a child's life.
Statistics show that there are fewer hospital admissions for girls than boys, reflecting community bias and that parents sometimes give less attention to newborn girls. In 2017, 150,000 fewer girls were admitted to SNCUs than boys.
Preventing maternal and newborn deaths requires concerted action at all levels of society – from families and communities to healthcare workers and governments.
Reaching every child: UNICEF strives to reach every mother and newborn with inclusive programming and equitable access to and utilization of RMNCHA services—even by the most vulnerable and marginalized populations nationwide.
The need for equitable access to health care for every girl child warrants an intensification of our combined efforts to bridge this gap. Even in the states that have met the MDG targets, there are persistent gender inequities.
Under-5 mortality for girls in India remains 3.3 per cent higher than for boys. Globally, this is 11 per cent higher (Source: UNIGME Child Survival Report 2022) for boys.
UNICEF, through enduring commitments, thoughtful investments, multi-sectoral collaborations, evidence-informed interventions and policy advocacy, works towards improving maternal, newborn, child and adolescent health outcomes and seeks to reduce inequities in care, strengthen health systems and incorporate resilience and risk-informed planning.
UNICEF works with the Ministry of Health and Family Welfare, Ministry of Women and Child Development, NITI Aayog and state governments around the following key areas:
Maternal Health: Using an integrated and equity approach, UNICEF is improving the lives and health of women in India. Through support planning, budgeting, policy formulation, capacity building, monitoring, and demand generation, UNICEF is enhancing pregnant women's access to quality and respectful care in health facilities, with follow-up home-based newborn care for both mother and child.
In addition, to ensure quality and universal coverage and minimize adverse outcomes, efforts are being made through strengthening GoI's Quality Assurance programmes, mid-wife care initiative, ANC care programmes, capacities of health systems in the management of obstetric emergencies and rational indication of caesarean deliveries, seamless referral mechanisms and community engagement.
Programmes are also geared to address inequities with particular emphasis on changing behaviours and practices around care seeking for newborn girls and adolescent mothers.
Newborn and child health: Most newborns die from causes that we know how to prevent or treat: complications due to premature birth or during labour and delivery and infections like sepsis, pneumonia, tetanus and diarrhoea.
UNICEF, through collaboration with national and state governments of India, professional bodies and partners, is:
• Strengthening health systems and building the capacity of health providers for quality and coverage of facility-based newborn and child health care (SNCU, MNCU, KMC, NBSU, Paediatric care, NICU, PICU)
• Engaging with caregivers and communities to promote nurturing care (ECD) and home-based newborn care through the involvement of health departments, Integrated Child Development Service (ICDS), etc.
• Ensuring growth and development of the child through proper nutrition, immunization and WASH initiatives
Adolescent health: Adolescents have unique and complex health needs. To ensure growth and development of young people, UNICEF supports GoI's adolescent health programmes through strengthening and scaling up of initiatives such as the School Health and Wellness programme, Rashtriya Kishor Swasthya Karyakram (RKSK) with particular focus on adolescent anaemia and menstrual hygiene, and Adolescent Friendly Health Clinics (AFHCs).