Reducing preterm births and stillbirths

Source– The post is based on the article “Reducing preterm births and stillbirths” published in The Hindu on 12th January 2023.

Syllabus: GS2- Issues related to development and management of health

Relevance– Child and maternal health

News– The article explains the issue of child mortality caused by preterm births and stillbirths in India. It also explains the scenario of healthcare funding in India.

What are some statistics about child mortality in India?

The ‘Levels and Trends in Child Mortality’ report on child mortality by the United Nations Inter-agency Group for Child Mortality Estimation estimates that globally, five million children died before their fifth birthday in 2021.

India’s share in these child mortalities was estimated at 7,09,366 under-five deaths; 5,86,787 infant deaths; and 4,41,801 neonatal deaths.

The Sample Registration System of 2022 showed wide inter-State variations in child mortality in India. The infant mortality rate in Madhya Pradesh was six-fold of the rate in Kerala. The children in rural parts have much higher mortality rates than their urban counterparts.

What are the challenges that are at the root of child deaths in India?

There are two neglected challenges:

1. Preterm births– It means they are born alive before 37 weeks of pregnancy are completed. Preterm babies are two to four times at higher risk of death after birth in comparison to those born after 37 weeks of gestation.

India has a high burden of preterm births. One in every six to seven births is preterm. Studies have shown that preterm births contribute to one in every six under-five child deaths.

2. 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. In 2021, the absolute estimated number of stillbirths in India was greater than the death amongst children in 1-59 months of age.

One of the reasons preterm births and stillbirths do not get due attention is lack of reliable data. 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.

What is the way forward to prevent stillbirths and preterm births?

The majority of these births can be prevented by scaling up the proven interventions and improving the quality of health services.

The focus must be on increasing access to family planning services. There is a need to improve antepartum services such as health and nutrition, including the intake of iron folic acid by pregnant mothers. Further providing counselling on the importance of a healthy diet and identification and management of risk factors is also important.

There is a need for measures to prevent, detect early and manage diseases which put mothers at high risk, such as diabetes, hypertension.

Monitoring labour and functional referral linkages and improving the quality of health care services can help in preventing stillbirths.

Data on preterm births and stillbirths need to be 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.

India needs to identify the hot spot clusters of stillbirths and preterm births for local and targeted interventions.

Multi-stakeholder collaboration is needed for effective health interventions.

What is the scenario of funding for the healthcare sector in India?

In the National Health Policy of 2017, the government had committed to investing 2.5% of the GDP on health by 2025. Even by the best estimate, spending on health is around 1.5% of the GDP. It is among the lowest in the world.

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. Inequities in the health system impact the poorest and marginalised families. The primary healthcare system is underfunded.