Infant Protection Day: India must reassess its healthcare system

India must address the rampant health issues among infants in India (Photo: Unsplash)

As India marks Infant Protection Day, activists aim to spread awareness about the safety of infants and the importance of proper protection and care in order to prevent early mortality of both the new-borns and mothers. India has made significant strides in its Infant Mortality Rate (IMR), with a 2020 report revealing that the number of under-five deaths have fallen by 30 pc from 2012 and have now dropped to the world average, and recorded a 3.48 pc decline from 2019, at 29.848 deaths per 1000 live births.

Yet, it remains a formidable challenge as India is still worse off than its poorer neighbours like Bangladesh, whose IMRs stand at 23.7 and Nepal at 25.2. Moreover, data released in 2021 from the sample registration system (SRS) shows that there are troubling differences between certain states, for example although Kerala has an IMR that equals the United States, Madhya Pradesh is worse off than Yemen and Sudan, which indicates a continuing high mortality risk in the first year of life for Indian children.

NGOs such as Save The Children, a child-rights organisation, advocate with national and local governments on child rights and work towards promoting gender equity, one of the major roadblocks in reducing IMR.

Female foeticide and infanticide still run rampant in India

“It is known in India that female children are at a disadvantage compared to male children. We advocate for child rights and the need to give extra care to the girl child and try to influence the family to raise awareness about the importance of gender equity,” Dr Vinod Kumar Anand, paediatrician and technical advisor at Save The Children, tells Media India Group.

India’s decades-old, deep-rooted preference for boys over girls, exacerbated by the society’s patriarchal structure and the South Asian dowry system which makes girls an economic burden, has led to a dangerously skewed sex ratio, significantly higher in states like Maharashtra, Haryana and Jammu & Kashmir. In 1991, the child sex ratio in India was 947 girls to 1000 boys and barely a decade later, it had fallen even further to 927 girls for 1000 boys. To address the rising incidence of female foeticide, which is the practice of abortion of a female foetus outside of legal channels and specifically for sex selection, the Indian government passed the Pre-Conception and Pre-Natal Diagnostic Techniques Act (PCPNDT) in 1994, to ban and punish prenatal sex screening, making disclosure of the baby’s gender by doctor to patient illegal.

According to a 2020 United Nations report, India accounts for 45.8 million of the world’s 142.6 million “missing females” over the past 50 years.

The State of World Population 2020 report released by the United Nations Population Fund (UNFPA), the UN’s sexual and reproductive health agency, said that the number of missing women has more than doubled over the past 50 years, from 61 million in 1970 to a cumulative 142.6 million in 2020. In 2019 for example, a governmental probe was ordered in Uttarakhand’s Uttarkashi district, where not a single girl was born in three months in 132 villages; all 200 births were boys.

“The Act has definitely worked in big hospitals and the formal sector, which have proper record of ultrasound machines and registered healthcare facilities and in these places, gynaecologists and paediatricians have become aware and practice this, but in India there is an equal number in the non-formal or unrecognised sector which are not registered in the system. The National Family Health Survey (NFHS) core data also shows there is a skewed sex ratio, so clearly something is wrong. We hear about raids taking place in these places and unregistered ultrasound machines being confiscated, but a lot more has to be done, especially in the informal sector,” says Dr Anand.

Insufficient healthcare, malnutrition leading cause of early infant mortality

Experts put the high IMR down to two main causes: prematurity and diseases, especially diarrhoea and pneumonia.

“We have a lot of prematurity and low birth weight in this country, so these babies are born and already start with a disadvantage because they have more complications. And if we look beyond the neonatal period, beyond the first month of life, pneumonia and diarrhoea contribute almost to 50 pc of infant deaths. But there’s a hidden factor which is the worst in India, and that is malnutrition – both in the mothers and babies. So, if we address this issue, a lot more can be done,” explains Dr Anand.

Malnutrition in particular, seems to be an unrelenting malady in India, with RTI data showing that more than 920,000 children in the country are “severely acute malnourished,” mostly in the states of Uttar Pradesh and Bihar, and experts fear India’s health and nutrition crisis will have worsened after economic difficulties caused by the Covid-19 pandemic.

The Global Hunger Index 2020, calculated based on total undernourishment of the population, child stunting, wasting and child mortality, placed India at the 94th spot out of 107 countries. Although showing improvement since the first ever National Family Health Survey (NFHS) in 1992-1993, which reported that more than 50 pc of children under four were underweight and stunted, with one in every six children wasted (excessively thin), numbers have remained alarming more than two decades later. Latest 2019-2021 NHFS data showed that chronic malnutrition or stunting (short for their age) among children below five years did not improve at all since the last survey, while acute undernourishment or wasting actually worsened in the last five years in a majority of surveyed states and Union territories (UT).

At Save The Children, maternal health and neonatal care is focused around the antenatal (identifying high-risk pregnancies and educating women in order experience a healthier delivery and outcome) and post-natal care, especially the first 42 days after birth, which is a critical time period. Along with a health and nutrition team, one major recent project by the NGO is their tie-up with the Pune Municipal Corporation and US-based IT company Avaya.

“We have connected Vijay Medical College in Pune with 16 health facilities, smaller primary and secondary level hospitals under the Pune Municipal Corporation and used special video-conferencing equipment given by Anaya for capacity building of these doctors and nurses working in maternal and new-born care, and focusing on providing high quality antenatal care,” says Dr Anand.

Employing this innovative method through video conferencing, rather of physical training, the doctors and nurses working can join the 1-2 hours sessions from the workplace when they have time, rather than not being able to attend to patients. Another project is based in Nuapada district in Odisha to strengthen post-natal care services, both at the facility level and community levels, with healthcare workers following up on the health of mothers and the new-borns for 42 days.

Although such schemes, both by NGOs and by government officials, have helped in improving neonatal health and mortality rates, experts believe that unless the healthcare system in India improves, these efforts will prove more or less futile. India is still one of the lowest healthcare spenders in the world, with public healthcare system in the country merely getting 1.26 pc of the total GDP, despite a much higher recommendation under the National Health Policy. India’s health spending is notoriously much lower than neighbours like Sri Lanka, where it is three times as much, and even in poorer nations like Bangladesh and Pakistan, over 3 pc of the country’s GDP is put towards the public healthcare system.

“Definitely, the only real solution is that we have to strengthen our public healthcare system, which needs more resources. Our health expenditure as part of the total budget is very meagre, despite the government recommendation. Ultimately, allocation to health needs to be sufficient for change to occur,” he says.