India’s Newborn Action Plan

Globally, 2.9 million newborns die within the first month of life. India, with a population totalling 17.5 percent of the global population, accounts for a startling 27 percent of the global newborn mortality rate with over 780,000 newborn deaths every year, the highest newborn mortality rate in the world. On September 17th, India launched its national Newborn Action Plan (INAP) to stop and reverse this disturbing trend.

Image c/o Gates Foundation

Based on the findings and strategies promoted in The Lancet’s Every Newborn series, INAP aims to reduce India’s newborn mortality rate from its current 29 deaths per 1,000 births to under 10 deaths per 1,000 births by 2030. In order to accomplish this goal, INAP focuses on improving the following six evidence-based, effective strategies:

  1. Preconception and antenatal care
  2. Care during labor and childbirth
  3. Immediate newborn care
  4. Care of healthy newborns
  5. Care of small and sick newborns
  6. Care beyond newborn survival

Additionally, the issue of gendercide does not go ignored. Because a girl’s family traditionally must pay a dowry in order to marry, families – especially in poorer regions – favor having boys over girls. As a result, each month approximately 50,000 female fetuses are aborted or killed at birth, thrown into rivers, or simply left to die. An estimated one million girls in India “disappear” every year. With INAP, the Health Ministry takes this long-standing tradition of gender-bias into account and aims to eliminate gender-based differences in newborn health care.

“These are preventable deaths and now we have an action plan for preventing them.” – Harsh Vardhan, India Health Minister

Although India as a whole is on track to achieve Millennium Development Goals (MDGs) 4 and 5 (reducing child mortality and maternal mortality by two-thirds and three-quarters respectively), MDG success is not consistent across the country. For example, the state of Kerala already has a neonatal mortality rate of seven deaths per 1,000 births, yet the poorer states of Bihar, UP, Madhya Pradesh and Rajasthan are far behind, with a combined neonatal mortality rate amounting to 56 percent of such deaths nationwide.

“Healthy mothers and healthy children are crucial for India to realize the demographic dividend.” – Melinda Gates

It is important to emphasize that India’s efforts to reduce the newborn mortality rate are not limited to merely survival. With the launch of INAP, the Health Ministry will focus increased attention on improving the health and lives of both healthy and sick newborns. In a country where shunning those with disabilities, neuro-developmental delays, and birth defects is not uncommon, recognizing the value of all newborns, both sick and healthy, is a major step in the right direction.

With support from the Bill & Melinda Gates Foundation, the World Health Organization and UNICEF, India’s Health Ministry is confident in its ability to reduce newborn deaths nationwide – and if India’s INAP efforts echo the success of its anti-polio campaign, the future for India’s newborns looks promising.


Newborn health: How do we care for the most vulnerable in our society?

When the UN millennium development goals (MDGs) were established in 2000, the reduction of child mortality was named as MDG 4. The target of MDG 4 is to reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. The indicators that are used to track progress against MDG 4 are under-five mortality rate, the infant mortality rate, and the proportion of 1 year-old children immunized against measles.

Photo Credit: United Nations Vaccination Programme Flickr Account
Photo Credit: United Nations Development Programme Flickr Account

Since 1990, the global infant mortality rate has decreased by almost half. According to the World Health Organization (WHO), in Europe in 2013, the lifetime risk of dying during pregnancy and childbirth was 1 in 3300, and the chance of an infant dying before her first birthday was 10 per 1000 live births.

Of course, we could do better, but these numbers don’t paint such a bad picture. Most of us in the developing world do not fear the risks involved with childbirth or worry about our child dying in the first year of life. For us, having a baby is a celebration with little fear.

Let’s change the setting. In Africa, in 2013, the lifetime risk of dying during pregnancy and childbirth was 1 in 40, and 63 infants per 1000 live births died before their first birthday. That is 6 times higher than the infant deaths in Europe. The United Nations update on MDG 4 explains that, ‘Despite determined global progress in reducing child deaths, an increasing proportion of child deaths are in sub-Saharan Africa and Southern Asia. Four out of every five deaths of children under age five occur in these regions.’

How would we feel about childbirth in this scenario?

What are mothers and babies dying from in Africa and other developing nations?

According to WHO, mothers are dying from severe bleeding, and preventable infectious and chronic diseases that become exacerbated during pregnancy, such as malaria, HIV, diabetes, and obesity.

27% of pregnant women in developing countries die from severe bleeding during childbirth.

That statistic is unbelievable to me. It sounds like something that would describe a scene from the 1900s in the United States, but this is a reality for a large number of people in the world today.

Newborn health is inextricably connected to maternal health. Similarly to maternal mortality, preventable diseases are the major causes of under-five deaths. Inadequate nutrition, limited access to clean water, and poor healthcare infrastructures lead to the spread of preventable infectious diseases.

Photo Credit: Liz Fortier
Photo Credit: Liz Fortier

When I traveled to South Africa to study public health in 2011, I met a 2-year-old girl who was HIV positive. During the time I spent with her and her family, she enjoyed playing with my camera and trying to recruit me for a game of hide-and-seek. She was just as playful as any 2-year old I’ve met, but sadly she is up against a lot more than most. In addition to her illness, she lives in a shack in a community of people who have been ostracized because of their diagnosis with HIV. She already lacks resources she needs to secure a healthy life.

Poverty perpetuates these health care dilemmas and is severaly slowing down progress towards reaching MDG 4 and 5 (improving maternal health) targets in developing nations.

Although it looks like MDGs 4 and 5 will not been achieved in the hardest to reach locations, increased research, awareness, and acknowledgement of protecting our newborns has led to a few new campaigns to create the needed change.

The ‘Every Newborn Action Plan’ includes different focus areas from MDG 4 and 5:

  • Empowering Women
  • Country Focus
  • Political Leadership
  • Accountability
  • Economic Return

Every Women Every Child is a global movement led by UN Secretary-General Ban Ki-moon to intensify action to improve the health of women and children.

Next week at the United Nations General Assembly, myself and other Girls’ Globe bloggers will be covering the discussion surrounding the Millennium Development Goal progress as it relates to women and children.

Newborn health is important to me because I feel that the ways in which we care for the most vulnerable in our society reflects what we value. If we are not putting true efforts toward protecting mothers and children we are failing.

Please tune in and use #Commit2Deliver to help influence our world’s leaders to effectively prioritize health care for women and newborns. Follow #MDG456Live on Twitter for live updates from UNGA from Girls’ Globe, FHI360, Women Deliver and Johnson&Johnson and sign up for the Daily Delivery and read fellow Girls’ Globe blogger, Esther Sharma’s, post that discusses how midwives should be central to achieving MDG 4 and 5.

Photo credit for the featured image: sean dreilinger’s Flickr Account. This photo was not changed from the original format.

Women Deliver Announces 2016 Conference on 500 Day MDG Milestone

August 18, 2014 marks the 500 day milestone until the deadline to achieve the Millennium Development Goals (MDGs) – the eight goals established by the United Nations and governments around the world tackling some of the world’s biggest problems. As the world gears up for a final push to raise awareness of the progress made through the MDGs and rally to continue the momentum, one advocacy organization working to advance the health of women and girls has made an exciting announcement.

Women Deliver – a global advocacy organization and leader in the call to advance the health and rights of women and girls – announced today that the next Women Deliver global conference  will be held in Copenhagen, Denmark, in May 2016. The announcement was made at the Invest in Girls and Women – Everybody Wins event held at the Danish Parliament, where Denmark’s new Strategic Framework for Gender Equality, Rights and Diversity was also launched.

“We are beyond thrilled that the Women Deliver 2016 Conference will be in Copenhagen,” said Women Deliver President Jill Sheffield. “The Danish government has played a key role in advancing girlsand womens health and rights and, with its support, this conference could catapult these issues to the forefront of the global development agenda and unify advocates from all around the world around one simple ask: Invest in girls and women – it pays.

The Women Deliver 2016 Conference – the fourth since 2007 –  marks the first large-scale global conference that will follow the launch of the post-2015 Sustainable Development Goals (SDGs). Recognized as a leader in convening advocates from across sectors and around the world, the 2016 conference will give advocates, researchers, policymakers, journalists, private sector leaders, and members of civil society a platform to ensure that investments in women and girls are at the heart of the post-2015 agenda.

The MDGs have been the central reference point for global development efforts and have made global poverty an urgent priority. Though the world has made progress towards achieving the MDGs, there is much work to be done, especially with regards to addressing the needs of sexual and reproductive health and rights (SRHR) of women and girls.

“There has never been a better time to raise our voices in support of the health and rights of girls and women,” said Women Deliver CEO Katja Iversen. “Together, we can – and we must – create a future where all girls and women, no matter where they are born, can lead healthy, productive and happy lives.”

As we countdown the expiration of the MDGs, let’s raise our voices for the challenges that remain for women and girls around the world. Not sure how you can help? Check out the Girls’ Globe To-Do List for the Next 500 Days.

Shining a Spotlight on Non-Communicable Diseases Post-2015

As the world turns to the 67th World Health Assembly this week in Geneva, the development community rightly focuses on what the Millennium Development Goals will look like in a post-2015 world. Health issues like HIV/AIDS, Malaria and maternal/child health have been at the forefront of international development, and rightly so. While big gains have been made in issues like child survival, efforts would have to be redoubled to meet the global targets to reduce child mortality. There is a key issue beginning to gain traction in international development, one that could cost the global economy more than $30 trillion in the next 20 years – non-communicable diseases (NCDs).

What are NCDs?

NCDs refer to chronic diseases that are not passed from person to person. There are four main types of NCDs:

  • Cardiovascular disease (i.e., heart attack and stroke)
  • Cancer
  • Chronic respiratory disease (i.e., chronic obstructed pulmonary disease and asthma)
  • Diabetes, illnesses that result in more than 36 million deaths annually

NCDs are the leading causes of death in all regions except Africa, however current projections show that by 2020 the largest increases in NCD deaths will occur in Africa.

While NCDs are typically associated with the elderly, all age groups and all regions are affected by them. According to the World Health Organization (WHO), more than 9 million of all deaths attributed to NCDs occur before the age of 60. In fact, NCDs are the leading cause of death for women worldwide, causing 65% of all female deaths (18 million deaths annually).

Caused by genetics or lifestyle choices (i.e. unhealthy diet, physical inactivity, exposure to tobacco smoke, harmful use of alcohol) NCDs threaten progress towards the Millennium Development Goals as diseases are driven by things like ageing, rapid urbanization, and the globalization of unhealthy lifestyles. Poverty exacerbates these issues, especially in low-income countries where the world’s most vulnerable are exposed to harmful pollution and poor nutrition yet have limited access to health services.

NCDs can have a devastating effect on families due to high medical costs, cost of transportation to and from health facilities, and loss of productivity. Death by NCDs can drive families deeper into poverty, resulting in a greater burden to children and surviving family members. As women in the developing world are often responsible for household work – such as collecting firewood, cooking, gathering water, and tending livestock – that burden then falls onto children.

Photo Credit: Pete Lewis / Department for International Development
Photo Credit: Pete Lewis / Department for International Development

Healthier Habits

In order to decrease the impact of NCDs, WHO recommends a comprehensive approach of all sectors (i.e., health, finance, foreign affairs, education, agriculture) to change the behavior of members of at-risk communities. By encouraging a healthy lifestyle (free of tobacco use, less alcohol, and proper nutrition) communities can begin to understand the risks of unhealthy habits and inform their families and communities. With this in mind, the International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) launched a global initiative called ‘4 Healthy Habits‘ during a side event at the 67th World Health Assembly.The partnership will provide Red Cross and Red Crescent volunteers information and tools to promote healthy lifestyles and change behaviors within communities around the world.

 ’4 Healthy Habits’ core strength is the empowerment of communities. Using simple tools adapted to local contexts, beneficiaries will be able to take charge of their own health.” – Eduardo Pisani, IFPMA Director General

 The ‘4 Healthy Habits’ initiative kicks off this month in Asia-Pacific and Europe, where 50 trained facilitators and volunteers from 33 countries will work to raise awareness about the dangers of NCDs, promote healthier habits, and conduct basic screenings.

Challenges Ahead

While behavioral change is challenging in itself, other trials loom in the face of preventing NCDs. Early diagnosis is a critical component of preventing deaths yet remains extremely difficult in less developed countries where communities have little to no access to health centers, vaccines, or proper equipment. Initiatives like ‘4 Healthy Habits’ are hoping to prove that interventions and early detection are positive economic investments as they can reduce the need for more expensive treatment or long-term care.

Financing also remains a challenge, though the global development community is hopeful that NCDs will gain more support after the MDGs expire in 2015. At last year’s World Health Assembly meeting, a 20.5% increase in WHO’s 2014-2015 budget for NCDs was approved – from $264 million to $318 million.

As the ‘4 Healthy Habits’ initiative launches this week, advocates for increasing visibility of NCDs are hopeful that NCD prevention will soon be included in donor and policymaker agendas. Preventative care is a cost-effective approach to creating a healthier world for all and ensuring the livelihood of men, women, and children all over the world.

Infographic by The NCD Alliance
Infographic by The NCD Alliance