5.5 million ‘invisible’ baby deaths a year

Globally, about 5.5 million babies — nearly three million neonates and about 2.6 million stillbirths — die every year. In other words, every day, about 8,000 neonates are dying and the number of stillbirths is about 7,000. Stillbirths happen at about 28 weeks of gestation and also during labour. Babies who die during labour — just five minutes before birth — account for nearly half of all stillbirths.

Half of all the newborn deaths across the world occur in five countries. With 7,79,000 deaths, India accounts for the highest number of newborn mortality in the world. The other four countries are Nigeria (2,76,000), Pakistan (2,02,400), China (1,57,000), and the Democratic Republic of Congo (1,18,000). The results were published recently in The Lancet

Slower progress

What is indeed significant is that while great strides have been taken in halving the number of deaths in children aged under-five, the progress in reducing the number of newborn deaths has been “slower.” In the case of stillbirths, the progress has been even worse — it is “substantially slower” than even that of reducing newborn mortality. Stillbirths are not counted in the Millennium Development Goals.

Shockingly, the 2.6 million stillbirths every year across the world are largely “invisible.” “In most countries stillbirths do not get birth or death certificates, which contributes to their invisibility; hence, most of the world’s newborn deaths and almost all stillbirths enter and leave the world without a piece of paper to record their existence,” Joy Lawn, professor of maternal, reproductive and child health at the London School of Hygiene and Tropical Medicine and lead author of one of the papers was quoted as saying in The Lancet . “The fact that the vast majority of these deaths — which have a huge effect on the women and families involved — are never formally included in a country’s health registration systems signifies acceptance that these deaths are inevitable, and ultimately links to inaction.”

According to the journal, “preterm babies are less likely to be counted, even in rich countries, especially where they are not expected to survive.”

Though the average annual rate of newborn deaths has been declining at 2 per cent since 1990, the rate of decline is lower compared with that seen in the under-five age group — 3.4 per cent. The lack of registration, The Lancet notes, is a key reason for slower progress in recent decades for prevention of newborn deaths compared with maternal and child mortality reduction.

But about three million deaths — 54 per cent of maternal deaths, 33 per cent of stillbirths, and 71 per cent of newborn deaths — can be easily prevented if “achievable interventions are scaled up to nearly universal coverage” at all stages — before conception, as well as before, during and after pregnancy.

Risk factors

According to the journal, preterm birth is the biggest risk factor in both 0-6 days and 7-27 days periods. While in the case of the early neonatal period (0-6 days), the intrapartum conditions that occur during childbirth or delivery play a significant role, infections become the predominating factor in the later neonatal period (7-27 days).

Published in The Hindu on May 22, 2014