Coverage of antenatal care in India has to be increased: WHO



India has little more than 50 per cent of antenatal coverage, says Dr. Flavia Bustreo. – Photo: R. Prasad

In 2013, globally, preterm birth complications were responsible for 15 per cent (0.96 million) of deaths in children under five years of age. It is a leading cause of death in neonates (0-27 days after birth). According to WHO, about 15 million babies are born preterm (before 37 completed weeks of gestation) every year. Such births are seen both in the developed and developing countries.

India ranks first in the list of 10 countries that account for 60 per cent of all preterm births; the U.S. is ranked sixth in the list.

“India has little more than 50 per cent of antenatal care coverage. So in order to face the issue of premature births, low birth weight babies and stillbirths, the first aspect is to increase the coverage of antenatal care,” Dr. Flavia Bustreo, Assistant Director General at WHO told this Correspondent. “During antenatal care, health workers can detect whether progress of foetal growth is happening normally, pregnant mother’s nutrition is good or look out for any other complications.”

What is evident in the latest data is that across the world, nearly 30 per cent of maternal deaths are linked to indirect causes like gestational diabetes and obesity — especially among young mothers, and the influence of communicable diseases on maternal deaths.

“So antenatal care is very important as health workers can detect mothers who are obese or have diabetes. These are specific risks during pregnancy and should be given particular care,” Dr. Bustreo said. “This is not happening in India. India has to particularly care for mothers for what we call as pre-existing conditions.”

Pregnant mothers who have diabetes, are obese or have preeclampsia (high blood pressure) are less likely to complete full term and babies will be born with low birth weight. Therefore, antenatal care becomes all the more important.

Of course, babies who are born before full term can still survive as simple interventions and treatments are available. For instance, corticosteroid given to mothers before delivery can greatly facilitate the development of the babies’ lungs. It can also be given to babies soon after their birth in cases when delivery takes place even before the steroid can be given to pregnant mothers. The steroid greatly reduce the possibility of neonatal deaths. Similarly, kangaroo mother care can go a long way in keeping babies warm and improve their chances of survival.


More to do

“India has to still progress. What is available as special care facilities for babies that are low birth weight and premature are not sufficient in number. What I have seen happening is that some of the facilities in private hospitals have moved very fast especially in the cities. But when you come to rural areas in North India, this is something that is still missing,” Dr. Bustreo said. “So this leads to loss of babies who are born too early or born too small. This is part of India’s challenge.”

Within reach

While being critical of the shortcoming of the Indian government, she is still very optimistic. “Our latest data show that India is just an inch away from reaching the MDG4 (child morality) and MDG5 (maternal mortality) targets. [The current under-five mortality rate is 56 and should reach 42 before December 2015. The MMR is 190 and should drop to 140 before the end of next year.] It’s just a matter of the curve accelerating a little bit. I am hopeful that if the new government concentrates constructively on the challenges and focuses on the strengths of immunisation programme then India can achieve the MDG4 target,” she stressed.

One big challenge that stares the country in the face is the reach of antenatal care. According to the 2014 data, antenatal care in rural areas is about 50 per cent for more than one visit and about 10 per cent for more than four visits. The availability of skilled attendant at the time of delivery is only about 20 per cent in rural areas.

Yet, Dr. Bustreo remains confident. “These data are retrospect. We don’t measure them in real time. I can tell you some countries that have seen huge progress when they applied themselves to the task. For example, in the case of child mortality, we have seen annual rate of reduction of seven per cent, nine per cent and even 10 per cent in the case of Ethiopia, Rwanda and Malawi,” she said. “So if India applies specific measures, I am quite confident that it would really come close to meeting the goals and it would surprise everybody.”

Talking about the huge number of adolescent marriages and women’s role in the society and education, she noted that positive results can be obtained despite certain determinants that impact on maternal and child mortality taking a long time to change.

“What we are arguing at this juncture is that India can strengthen the provision of care so even if you have a young adolescent pregnant mother or if a pregnant mother is affected by gestational diabetes or is biologically not matured and delivers a preterm baby, she and the baby can be saved,” she noted. “Some determinants will take a generation to change but providing critical care will not take a generation.”

(The Correspondent participated in the events surrounding the United Nations General Assembly, New York as a Partnership for Maternal, Newborn and Child Health Scholarship Journalist at the invitation of PMNCH, Geneva)

Published in The Hindu on October 1, 2014