‘There is fantastic immunisation coverage in India’

WHO
Dr. Flavia Bustreo says there is lack of people with skills to assist childbirth. – Photo: R. Prasad

Both child and maternal mortality have reduced by 50 per cent since 1990, and compared with previous decades, the average rate of reduction in child mortality during this decade has more than doubled. Dr. Flavia Bustreo , Assistant Director General at WHO explained to me that the reasons why the Millennium Development Goal ignored newborn mortality reduction while concentrating on maternal and child mortality.

Unlike reducing maternal and child mortality, why was reducing newborn mortality ignored?

When we started in 1990, there were 30 million children under five years of age who died every year. At that time the proportion of newborn deaths was less than 30 per cent. As we were successful in reducing the child deaths by half, the proportion of newborn deaths kept increasing. We were successful in things that were simpler like treatment of diarrhoea and treatment of pneumonia.

We didn’t recognise the importance of mother and child at the critical time during and after birth. This was partly because providing care at birth was difficult because these births are happening at many places at home. So you don’t have people with skills to assist. The awakening now has come partly because of the large number of newborn deaths and also the importance of recognising that deliveries should happen at places where skilled workers are present.

Why was newborn mortality missed out despite it being 30 per cent of all deaths?

It was not missed. It was an area where we had less ability to do action fast because as I said the births were happening at many places. Now the situation has changed. So there is more opportunity to reduce newborn deaths. It is also clearly linked to the status of the women. In many countries, assisting a woman at the time of birth is not considered as something that is right for a woman to do. It is demeaning… That has taken so much of our time.

What is the role and importance of midwives in providing care to pregnant women?

Midwifery cadre is absolutely important both for the mother during pregnancy and at the time of delivery. Midwives have the right skills and have the right closeness with the mothers to provide care in a more sensitive manner in many countries. So midwives are critical. When we released the midwifery report in June [2014], we called for increasing the number of midwives across the world. This is a cadre that is very important. But this is the cadre we don’t have in many countries.

Within what time frame can newborn death reduction be achieved?

There is a strategic plan till 2020, 2025 and 2030. The hope is if countries adhere to the plan, we will arrive at a world in 2030 where there are less than 12 deaths per 1,000 live births. That’s the horizon we are projecting in 15 years.

But 15 years is a long time…

It will take time to build the cadre, to build infrastructure, the skills and the provision of care.

How is India’s response?

India has been absolutely unbelievable. I had worked with the Indian government in 2005. At that time there was really no focus on women and children. Progressively, India took initiatives through the National Rural Health Mission and other schemes to bring women to health facilities. There is also fantastic immunisation coverage. India is on the brink … additional push will help India to reach the Millennium Development Goal 4.

Do you really think so?

I am hopeful that if the new government takes it up and addresses this with force, then it can be done. And if India makes it, it changes the situation for the world. It would be a huge change.

What about India meeting the MDG 5 goal of reducing maternal mortality?

Meeting MDG 5 goal would be more difficult, more challenging.

Why?

I think because that the care for the women at the time of delivery requires longer time to establish. One, women should have access to facilities, then the quality of care at the facility to provide care to women when they have complications like post-partum haemorrhage or when women have serious infections like sepsis. All of these are elements of strength of the health system. And the health system takes a bit longer to establish and strengthen. There has been great progress but not sufficient to reach MDG5 goal.

Published in The Hindu on September 25, 2014

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