Neonatal care in India: A new way for a new generation

India is at the crossroads of change. The indicators are everywhere. More and more Indians are making the Fortune 500 list, and the countrys many IT and industrial successes have generated much admiration and discussion around the globe. In the international world of art, culture, and entertainment, Indian literature and movies are now making headlines with unprecedented frequency. However, while there is much in these developments to be optimistic and confident about, if India truly wants to be a success story, it must look ahead to the needs of the generation to come.

As it stands now, a quarter of all maternal and newborn deaths in the world occur in India. This means that an estimated 78,000 mothers die giving birth every year, and a million babies die within their first month of life. The tragic fact is that India has the highest estimated number of maternal deaths in any country.

Part of the problem is limited access to hospital and institutional support. In India, 65 percent of all births occur at home, often without the assistance of a skilled birth practitioner. Additionally, skewed gender dynamics in Indian society do not always make it possible for a pregnant woman to be given her supply of nutritional supplements or to avail of adequate care. Expectant women live, and usually work, with their husbands and mothers-in-law. By tradition, they eat last and least, so many go though pregnancy underweight and undernourished. As a result, many mothers are unhealthy and give birth to unhealthy children.

But perhaps even more dangerous, is the lack of awareness about this issue despite endemic newborn and pregnancy-related deaths across the country. The majority of the countrys population is struggling for the basics of survival, and the health of mothers and their newborns is simply not seen as a priority.

So, how is a problem of this magnitude tackled?

While the current picture is bleak, there is hope in the form of the numerous people and organizations who each day work tirelessly tackling this issue. The Indian government has recently launched a series of innovative policies and schemes to address this ongoing tragedyfor instance, the National Rural Health Missions goal is to improve the availability of and access to quality healthcare for those on the lowest rung of the socio-economic ladder. The soon-to-be-launched National Urban Health Mission has also given high priority to the issue of maternal and newborn health in the country. These are encouraging signs of change for the better.

However, many challenges remain. While the government is building new hospitals and maternity homes, and offering free supplies of vaccines and iron and folic acid tablets, supply gaps will inevitably remain in a country of Indias size.  Also, if a change in attitude to maternal and newborn health is not achieved, then these new healthcare facilities and nutritional supplies run the risk of being seriously under-utilized. The motivation for behavioral change must come from within communities and individuals themselves.

There is an important role here for the voluntary and nonprofit sector. Synergizing the efforts of both local and international agencies, they can help to empower local communities and this has the potential to save many, many lives.

One such organization is PATH, a global nonprofit organization that is running a five-year program in India called Sure Start. The project works with rural communities in Uttar Pradesh and among settlements of marginalized people in Maharashtras sprawling cities.

Organizations such as PATH are implementing pragmatic maternal and newborn programs and using innovative methods to effect lasting change. These include building networks of community health workers to assist birth attendants and visit mothers within the first few days of birth, training workers to recognize danger signs during pregnancy and delivery, and developing savings programs to help cover the cost of newborn and maternal complications and referrals

In this way, these projects work in tandem with the Indian governments efforts and help to develop community-level systems for improved services.

So often, development is a story of the need for breakthrough innovation or for massive shifts in government policy and budget priorities. But lets not forget what can be achieved when people decide that things have to get better and start working together to achieve that end. In thousands of villages across India, people are awakening to the crisis in maternal and newborn care and are now changing their behavior to protect the health and wellbeing of their women and children. Even the smallest changes, when properly directed, have already proven to have a large and lasting impact for the good.

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A million babies in India die each year during child birth. 78,000 women die in India during labor. Simply because they do not know about safe child birth practices. Sure Start project, a five-year initiative by PATH, supported by the Bill & Melinda Gates Foundation works towards educating more


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