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New Delhi: A new analysis published in suggests that India has shown no improvement in reducing preterm or preterm births over the past decade the Lancet on Friday, 6 October. This is in contrast to the improvement that the country has made in other maternal and infant mortality indicators over the same time period.
paper Premature births in 2020 in 194 countries were analyzed and compared with 2010 trends. It was found that the premature birth rate – In other wordsThe number of premature births per 1,000 live births was 13.0 in 2020, almost the same as the rate of 13.1 in 2010. Premature birth is defined as a baby who is born before the 37th week of gestation, as opposed to the normal term of 40 weeks.
India accounted for 20% (3·02 million) of all premature births – the highest in the world. This was followed by Pakistan, Nigeria, China, Ethiopia, Bangladesh, Democratic Republic of Congo and America.
However, these absolute numbers should be interpreted with some caveats, two of which are a reflection of the large population size and the high number of total births occurring in these countries. The paper’s authors say these high numbers of preterm births “also reflect weak health systems that are unable to provide high-quality family planning, prenatal care, and delivery services to all individuals who need them”.
Neonatal mortality (death of babies within one month of birth) is higher when born prematurely. India has significantly reduced the infant mortality rate According to 24.9 per 1000 live births National Family Health Survey (NFHS)-5 data, down from 29.5 in the previous survey. Its share in the global neonatal mortality burden came down From one third in 1990 it has now fallen to less than a quarter. But the country still registers Highest number of deaths of newborns Worldwide. while premature births occur No The only cause of death in newborns, they are one of the most important.
T. Sundararaman, former head of the National Health System Resource Centre, Union Ministry of Health and Family Welfare, told Wire Premature birth puts a strain on the health care system. Sundararaman said, a baby born before full term will need special care Was not associated with lancetea paper,
“Some of these babies are born so small (low birth weight) that saving them is a real challenge,” he said.
Bijnor-based pediatrician Dr. Vipin Vashishtha is also not associated with this. the Lancet Paper, agreed. “They [preterm babies] Resuscitation, ventilation to prevent asphyxiation may be required…these services may not be readily available on the periphery,” he said.
Apart from these specialized services, the presence of a pediatrician is also extremely important. ‘Rural Health Statistics (RHS) 2021-22’ show There are thousands of community health centers (CHCs) across India where there is not even a single pediatrician posted. Take Uttar Pradesh, for example. More than 600 CHCs do not have pediatricians. At least 4,474 community health centers across India have no pediatricians.
A newborn who develops complications may need treatment. Special Newborn Care Unit (SNCU), It is a separate unit adjacent to the labor room with 12 or more beds which is managed by adequately trained doctors, staff nurses and support staff to provide 24×7 services. It is usually set up in district hospitals (DH) or sub-divisional hospitals. Now, the same RHS 2021-22 says that there is a shortage of more than 5,000 doctors and about 16,000 paramedical staff members in India’s district hospitals.
In other words, while the burden of prematurity in the country is high, there is inadequate healthcare delivery to prevent the deaths of premature newborns and those who may further develop complications.
Not all premature babies are at risk for neonatal mortality. But many people may experience delayed brain development, cognitive impairment or cerebral palsy, Dr. Vashishtha said. Many of these complications can be avoided if proper facilities are available for newborn care.
Furthermore, the World Health Organization (WHO) in its report ‘born too early‘Premature birth’, released in May 2023, was considered one of the two underlying causes of low birth weight.
It states, “Newborns with low birth weight are more likely to be stunted or wasted, experience growth delays, and are more likely to become malnourished adolescents and then malnourished adults.”
Also read: ’13 million babies were born prematurely in 2020. India is among the top five countries where this happened’
Can premature birth be avoided?
Can premature birth be avoided? The answer to this question lies in the circumstances that give rise to them. the Lancet The paper says, yes, they can be.
One of the underlying reasons why women give birth before full term is receiving less care during pregnancy, also known as antenatal care (ANC).
If proper prenatal care is provided, premature pregnancy can be predicted in advance, and plans can be made accordingly. Furthermore, infection is one of the main causes of premature birth – which can be diagnosed and treated with proper ANC.
author of the Lancet The paper states that an expectant mother should undergo eight prenatal checkups at a health care facility. while indian guidelines recommend at least four, data shows that even that goal is not met for a significant group of pregnant women. According to NFHS-5Just over half of pregnant women – 58.1% – received four ANC tests.
Besides, these are just numbers. In other words, 58.1% of women visited a health care facility at least four times during pregnancy – but we know nothing about the quality of ANC they received.
Some clues about the quality of the ANC can be obtained from a paper published BJOG (A Journal of the Royal College of Obstetricians and Gynaecologists) July 2019. Three of the paper’s five authors Funded by the Indian Council of Medical Research, They used NFHS-4 data to find that 51% of women received four ANC tests. Less than a quarter of them – 23.5% – found what they describe as “enough ANC”. As many as 58.8% received “inadequate ANC”.
They used eight indicators to determine whether ANC was adequate, such as weight measurements, urine tests, blood samples to check for infections in pregnant women, and intake of iron and folic acid tablets.
The authors also found rich-poor and rural-urban divides. Two out of five women belonging to the richest wealth class received adequate ANC, but among the poorest it was 7.9%.
Representative image of a pregnant woman. Photo: Unsplash@Freestocks
According to Sundararaman the second important factor is what are called social determinants of health. WHO’s ‘Born Too Soon’ report also emphasizes on factors such as management of anemia and proper diet. “Nutrient deficiencies, especially iron deficiency anemia, can lead to premature delivery and low birth weight,” it says.
Now, NFHS-5 (conducted between 2019-21) revealed that more than half, i.e. 52.2%, of pregnant women aged 15-49 years were suffering from anemia. The corresponding figure for NFHS-4 (conducted between 2015-16) was 50.4%.
“Only a woman has to pay three or four visits to a nearby health facility [for ANC] Unless these social determinants of health – nutrition and anemia – are addressed, it will serve no purpose,” Sundararaman said.
Whereas Dr. Vashishtha admitted that there were these flaws in the address. stop Regarding the causes of premature birth, he also said that “a large number” of such births are idiopathic – those whose cause is not known. However there is no nationwide study to tell what percentage of preterm births are idiopathic, according to the paper published in Knife It doesn’t count as a reason.
A comment published in American Journal of Obstetrics and Gynecology Stated in 1993 that even idiopathic premature birth can be avoided. “We suggest that a detailed evaluation plan can identify potential causes in the majority (96%) of cases.”idiopathic’ Premature labor resulting in premature delivery,” it read.
Multiple pregnancies, especially during adolescence, is one of the causative factors of premature birth.
global perspective
Meanwhile, the eight countries with the highest rates of prematurity (number of preterm births per 1,000 live births) remained unchanged between 2010 and 2020 – although the order of some has changed. These are India, Pakistan, Bangladesh, China, Ethiopia, America, Democratic Republic of Congo and Nigeria. Even from a global perspective, the scenario did not improve in 2020 compared to 2010.
“Although most of the high rates of preterm birth occur in low-income and middle-income countries and regions, rates of 10% or more [preterm births] “Also seen in high-income countries such as Greece and the United States,” the paper reads.
However, the authors make an important observation. survival of newborns born at low birth 26 weeks Gestations in resource-rich settings “are more likely to survive than those born in contexts with poor access to care, regardless of gestational age”. In other words, while the number of premature births may also be high in some wealthy countries, the chances of survival for those babies there are much better than in countries where health facilities are poor.