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Resource centre on India's rural distress
 
 

In China's battle against newborn deaths, lessons for India by Ananth Krishnan


China has reduced deaths among newborn babies by almost two-thirds in little over a decade — an unprecedented success rate that a new study says holds lessons for countries like India still struggling with high neonatal and maternal mortality rates.

Deaths among newborn babies fell from 24.7 per 1,000 in 1996 to 9.3 in 2008 — a 62-per-cent decrease — according to a paper published in The Lancet medical journal on Friday.

At the heart of China's success, the paper found, was a vast improvement in access to obstetric care in rural areas, and a nationwide programme that specifically targeted increasing the number of hospital births.

The study found that less than half of all women in China gave birth in hospitals in 1988. By 2008, however, hospital births had almost become universal.

Other countries, the study said, could learn from China's focus on improving access to health care in rural areas, with the findings proving “a great impetus for countries to increase demand for and quality of facility-based intrapartum care.”

Five countries account for more than half the world's newborn deaths — India, China, Nigeria, Pakistan and the Democratic Republic of Congo.

Ahead of India

India accounts for the highest number of newborn deaths in the world — over nine lakh in 2009 — despite a 33-per-cent drop from 1990, according to a recent study released by the World Health Organisation. Newborns account for 41 per cent of all child deaths.

According to UNICEF, India's Neonatal Mortality Rate (NMR) in 2009 was 34 per 1,000 live births — more than three times higher than China's NMR, which UNICEF estimated at 11 in 2009. India's NMR in 1990 was 49.

A Lancet study published last year found that in India, too, expanded neonatal and obstetric care, as well as adding new vaccines to immunisation programmes, could considerably reduce child mortality rates. Most newborn and child deaths occur at home, in the absence of medical attention.

India's Maternal Mortality Rate (MMR), which is closely tied to NMR figures, is also far higher than China's. In 2008, India's MMR, or the deaths of women from pregnancy-related causes, was 230 per 100,000 live births. China's, that same year, was 38.

Behind China's success

The study, which was based on data from 37 urban districts and 79 rural counties, found that babies born in urban hospitals in China had a lower NMR of 5.7, but those in rural counties were almost four times more likely to die.

The study was conducted by two scholars in Peking University, Xing Linfeng and Yan Guo, and Carine Ronsmans from the London School of Hygiene and Tropical Medicine, and supported by UNICEF.

David Hipgrave, chief of health and nutrition at UNICEF China, attributed the country's success to a nationwide programme to boost hospital births that began in the late 1990s.

The project, first launched by UNICEF, provided subsidies for women in poor rural areas to help bear the costs of hospital deliveries. When the pilot was launched, Mr. Hipgrave said, China's hospital deliveries were between 50 and 60 per cent.

“UNICEF and the government were able to demonstrate that women delivering in hospitals were much better off in terms of the pregnancy outcome,” he told The Hindu in an interview earlier this year.

Following the success of the project, the government introduced a pilot project in 450 high MMR counties.

The programme is now in place nationwide, in every rural county.

“Since then, the MMR has dropped from around 70 to the thirties,” he said.

“Evidence shows that in counties where the subsidised hospital programme was running, the fall in maternal mortality was faster than in counties where it was not available.”

Another landmark development was the passing of a law on maternal and child health in 1995, which stipulated the kinds of services, qualifications of personnel and level of funding needed to increase staffing in rural health clinics.

“The law drew attention to something that was not a central concern of provincial and lower-level authorities at that time,” Mr. Hipgrave said. “It provided a framework for provision of services.”

China's controversial one-child policy, which reduced the risk of child and maternal deaths by limiting the number of children for each family, has also been cited as bringing down infant mortality rates.

A more relevant prescription for India from China, experts said, was the reinvigoration of a failing rural cooperative medical scheme in the 1990s, after it had all but collapsed following the commercialisation of health care in the wake of economic reforms.

The scheme now extends to 90 per cent of the rural population, and helps cover delivery costs along with the hospital subsidy.

“Now, you can have a situation where a woman goes to a hospital and pays nothing,” Mr. Hipgrave said. “And that is a fantastic outcome both for women, and public health in general.”