India accounted for 20% global pre-term births: Lancet study

As per the findings of a new Lancet studyhighlighted that India had the highest number of pre-term births in 2020 which is around 3.02 million in the world.

What is a Pre-term birth?

• Pre-term birth means delivery of the foetus in less than 37 weeks of gestation and is considered to be one of the main risk factors for neonatal mortality (aged under five years).
• In 2010, there were 49 million pre-term births in India.
• The common reasons include;
  • Acute or long-standing sickness in the mother,
  • Twins or triplet pregnancy and
  • Cervical problems.

Findings of the study:

• India’s pre-term birth accounts for over 20 per cent of all pre-term births worldwide.
• It was followed by Pakistan, Nigeria, China, Ethiopia, Bangladesh, Democratic Republic of the Congo and the USA.
• At the global level, there has not been any change in pre-term birth rate between 2010 (9.8 per cent of live births) and 2020 (9.9 per cent of live births).
• Approximately 15 per cent of all pre-term births between 2010 and 2020 occurred at less than 32 weeks of gestation, highlighting the need for better prenatal and neonatal care.
• Also a few, about 13 countries experienced a decline in pre-term births by 0.5 per cent or more namely, Austria, Brazil, Brunei, Czechia, Denmark, Germany, Hungary, Latvia, the Netherlands, Singapore, Spain, Sweden, and Switzerland.
• Concerns highlighted:

• • Many survivors of pre-term birth face lifetime disabilities, including learning difficulties, behavioural disorders, visual and hearing impairments.
  • The true global burden of pre-term birth is unknown due to a shortage of data in many countries, especially in low-income and middle-income countries (LMICs).
  • According to the report, this situation is a result of inadequate record keeping, poor measurement of gestational age, and the absence of systems in countries for routinely collecting and reporting pre-term birth data.
• Recommendations:
  • Gaps in national routine data for preterm birth are most marked in regions of southern Asia and sub-Saharan Africa, which also have the highest estimated burden of pre-term births.
  • Countries need to prioritize programmatic investments to prevent pre-term birth and to ensure evidence-based quality care when pre-term birth occurs.
  • Investments in improving data quality are crucial so that pre-term birth data can be improved and used for action and accountability processes.

Government Interventions

• JananiSurakshaYojana: Institutional deliveries were first incentivised by the central government in 2005 with JananiSurakshaYojana (JSY), under which a direct cash transfer is promised if a woman delivered a baby at a medical facility, rather than at home.
  • JSY is a 100% centrally sponsored scheme which is being implemented with the objective of reducing maternal and infant mortality by promoting institutional delivery among pregnant women.
• JananiShishuSurakshaKaryakram (JSSK): The Government of India launched JananiShishuSurakshaKaryakram (JSSK) in June, 2011.
  • It is an initiative to provide completely free and cashless services to pregnant women including normal deliveries and caesarean operations and sick newborn (up to 30 days after birth) in Government health institutions in both rural & urban areas.
  • In 2013, the cost of treating “complications during ante-natal and postnatal period and sick infants up to one year of age” was also brought within the ambit of the scheme.
• PradhanMantriMatruVandanaYojana (PMMVY): It is a maternity benefit programme being implemented in all districts of the country with effect from 1st January, 2017.
• PoshanAbhiyaan: The goal of PoshanAbhiyaan is to achieve improvement in the nutritional status of Children (0-6 years) and Pregnant Women and Lactating Mothers in a time-bound manner.

Way forward:

• Holistic Approach is needed: Schemes incentivising institutional delivery are not enough to ensure a safe birth. A holistic approach is needed to address infrastructure and human resource shortcomings.
• Strengthened Workforce: The workforce involved in delivery of the various government schemes need to be strengthened to bring about a noticeable change.
  • Accredited Social Health Activists (ASHA) and Auxiliary nurse midwives are the backbone of the government schemes but are severely burdened.
• Expansion of Eligibility Criteria: The eligibility criteria for such schemes need to be expanded, because currently it excludes those who actually need it.
  • Some schemes are applicable only if the mother is 19 years of age or above, some are only for the first child and some require ‘below poverty line’ identification.
  • An 18-year-old pregnant woman living below the poverty line is most vulnerable but would not make the cut for several schemes.
• Monitoring of the Scheme: An ideal institutional delivery needs to be defined for better monitoring of the scheme outcomes, so there is a need to monitor outcomes to understand how successful the scheme really is.
• Address Data Gaps: India must also close the data gap; each institution must publish their morbidity and mortality data regularly. Health centres must also be incentivised to deal with such a high load.