Thursday, January 22, 2009

UNICEF Report on Healthcare

Improvement in health has been an important part in the overall strategy for socio-economic development over the planning periods including the11th Five-Year Plan (2007-12). Significant demographic changes and epidemiology shifts have occurred but the health scenario in India is still at crossroads with a wide gap between demand and supply of health services. However, some measures of success has been achieved on the communicable diseases. But the latest UNICEF State of the World Children (SOWC) report, released recently, states that India faces a major challenge in healthcare. Its record in treating mothers and children, the most vulnerable section of the population, seems most disheartening.
According to the report, India loses nearly one million neonates annually. About 78,000 women die due to pregnancy and childbirth complications. The track record of Uttar Pradesh is predictably the worst. The State’s maternal mortality rate, the maximum in the country, puts it par with Sudan. Three–quarters of all maternal deaths in India are occurring from hemorrhage (38 per cent), followed by infections (11 per cent), unsafe abortions (8 per cent) and hypertensive disorders (5 per cent). On an average, every seven minutes, one woman dies of pregnancy problems; institutional delivery rate remains a poor 40 per cent.
The UNICEF’s analysis of maternal and newborn health across the world further shows that the global community is not on target to achieve the Millennium Development Goal on maternal mortality, which requires 70 per cent reduction in maternal deaths by 2015. The report states that the nations cannot save their children unless they save mothers. It states maternal and infant survival is inextricably linked.
Perusal of the Report
A perusal of the report shows that about 99 per cent of all global deaths arising from pregnancy complications are occurring in the developing world, where having a child remains among the most serious health risks for women. Most of these deaths occur in Africa and Asia where high fertility rates, shortage of trained personnel and weak health system spell tragedy for women. For every woman who dies, another 20 suffer illness or injury, often with lasting consequences. The report also reveal serious inequity between the developing and developed world—a woman has a 1 in 76 lifetime risk of maternal death in the developing nations, compared to a probability of just 1 in 8,000 for women in the developed countries. In Uttar Pradesh, this probability is 1 in 42 women.
Women in the least developing nations are, in fact, 300 times more likely to die of childbirth and pregnancy related complications than the women in the industrialised countries. No other mortality rate across the world is so unequal.
Further, a child born in a developing nation is 14 times more likely to die in the first 28 days of life than a child born in a developed country. Like maternal deaths, 98 per cent of neonatal deaths happen in low and middle countries. They are mostly preventable. Babies whose mothers die during the first six months of lives are likely to die in the first two years of life than others whose mothers survive. Primary healthcare embracing every stage of maternal and newborn health must reach of India’s most vulnerable women and children for them to survive.
Condition of Indian States
As far as Indian States are concerned, the report shows that 50 per cent of all under-five deaths in the country occur in the first 28 days of life. Top five neonatal mortality rates in India are reported from Orissa (52 deaths per 1000 lives); Madhya Pradesh (51); Uttar Pradesh (46); Rajasthan (45) and Chhattisgarh (43).
Two-thirds of maternal deaths in the country reported from a handful of States—Uttar Pradesh (which contributes one-fourth of all maternal deaths), Uttarakhand, Bihar, Jharkhand, Orissa, Madhya Pradesh, Chhattisgarh, Rajasthan and Assam.
Lack of Awareness
What is shocking is that a majority of the neonatal and maternal deaths can be prevented. The Government’s Integrated Child Development Scheme, the local Non-Governmental Organisations (NGOs),CARE and USAID have been trying to reduce infant mortality and child nutrition in several Indian States. The Government has also taken steps to increase public awareness on the importance of neonatal care. The pursuit of Safe Motherhood has not yielded the same desirable results in developing countries like India as in the developing world.
Since the institutional delivery rate in India is rather poor, undisputedly there is an urgent need to step up institutional deliveries. There is also an equally pressing requirement to train mid-wives to ensure safe deliveries at home. The health programmes have to lay emphasis on recognising mother and child as a single entity that deserves care.
Contributory factors like poor education, low socio-economic status and malnutrition too need to be addressed. In a country like India that has begun to boast of medical tourism, ironically healthcare for all, especially the rural poor still remains a distant dream.

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