Neonatal mortality: are we doing enough?

Published April 26, 2015
Chances of survival increase with proper care
Chances of survival increase with proper care

A child’s birth brings joy and happiness, and parents and family look forward to healthy growth and development. But that is not always the case. It’s a sad situation that in Pakistan more than 40 out of every 1,000 newborns die during the first month of their lives; in 2013, almost half of all under-five deaths took place during the first 28 days of a baby’s life — a period that is considered most crucial in a newborn’s life.

It is heart-wrenching to see so many newborns dying each year. Though there can be many causes for this, out of the estimated 200,000 newborns who die every year in Pakistan, at least 36,000 lose their lives due to premature birth, 80,000 due to complications arising during childbirth and 50,000 due to infections during the first month of life.

The tragedy is that most, if not all of these issues, are easily preventable.


The first few days of a baby’s birth can be the most exciting time for parents. But for some, it is a time of agony and irreparable loss


There are many ways to deal with this issue — improving nutrition and providing prenatal care and basic medical services are some of the interventions that can lower infant mortality rates. The National Nutritional Survey, 2011, for example, revealed that a large percentage of pregnant women suffered from vitamin and mineral deficiency, while more than half of the pregnant women surveyed were iron deficient. According to research, iron-deficiency in pregnancy results in premature birth and low birth weight babies, some of whom then require intensive care.

Such babies are more susceptible to disease as their organs, including lungs and heart as well as their immune system, are not adequately developed. Premature babies require advanced medical care — including state-of-the-art facilities such as ventilated incubators and special care units, as well as trained and sufficient staff members. If they receive proper care, their chances of survival increase.

Unfortunately, despite the growing demand for neonatal care in Pakistan, few hospitals have neonatal wards or adequately staffed facilities to cater to the needs of these babies.

In order to improve newborn survival rates so that babies can survive the first month of their lives, we need to focus on providing prenatal care to expectant mothers in underserved areas, training medical personnel to identify high-risk pregnancies, as well as improving facilities and providing advanced care for premature babies.

Likewise, to identify high-risk pregnancies, there is a need to train existing healthcare practitioners serving in rural areas. Though efforts have been made in this area, there remains an on-going need for skill enhancement and training midwives, nurses and paediatricians so they can provide quality care, which will ultimately reduce neonatal and maternal mortality rates.

Mobilising well-trained medical professionals in rural and underserved areas is critical but so far there appears to be little commitment from the government to address this issue. Medical officers can help counsel expecting women and to-be fathers on: delivering babies in healthcare facilities as opposed to delivering at home, enhancing hygiene levels, adopting breastfeeding habits and timely vaccination, among other pertinent issues. Professionals can also provide antenatal care and delivery, as well as postnatal care, including training mothers on how to look after premature babies.

Additionally, medical officers can work in collaboration with nutritionists to develop and administer diet plans for expectant mothers. Undernourished mothers are more likely to give birth to premature babies, increasing the incidence of neonatal deaths. Raising awareness about the underlying causes of neonatal mortality can play a significant role in improving the survival rate of newborns.

Few children in rural areas are lucky enough to receive medical attention
Few children in rural areas are lucky enough to receive medical attention

An important step in improving neonatal mortality would be to create awareness among the general public that expectant mothers need to seek professional help. In rural areas most of the women do not go for antenatal care throughout the pregnancy as they think it an ordinary matter and only depend on the dai / midwife for delivery. These midwives are often not trained to handle complications, or deal with factors which may result in premature birth. Women are often malnourished and also are not aware of the importance of proper balanced diet during pregnancy and midwives fail to address this aspect. Malnourished mothers give birth to low birth weight babies who are more vulnerable to infections which may result in death.

Lack of female doctors in rural areas also contribute to women not seeking professional help as women shy away from visiting a male doctor or the family may consider it inappropriate. Delay in reaching a doctor, especially when specialised care is needed, also results in complications rendering the mother and child more at risk.

It is a sad situation that specialist care is only available at tertiary care hospitals in the public and private sectors, to which access for a large section of the population is not easy due to distances and transport issues. While it is the government’s responsibility to provide health care to all at primary and secondary levels, in the absence of such facility corporations are encouraged to invest in healthcare initiatives as part of their corporate social responsibility efforts, which they are doing to some extent.

Looking at the global scenario, there has been progress in reducing neonatal and under-five mortality rates; however, despite solutions being available to tackle challenges, 2.8 million newborn babies were lost around the world in 2013. These staggering statistics call to step up our efforts and take responsibility for the issues we face nationally — and simultaneously, work collaboratively with local and international donors, NGOs and health organisations to ensure that right steps are being taken to reach out to high-risk babies and mothers across Pakistan.

Let’s give ourselves a deadline — let’s unite — and together, let’s fight to curb neonatal and maternal deaths.


The writer is a freelance journalist, editor and owner of www.54thedition.com, a writing and editing boutique. Additional information acquired from Nazish Shekha, sustainability consultant at the Triple Bottom Line (TBL) — a sustainability advocacy platform.

Published in Dawn, Sunday Magazine, April 26th, 2015

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