Newborns face uphill battle to earn life

Birth asphyxia, low birth-weight and infections are the main causes of newborn mortality in Pakistan, according to a doctor working with Save The Children US, which recently published a landmark study that focused on the causes of an estimated 270,000 neonatal deaths annually in the country. “Before starting a programme on new-born care, we wanted to carry out a situation analysis because, in Pakistan, there is no local report that is published by Pakistani sources,” Dr Nabila Ali, Save The Children US’ deputy director of programmes, told IRIN in the capital, Islamabad. Mostly of the reports available were UN-generated reports, Ali added. “So, for the first time, we wanted to look at published and unpublished data and get information on maternal and new-borns both,” she explained. “Besides getting information on maternal and new-born health, we also wanted to look at the gaps in programmes and in policies. So the report covers maternal health, newborn health as well as gaps in policy,” Ali maintained. The “State of the World’s Newborns: Pakistan,” study reveals that the total neonatal mortality rate is roughly 10 times higher in the country as compared to others. “The chances of new-borns dying in Pakistan - or in other countries in the region: such as Bangladesh and Nepal - are 10 times higher than compared to under-developed countries,” Ali said. But there were certain factors that led to such mitigating circumstances, she stressed. “In Asia, if we say the chances of new-borns dying are more than compared to other countries in the region, this is because of certain things which are linked to our programmes, [reasons] which are linked to our culture and our behaviour,” Ali explained. “That makes the situation very unique. Pakistan is still unable to reduce the infant mortality rate. And the reason why that is so is because 60 to 61 percent of the infant mortality is because of neonatal deaths,” she said. The reason why the infant mortality rate hadn’t been reduced further was because Pakistan still didn’t have skilled birth attendants at the community level, Ali said. “More than 80 percent of the births take place in the rural communities where the government extension workers are present in the form of Lady Health Workers. But they do not deliver the babies. And this is one core reason why, despite the fact that the socio-economic status has improved and overall development has occurred, there is no skilled provider at the community level,” she maintained. Once a baby was born, he or she was vulnerable in the first week of life and required skilled attendants more than at any later stage, Ali explained. “There’s nobody there, though. So, that’s the aspect from the service delivery point of view,” she added. But Pakistan’s social and behavioural set-up was such that a new-born baby’s death was not recognised as a “big event”, Ali said. “People take it for granted here that babies have to die. So, in Pakistan, for the first 40 days, the baby isn’t even given a name and is called by all sorts of euphemisms, because they want to be sure that the baby survives before they register the new-born and give it a name,” she explained. The problem was the perceived magnitude of the problem, which “is very, very low,” Ali said. “We wanted to work against that. And, then, also, the quality of health workers’ training and the recognition of danger signs in time so that they can refer them to hospitals or to health facilities is not there. So, it’s a deadly double,” she maintained. Sometimes, the problem was compounded further by families themselves who didn’t realise the magnitude of the problem, choosing to opt for soothsayers and spiritual healers in the hope that they might be able to make it work, Ali said. “So the situation is very complex. It’s not just about providing services - it’s also working on behavioural change at the community level. So this is one of the reasons why infant mortality has not come down. We do not have skilled attendants at the grassroots level,” she stressed. Birth asphyxia usually occurred because of unskilled birth attendants delivering the baby, Ali explained. “It’s not that every baby has to be delivered through the normal route. They just try to deliver the baby the normal way, never taking account the mother’s bone structure, for example; or how the child might be positioned inside. Now, once the baby is asphyxiated, that baby requires immediate attention, within a few hours. This is a danger sign that has to be recognised. For each baby that survives and doesn’t die, there are four others that suffer from long-term impairments,” she said. But there were also positive developments. According to the study, a World Health Organisation (WHO) estimate put the number of neonates dying of tetanus in 1997 at 26,400. Ali said she thought the number might have gone down because of a follow-up exercise that aimed to extend immunisation cover to beyond the 50 percent it portended to reach in the past. “I think that might have gone down because, after this analysis, we carried out a national level neonatal tetanus elimination camp in collaboration with the Ministry of Health and the United Nations International Children's’ Fund (UNICEF). The coverage of tetanus immunisation went up to 80 percent from 50 percent in the past. So we’re hoping that neonatal mortality might be reduced because of this,” Ali maintained.