ACTION TO E PUBLIC G D E L W W HEALTH O O N N K K FOUNDATION OF INDIA State of India’s NEWBORNS 2014 Individuals in the photo provided permission for publication of image. STATE OF INDIA’S NEWBORNS 2014 Supported by: Save the Children’s Saving Newborn Lives Programme State of India’s Newborns 2014 Disclaimer The contents of this publication represent personal views of respective authors and not necessarily those of the institutions/organizations to which they are affiliated. © Copyright 2014 Public Health Foundation of India, New Delhi and All India Institute of Medical Sciences, New Delhi. All rights reserved. No part of this report may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise for commercial purposes, without the prior written permission of PHFI. Suggested Citation: PHFI, AIIMS, and SC- State of India’s Newborns (SOIN) 2014- a report. (Eds) Zodpey S and Paul VK. Public Health Foundation of India, All India Institute of Medical Sciences and Save the Children. New Delhi, India AdvisORS Prof. K. Srinath Reddy Dr. Rakesh Kumar Dr. Steve Wall President Joint Secretary Senior Director Public Health Foundation of India Ministry of Health and Savings Newborn Lives Family Welfare, Government of India Save the Children (US) CORE WRITING TEAM Public Health Foundation of All India Institute of Medical India (PHFI) Sciences (AIIMS) Prof. Sanjay Zodpey Prof. Vinod K. Paul Director Head, Department of Pediatrics Indian Institute of Public Health, Delhi All India Institute of Medical Sciences, New Delhi Dr. Sutapa B. Neogi Dr. M. Jeeva Sankar Additional Professor Assistant Professor, Department of Pediatrics Indian Institute of Public Health, Delhi All India Institute of Medical Sciences, New Delhi Dr. Jyoti Sharma Associate Professor Indian Institute of Public Health, Delhi Mr. Maulik Chokshi Associate Professor Indian Institute of Public Health, Delhi Ms. Monika Chauhan Research Associate Indian Institute of Public Health, Delhi State of India’s Newborns 2014 INVITED AUTHORS Dr. David Osrin Dr. Anu Thukral Reader in Global Health Senior Research Associate, Department of Pediatrics University College London, London All India Institute of Medical Sciences, New Delhi (Newborn Health in Urban India) (Educational Innovations for Improving Newborn Care) Prof. Ashok K. Deorari Prof. Uma S. Nayak Department of Pediatrics Department of Pediatrics All India Institute of Medical Sciences, New Delhi GMERS Medical College and Hospital, Baroda (Educational Innovations for Improving Newborn Care) (Educational Innovations for Improving Newborn Care) Dr. Akash Ganju Mr. V. Sashi Kumar Managing Director Managing Director A-Square Healthcare Ventures, Mumbai Phoenix Medical Systems (P) Ltd., Chennai (Harnessing New Technologies for Newborn Care) (Innovating Affordable Indigenous Equipment for Use at Scale) State of India’s Newborns 2014 REVIEW TEAM Ministry of Health and Family Welfare (MOHFW) Dr. Ajay Khera Dr. P. K. Prabhakar Deputy Commissioner Deputy Commissioner Child Health & Immunization Child Health Dr. Himanshu Bhushan Dr. Manisha Malhotra Deputy Commissioner Deputy Commissioner Maternal Health Maternal Health Mr. Vipin Garg Dr. Renu Srivastava National Consultant National SNCU Coordinator Janani Suraksha Yojana Child Health Division INVITED REVIEWERS Prof. Dileep Mavalankar Prof. Siddarth Ramji Director Department of Neonatology Indian Institute of Public Health, Gandhinagar Maulana Azad Medical College, New Delhi SavE THE CHILDREN Dr. David Oot Dr. Sudeep S. Gadok Associate Vice President, Health and Nutrition Director, Programmes Dr. Joy Riggs-Perla Dr. Rajiv Tandon Senior Director, Saving Newborn Lives Programme Formerly at Save the Children Ms. Elaine Scudder Dr. Rajesh Khanna Programme Manager, Newborn Health Technical Advisor, Saving Newborn Lives Ms. Lara Vaz Dr. Anuradha Jain Senior Advisor, Monitoring and Evaluation Advisor, RMNCH+A Coalition Dr. Uzma Syed Dr. Benazir Patil Advisor, Newborn Health, Asia Region Advisor, Urban Health Dr. Isha Prasad Bhagwat National Manager, Health/Nutrition Mr. Prasann Thatte National Manager, Research Dr. Naomi Patrao Programme Manager, Saving Newborn Lives State of India’s Newborns 2014 ACKnowledgementS We would like to express our sincere gratitude to the following colleagues who participated in the stakeholders’ meeting for this Report held in July 2013 and provided valuable suggestions and inputs: Dr. Abhay Bang Dr. Malabika Roy SEARCH, Gadchiroli Indian Council of Medical Research, New Delhi Dr. Anand Bang Ms. Nirupama Sarma NHSRC, New Delhi Save the Children India, New Delhi Dr. Anju Puri Ms. Projna Sadhukhan USAID-MCHIP, New Delhi Indian Institute of Public Health, Delhi Dr. Anil Verma Dr. Rajani Ved NRHM, Lucknow NHSRC, New Delhi Dr. Bhaskar Mishra Dr. Rajesh Sinha UNICEF, New Delhi Ekjut, West Singhbhum Mr. Colin Almeleh Dr. Reeta Rasaily Child Investment Fund Foundation, London Indian Council of Medical Research, New Delhi Dr. Deepti Agarwal Dr. Sachin Gupta Ministry of Health and Family Welfare, New Delhi USAID, Washington DC Dr. Devendra Khandait Prof. Shally Awasthi Bill and Melinda Gates Foundation, New Delhi King George Medical University, Lucknow Dr. Gagan Gupta Prof. Sushma Nangia UNICEF, New Delhi Lady Hardinge Medical College, New Delhi Dr. Hariom Dixit Ms. Suzanne Fournier NRHM, Lucknow Child Investment Fund Foundation, London Dr. Harish Chellani Prof. Vikas Desai Safdarjung Hospital, New Delhi Urban Health and Climate Resilience Centre, Surat Ms. Lily Kak Dr. Vikram Datta USAID, Washington DC National Neonatology Forum, New Delhi State of India’s Newborns 2014 Dr. Harsh Vardhan State of India’s Newborns 2014 Shri Lov Verma Secretary, Health and Family Welfare State of India’s Newborns 2014 Dr. Joy Riggs-Perla Director, Saving Newborn Lives Save the Children US Foreword Save the Children, through its Saving Newborn Lives programme, is pleased to have supported this 2014 edition of the State of India’s Newborn (SOIN) report. Reading the first SOIN report, issued in 2004, provides a clear reminder of the global leadership India has provided over the years in newborn health, as well as how much progress has been made since 2004 for India’s youngest citizens. India continues to be a global pioneer in demonstrating, even in low resource settings, how effective and high impact programmes can be developed and implemented to improve the outcomes for mothers and their newborns. This second edition of the SOIN report reviews the evidence generated progress and learning in newborn health in India over the past ten years, and actions needed to accelerate progress in newborn health and survival in the decade ahead. This SOIN report comes at a time when the potential for accelerating progress is both optimal and unprecedented. The Government of India is making massive investments through the National Rural and National Urban Health Missions to reach the poorest and most vulnerable segments of society with improved reproductive, maternal, newborn, child and adolescent health services (RMNCH+A). It is precisely those 184 districts that contribute to the highest numbers of deaths among babies under one month of age. A number of new policies are now in place in India that support the introduction, implementation, and effective scale up of the high impact, evidence-based newborn health interventions. Importantly, India has the programme platforms and resource allocations needed to facilitate the rapid and effective expansion of coverage of these life-saving maternal and newborn interventions. The newly launched India Newborn Action Plan (INAP) is tangible evidence of the government’s commitment to focus increased attention on newborn health and survival, and we commend the government for setting ambitious targets for reducing newborn mortality within the context of a continuum of care as reflected in the overall RMNCH+A programme. The 2014 SOIN report provides an up to date assessment of the status of the newborn, what has been done and learned, and suggests actions needed to further accelerate progress in support of the INAP. We are grateful for the guidance and encouragement provided by the Ministry of Health and Family Welfare in the preparation of this report. We also want to express our gratitude to the talented and dedicated team from the Public Health Foundation of India and the All India Institute for Medical Sciences in New Delhi who worked tirelessly to prepare this report. Finally, we wish to thank the Bill & Melinda Gates Foundation for supporting the preparation of this report, and for their support for newborn health work in India since 2001 through Save the Children’s Saving Newborn Lives programme. Save the Children is honored to be a part of this historic effort on behalf of mothers and newborns in India. Joy Riggs-Perla State of India’s Newborns 2014 Mr. Thomas Chandy CEO Save the Children India Message India has made considerable progress over the last two decades in the area of maternal and child health, through innovative and comprehensive health packages that covers the spectrum of Reproductive Child Health (RCH). Newborns however have missed out on the attention. The neonatal mortality rate (NMR) has declined at a slower pace compared to that of under-five mortality rate (U5MR). Of the 6.6 million under-five child deaths that occur globally every year, about 44 percent occur in the neonatal period; the proportion is much higher – around 56 percent – in India. The Millennium