Skip to main content

Early Neonatal Mortality in India, 1990–2006

Journal of Community Health volume 38, pages 120–130 (2013)Cite this article

An Erratum to this article was published on 20 November 2012

Abstract

The increased reach of health programs in India during the past few decades has contributed to a decline in postnatal mortality including infant and child mortality; however, reduction in neonatal mortality remained negligible. About seven out of ten neonatal deaths take place within a week after birth. The progress in reduction as well as dimension along which early neonatal mortality is patterned in India remains unclear. We examine the trend in early neonatal mortality and its possible demographic and socioeconomic predictors using nationally representative data. Data from the three cross-sectional rounds of the National Family Health Survey of India from 1992 to 1993, 1998 to 1999 and 2005 to 2006 were analyzed. Early neonatal mortality rate was estimated for selected demographic and socioeconomic population groups and for major states in India using information on births and deaths during the 3 years preceding the respective surveys. Using the multivariate logistic regression model, we assessed proximate determinants of early neonatal deaths during 1990–2006. Sex of the child, child’s birth size, birth order and interval, type of child’s birth, mother’s age at child’s birth, mother’s educational status, religion, household economic status and region of residence emerged as significant predictors of early neonatal deaths. The adjusted multivariate analysis indicates that majority of the socio-demographic predictors reveal a negligible decline in the probability of early neonatal deaths during 1990–2006. Moreover, based on comprehensive reviews of scientific literature on newborn’s survival we document some of the recommended ways to prevent early neonatal mortality in India.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. UNICEF. (2009). State of the world’s children 2010. New York, USA: United Nations Children’s Fund.

    Google Scholar 

  2. United Nations. (2009). The millennium development goals report 2009. New York: United Nations.

    Google Scholar 

  3. WHO. (2009). World health statistics 2009. Geneva: World Health Organization.

    Google Scholar 

  4. Cabral, S. A., & de Moura, A. T. S. (2012). Overview of the global health issues facing children. Pediatrics, 129(1), 1–3.

    PubMed  Article  Google Scholar 

  5. Rajaratnam, J. K., Marcus, J. R., Flaxman, A. D., Wang, H., Levin-Rector, A., et al. (2010). Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet, 375, 1988–2008.

    PubMed  Article  Google Scholar 

  6. WHO. (2006). Neonatal and perinatal mortality: Country, regional and global estimates. Geneva: World Health Organization.

    Google Scholar 

  7. Lawn, J. E., Cousens, S., Zupan, J., & Lancet Neonatal Survival Steering Team. (2005). 4 million neonatal deaths: When? Where? Why? Lancet, 365(9462), 891–900.

    PubMed  Article  Google Scholar 

  8. Ghosh, R. (2012). Child mortality in India: A complex situation. World Journal of Pediatrics, 8(1), 11–18.

    PubMed  Article  Google Scholar 

  9. Bhutta, Z. A., Ahmed, T., Black, R. E., et al. (2008). What works? Interventions for maternal and child undernutrition and survival. Lancet, 371, 417–440.

    PubMed  Article  Google Scholar 

  10. Bhutta, Z. A., Darmstadt, G. L., Hasan, B. S., & Haws, R. A. (2005). Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: A review of the evidence. Pediatrics, 115(2 Suppl), 519–617.

    PubMed  Google Scholar 

  11. Kumar, V., Mohanty, S., Kumar, A., Misra, R. P., Santosham, M., Awasthi, S., et al. (2008). Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: A cluster-randomised controlled trial. Lancet, 372(9644), 1151–1162.

    PubMed  Article  Google Scholar 

  12. The Million Death Study Collaborators. (2010). Causes of neonatal and child mortality in India: A nationally representative mortality survey. Lancet, 376, 1853–1860.

    Article  Google Scholar 

  13. Shonkoff, J. P., Richter, L., van der Gaag, J., & Bhutta, Z. A. (2012). An integrated scientific framework for child survival and early childhood development. Pediatrics, 129(2), e460–e472.

    PubMed  Article  Google Scholar 

  14. Saugstad, O. D. (2011). Reducing global neonatal mortality is possible. Neonatology, 99, 250–257.

    PubMed  Article  Google Scholar 

  15. Azad, K., Barnett, S., Banerjee, B., Shaha, S., Khan, K., Rego, A. R., et al. (2010). Effect of scaling up women’s groups on birth outcomes in three rural districts in Bangladesh: A cluster-randomised controlled trial. Lancet, 375(9721), 1193–1202.

    PubMed  Article  Google Scholar 

  16. Titaley, C. R., Dibley, M. J., Agho, K., Roberts, C. L., & Hall, J. (2008). Determinants of neonatal mortality in Indonesia. BMC Public Health, 8, 232.

    PubMed  Article  Google Scholar 

  17. Ayaz, A., & Saleem, S. (2010). Neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan: A cross-sectional study. PLoS One, 5(11), e13783.

    PubMed  Article  Google Scholar 

  18. Lieberman, B. (1998). An embryo too many? Human Reproduction, 13, 2664–2666.

    PubMed  Article  CAS  Google Scholar 

  19. Lawn, J. E., Shibuya, K., & Stein, C. (2005). No cry at birth: Global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bulletin of the World Health Organization, 83, 409–417.

    PubMed  Google Scholar 

  20. Titaley, C. R., Dibley, M. J., & Roberts, C. L. (2011). Type of delivery attendant, place of delivery and risk of early neonatal mortality: analyses of the 1994–2007 Indonesia Demographic and Health Surveys. Health Policy and Planning. doi:10.1093/heapol/czr053.

  21. Darmstadt, G. L., Lee, A. C., Cousens, S., Sibley, L., Bhutta, Z. A., Donnay, F., et al. (2009). 60 Million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths? International Journal of Gynaecology and Obstetrics, 107(Suppl 1), S89–S112.

    PubMed  Article  Google Scholar 

  22. IIPS. (1995). National Family Health Survey India, 1992–93 NFHS-1. Mumbai: International Institute for Population Sciences.

    Google Scholar 

  23. IIPS, & ORC Macro. (2000). National Family Health Survey India, 1998–99 NFHS-2. Mumbai: International Institute for Population Sciences.

    Google Scholar 

  24. IIPS, & ORC Macro. (2007). National Family Health Survey India, 2005–06 NFHS-3. Mumbai: International Institute for Population Sciences.

    Google Scholar 

  25. Pandey, A., Bhattacharya, B. N., Sahu, D., & Sultana, R. (2005). Components of under-five mortality trends, current stagnation and future forecasting levels. NCMH Background Papers, Burden of Disease in India. National Commission on Macroeconomics and Health, Ministry of Health and family Welfare, Government of India, New Delhi, pp. 152–178.

  26. Chitnis, S. (1997). Definition of the terms scheduled castes and scheduled tribes: a crisis of ambivalence. In V. A. P. Panandiker (Ed.), The politics of backwardness: Reservation policy in India. New Delhi: Centre for Policy Research.

    Google Scholar 

  27. Bhagat, R. B. (2005). Rural-urban classification and municipal governance in India. Singapore Journal of Tropical Geography, 26, 61–73.

    Article  Google Scholar 

  28. Filmer, D., & Pritchett, L. (2001). Estimating wealth effects without expenditure data or tears: an application to educational enrollments in states of India. Demography, 38, 115–132.

    PubMed  CAS  Google Scholar 

  29. Rutstein, S. O., & Johnson, K. (2004). The DHS Wealth Index. DHS comparative reports no. 6. Calverton, MD: ORC Macro; Measure DHS, USA.

  30. Howe, L. D., Hargreaves, J. R., Gabrysch, S., & Huttly, S. R. A. (2009). Is the wealth index a proxy for consumption expenditure? A systematic review. Journal of Epidemiology and Community Health, 63, 871–877.

    PubMed  Article  CAS  Google Scholar 

  31. Agresti, A. (2007). An introduction to categorical data analysis. New Jersey: Wiley.

    Book  Google Scholar 

  32. Mishra, V., Roy, T. K., & Retherford, R. D. (2004). Sex differentials in childhood feeding, health care, and nutritional status in India. Population and Development Review, 30(2), 269–295.

    Article  Google Scholar 

  33. Kandala, N. B., Fahrmeir, L., Klasen, S., & Priebe, J. (2009). Geo-additive models of child undernutrition in three sub-Saharan African countries. Population, Space and Place, 15(5), 461–473.

    Article  Google Scholar 

  34. Subramanyam, M. A., Kawachi, I., Berkman, L. F., & Subramanian, S. V. (2010). Socioeconomic inequalities in childhood undernutrition in India: Analyzing trends between 1992 and 2005. PLoS One, 5(6), e11392.

    PubMed  Article  Google Scholar 

  35. Corsi, D., Finlay, J. E., & Subramanian, S. V. (2012). Weight of communities: A multilevel analysis of body mass index in 32,814 neighborhoods in 57 low- to middle-income countries (LMICs). Social Science and Medicine, 75(2), 311–322.

    PubMed  Article  Google Scholar 

  36. Statacorp. (2007). Stata statistical software: Release 10. College Station: Statacorp LP.

    Google Scholar 

  37. Shakya, K., & McMurray, C. (2001). Neonatal mortality and maternal health care in Nepal: Searching for patterns of association. Journal of Biosocial Science, 33(1), 87–105.

    PubMed  Article  CAS  Google Scholar 

  38. Kerber, K., de Graft-Johnson, J. E., Bhutta, Z. A., Okong, P., Starrs, A., & Lawn, J. E. (2007). Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet, 370, 1358–1369.

    PubMed  Article  Google Scholar 

  39. Ngoc, N. T., Merialdi, M., Abdel-Aleem, H., Carroli, G., Purwar, M., Zavaleta, N., et al. (2006). Causes of stillbirths and early neonatal deaths: Data from 7993 pregnancies in six developing countries. Bulletin of the World Health Organization, 84, 699–705.

    PubMed  Article  Google Scholar 

  40. Lawn, J. E., Kerber, K., Enweronu-Laryea, C., & Cousens, S. (2010). 3.6 million neonatal deaths—What is progressing and what is not?. Seminars in Perinatology, 34(6), 371–386.

    PubMed  Article  Google Scholar 

  41. Save the Children. (2001). The state of the world’s newborn. Washington, DC: Save the Children.

    Google Scholar 

  42. Conde-Agudelo, A., Belizán, J. M., & Diaz-Rossello, J. (2011). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews, 3(CD002771) doi:10.1002/14651858.CD002771.pub2.

  43. McClure, E. M., Goldenberg, R. L., Brandes, N., Darmstadt, G. L., Wright, L. L., et al. (2007). The use of chlorohexidine to reduce maternal and neonatal mortality and morbidity in low-resource settings. International Journal of Gynaecology and Obstetrics, 97, 89–94.

    PubMed  Article  CAS  Google Scholar 

  44. Darmstadt, G. L., Bhutta, Z. A., Cousens, S., Adam, T., Walker, N., de Bernis, L., et al. (2005). Evidence-based, cost-effective interventions: How many newborn babies can we save? Lancet, 365, 977–988.

    PubMed  Article  Google Scholar 

  45. Bang, A. T., Baitule, S. B., Reddy, H. M., Deshmukh, M. D., & Bang, R. A. (2005). Low birth weight and preterm neonates: can they be managed at home by mother and a trained village health worker? Journal of Perinatology, 25(Suppl1), S72–S81.

    PubMed  Article  Google Scholar 

  46. Lopez, N. B., & Choonara, I. (2009). Can we reduce the number of low-birth-weight babies? The Cuban experience. Neonatology, 95, 193–197.

    PubMed  Article  Google Scholar 

  47. Rodriguez, F. V., Lopez, N. B., & Choonara, I. (2008). Child health in Cuba. Archives of Disease in Childhood, 93, 991–993.

    PubMed  Article  CAS  Google Scholar 

  48. Bhalotra, S., & van Soest, A. (2008). Birth-spacing, fertility and neonatal mortality in India: Dynamics, frailty, and fecundity. Journal of Econometrics, 43(2), 274–290.

    Article  Google Scholar 

  49. Mercer, A., Haseen, F., Huq, N. L., Uddin, N., Hossain Khan, M., & Larson, C. P. (2006). Risk factors for neonatal mortality in rural areas of Bangladesh served by a large NGO programme. Health Policy and Planning, 21(6), 432–443.

    PubMed  Article  Google Scholar 

  50. Singh, P. K., Rai, R. K., Alagarajan, M., & Singh, L. (2012). Determinants of maternity care services utilization among married adolescents in rural India. PLoS One, 7(2), e31666.

    PubMed  Article  CAS  Google Scholar 

  51. Santhya, K. G., Jejeebhoy, S. J., & Ghosh, S. (2008). Early marriage and sexual and reproductive health risks: Experiences of young women and men in Andhra Pradesh and Madhya Pradesh, India. New Delhi: Population Council.

    Google Scholar 

  52. WHO. (2008). Adolescent pregnancy. Geneva: World Health Organization.

    Google Scholar 

  53. Raj, A., Saggurti, N., Winter, M., Labonte, A., Decker, M. R., Balaiah, D., et al. (2010). The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample. British Medical Journal, 21, b4258.

    Article  Google Scholar 

  54. Chomba, E., McClure, E. M., Wright, L. L., Carlo, W. A., Chakraborty, H., & Harris, H. (2008). Effect of WHO newborn care training on neonatal mortality by education. Ambulatory Pediatrics, 8(5), 300–304.

    PubMed  Article  Google Scholar 

  55. Frost, M. B., Forste, R., & Haas, D. W. (2005). Maternal education and child nutritional status in Bolivia: Finding the links. Social Science and Medicine, 60(2), 395–407.

    PubMed  Article  Google Scholar 

  56. Bhalotra, S., Valente, C., & van Soest, A. (2010). The puzzle of Muslim advantage in child survival in India. Journal of Health Economics, 29(2), 191–204.

    PubMed  Article  Google Scholar 

  57. Ghuman, S. J. (2003). Women’s autonomy and child survival: A comparison of Muslims and non-Muslims in four Asian countries. Demography, 40(3), 419–436.

    PubMed  Article  Google Scholar 

  58. Drèze, J., & Sen, A. (1997). Indian development: Selected regional perspectives. Oxford: Clarendon Press.

    Google Scholar 

  59. Robinson, R. (2007). Indian Muslims: The varied dimensions of marginality. Economic and Political Weekly, 42(10), 839–843.

    Google Scholar 

  60. Gonzalez, R., Requejo, J. H., Nien, J. K., Merialdi, M., Bustreo, F., Betran, A. P., et al. (2009). Tackling health inequities in Chile: Maternal, newborn, infant, and child mortality between 1990 and 2004. American Journal of Public Health, 99, 1220–1226.

    PubMed  Article  Google Scholar 

  61. GoI. (2006). Janani Surkasha Yojana (JSY: Features). New Delhi: Ministry of Health and Family Welfare, Government of India.

    Google Scholar 

  62. Lim, S. S., Dandona, L., Hoisington, J. A., James, S. L., Hogan, M. C., & Gakidou, E. (2010). India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: An impact evaluation. Lancet, 375, 2009–2023.

    PubMed  Article  Google Scholar 

  63. Paul, V. K. (2010). India: Conditional cash transfers for in-facility deliveries. Lancet, 375(9730), 1943–1944.

    PubMed  Article  Google Scholar 

  64. Malini, S., Tripathi, R. M., Khattar, P., Nair, K., Tekhre, Y., Dhar, N., et al. (2008). A rapid appraisal on functioning of Janani Suraksha Yojana in South Orissa. Health and Population: Perspectives and Issues, 31, 126–131.

    Google Scholar 

  65. Subramanian, S. V., Nandy, S., Irving, M., Gordon, D., Lambert, H., & Davey, S. G. (2006). The mortality divide in India: The differential contributions of gender, caste, and standard of living across the life course. American Journal of Public Health, 96(5), 818–825.

    PubMed  Article  CAS  Google Scholar 

  66. Arokiasamy, P., & Gautam, A. (2008). Neonatal mortality in the empowered action group states of India: Trends and determinants. Journal of Biosocial Science, 40, 183–201.

    PubMed  Article  Google Scholar 

  67. Dyson, T., & Moore, M. (1983). On kinship structure, female autonomy, and demographic behavior in India. Population and Development Review, 9(1), 35–60.

    Article  Google Scholar 

  68. Lee, A. C. C., Mullany, L. C., Tielsch, J. M., Katz, J., Khatry, S. K., LeClerq, S. C., et al. (2008). Risk factors for neonatal mortality due to birth asphyxia in Southern Nepal: A prospective, community-based cohort study. Pediatrics, 121, e1381–e1390.

    PubMed  Article  Google Scholar 

  69. MoHFW. (2009). Navjaat Shishu Suraksha Karyakram-2009. New Delhi: Ministry of Health and Family Planning, Government of India.

    Google Scholar 

  70. Mohapatra, B., Datta, U., Gupta, S., Tiwari, V. K., Adhish, V., & Nandan, D. (2008). An assessment of the functioning and impact of Janani Suraksha Yojana. Health and Population: Perspectives and Issues, 31, 120–125.

    Google Scholar 

  71. IIPS. (2011). Concurrent evaluation of National Rural Health Mission (NRHM), 2009: India. Mumbai: International Institute for Population Sciences.

    Google Scholar 

  72. MoHFW. (2012). Rural health statistics in India—2010. New Delhi: Ministry of Health and Family Planning, Government of India.

    Google Scholar 

  73. Kesterton, A. J., & Cleland, J. (2009). Neonatal care in rural Karnataka: Healthy and harmful practices, the potential for change. BMC Pregnancy Childbirth, 9, 20. doi:10.1186/1471-2393-9-20.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

We express our gratitude to Prof. Sulabha Parasuraman, Former Head, Department of Population Policy and Programmes, International Institute for Population Sciences, Mumbai, India and Dr. Ravi Prakash, Karnataka Health Promotion Trust, Bangaluru, India for their generous support during preparation of this paper.

Author information

Affiliations

  1. Department of Humanities and Social Sciences, Indian Institute of Technology (IIT) Roorkee, Roorkee, 246 667, Uttarakhand, India

    Chandan Kumar

  2. International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400 088, India

    Prashant Kumar Singh & Lucky Singh

  3. Tata Institute of Social Sciences (TISS), V N Purav Marg, Deonar, Mumbai, 400 088, India

    Rajesh Kumar Rai

Authors
  1. Chandan Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prashant Kumar Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rajesh Kumar Rai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lucky Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chandan Kumar.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kumar, C., Singh, P.K., Rai, R.K. et al. Early Neonatal Mortality in India, 1990–2006. J Community Health 38, 120–130 (2013). https://doi.org/10.1007/s10900-012-9590-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-012-9590-8

Keywords

  • Early neonatal mortality
  • Sample Registration System
  • National Family Health Survey
  • India