Low birth weight emerges big killer

• Low birthweight and premature births has steadily risen from 12.3 per 1,000 live births in 2000 to 14.3 by 2015.
• They accounted for about 55% of all neonatal deaths in 2015.
• Poor nutrition of mothers, under-age motherhood and inadequate pre-natal care are the major causes.

Low birthweight and premature births, the top cause of death for new born babies in India, has steadily risen from 12.3 per 1,000 live births in 2000 to 14.3 by 2015. With other major causes of neonatal mortality falling significantly, low birthweight and prematurity accounted for about 55% of all neonatal deaths in 2015 compared to around a quarter in 2000, according to a Lancet study.

Back-of the envelope calculations show that if the rate of mortality due to babies being born too small or too early had remained the same in 2015 as in 2000, about half a lakh fewer babies would have died that year.

Poor nutrition of mothers, under-age motherhood and inadequate pre-natal care are the major causes for underweight or premature babies.

Three causes — prematurity or low birthweight, neonatal infections, and birth asphyxia or trauma — accounted for more than three-quarters of neonatal deaths in 2000. Of these, neonatal infections and birth asphyxia or trauma fell dramatically over the next 15 years in both rural and urban areas, rich and poor states.

However, prematurity or low birthweight mortality rates rose in rural areas from 13·2 per 1,000 livebirths in 2000 to 17 in 2015 and in poorer states from 11·3 to 17·8. They fell in urban areas and richer states, but that wasn’t enough to offset the damage.

In a clear indication of the effect of maternal malnutrition, the study found that most of the increase in prematurity or low birthweight deaths was happening in babies born at full term but with low birthweight and not in premature babies.

The study was based on data gathered as a part of the ongoing Million Death Study (MDS), in which the Registrar General of India’s surveyors do verbal autopsies of the deaths that occurred after the previous census round. A verbal autopsy involves surveyors asking detailed questions on the circumstances in which a death took place.

Trained physicians then study these autopsies and assign cause of death. The MDS captured 94,309 child deaths (52,252 neonatal deaths and 42,057 deaths at ages 1–59 months) from 2001 to 2013.

The study observed marked variation in the trends in mortality rates from prematurity or low birthweight, with increases in the rates in Madhya Pradesh, Uttar Pradesh, Rajasthan, Bihar, Punjab, and Haryana, but declines in Odisha, Assam and most of the richer states. The study revealed that annual mortality rate declines were faster in under-five children than among newborns.

Child mortality rates in India have substantially reduced since 2000, with the steepest decline in 2010–15.