Our country has fallen short of the under-five child mortality rate target of 42 per 1,000 live births by 2015. The Lancet medical journal informs that India fell short, but what appears worse is that India does not figure in the list of 62 countries (Bangladesh and Nepal are there) to have achieved the desired Millennium Development Goal!
However the Union Health and Family Welfare Ministry is yet hopeful that we can achieve targets! Offering reasons for gaps it concurrently stepped up interventions in identified 184 high-risk districts. The fact of the matter is more than half of child deaths occur in the first month of life! Also clinical causes create complications of premature delivery. Infectious diseases are also responsible for deaths right from first month of life up till five years.
These are frightening aspects in this day and age! India has the highest number of child deaths in the world! Nearly 1.2 million deaths in 2015! That is 20% of 5.9 million global deaths. Countries topping this macabre list include Nigeria, Pakistan, Democratic Republic of Congo and Ethiopia. Add to this the fact 44,000 women in India still die every year during pregnancy and childbirth. Half the women who die in India are under the age of 21!
It is for this reason that public health experts and NGOs advocate the creation of special cadre of nurse-midwives, especially for rural India. Such midwives need critical training with adequate payment for their services later to make a go at things. A cadre of trained nurse-midwives will decidedly contain maternal and infant mortality rates. Doctors are not always available everywhere and this critical niche cadre can help control pregnancy related deaths of mother and child.
It is said that only 10-15 percent of high-risk women need referrals by midwives for emergency care and specialist interventions that can be interlinked with nearest hospitals. As of now there are few specialty courses available for midwives/dais to be trained accordingly. Some innovative programmes developed by medical institutions along with healthcare NGOs are experimenting on and off. This is an area that needs to be explored seriously to get dais, ANMs, ASHA workers, health-workers and the like to be effectively trained in midwifery.
With specialized skill sets they can actually be readily recognized as health providers to play a crucial role in needed areas. Given proper training they can perform a far important and useful role in containing mother and child mortality rates. This will be especially critical at the grassroots level. A separate cadre of midwives will not only ably assist birthing but by upgrading their financial status, providing clarity to their role it can open up career opportunities. While at the same time they will help in addressing health needs of under-served rural areas.