Perinatal scenario in India

New born consletali the foundation of life. Healthy and sturdy baby are likely to evolve as physically and mentally strong adults. Healthy mother produce healthy baby. Female child must be accorded special status and attention. Current population of India is one billion plus.
National Literacy rate is 52% of Female literacy rate is 37.7%. Current perinatal scene in India are indeed dismal. Some Antenalal care of poor quality is received by 60 % of pregnant women. Only 24.5% of deliveries occur at health post and Hospitals. Among domicillary births, only 24.5% of deliveries are attended by trained traditional birth attendants. The current Neonatal and Perinatal mortality rate is 47 and 44 per thousand like births.
There is an excellent pyramid of MCH Services through the network of Sub Centers, Primaty Health Centers District and States Hospitals for providing Health care services in rural area. 75% Population stili leave in villages.
The provision of health is in domain of individual states but Federal/Central Govt. provide the policy of guidelines and resources for any national programmes. As opposed to recommended allocation of 5% and 15 % of Gross National Product for health and education respectively by W.H.O., India spares only 2.1 % of GNP for health and education. Only 15 % of health budget is spent on MCH.
Due to integrated child survival services scheme the infant mortality rate has come down to 74/ 1000. All India Post Partum programme was introduced three decade ago for providing population control services and immunization. But no inputs have been provided to create level II new born care facility.
Govt. of India launch the Child Survival and Safe Motherhood Programme with the help of World Bank and UNICLT' in 1992. child Survival component comprises of universal immunization, VitaminA PROPHYLAXIS, and rational case management if acute Diarrohea and acute respiratory infection and essential new born care, Neonatal resuscitation and care of sick and low birth weight babies in community.
In 1997 the CSSM PROGRAMME has been replaced by the integrated RCH PROGRAMME. The concept of neonatology first started in early sixties and since then there ahs been a gradual increase in the number of such units in the country.
Ina survey in 1987 only four hospitals was equipped wit level II neonatal untis.
At present 30 Neonatal nurseries fulfill the requirement of level II units. Intensive care services and Ventillation are provided by fifteen of them. Most of them are located at Teaching hospitals in metropolitan cities. National Neonatal Forum was formed in 1980.
Neonatal Resuscitation Programme was launehed in 1985 and around 200 paediatrician have been trained. National Neonatal Perinatal Data Network is located at All India Institute Of Medical Sciences, New Delhi.
Neonatal forum has conducted regular annual meetings with Indain Society of Perinatology and Reproduetive Biology lo enhance collaboration with obstetrician for improving New born survival.
Innovative strategies further çare of newborn has been introduced by introduced by introduetion of spoon and cup feeding, expressed breast feeding lo very small babies in NICU.Most of NICU are focusing efforts on babies 1000 gms. Only a very few tertiary care centers are focusing the care of babies upto 750 gms.
Unlike developed countries where cross training nurses has revolutionized the new born care,in India resident doctors have been trained for this. Due to unsatisfactory referral systems efforts are being made to develop module for identificationa dn management of sick new born babies in community.
The future prespeetive are to improve maternal health,to raise female literacy, to launch healt education programme.
Furthur expansion and strengthening the facilities at First Referral units and District Hospitals and better utilization of MCH Services. Basic Antenatal care to all the preganat mothers delivers to be conducted by trained birth atlendants in community. High risk pregnant women to be referred to hospitals for delivery. Level II petinatal services to all the medical colleges,political commitments, community involvement and multisectoral approach to health is key to health for all.
It is hoped due lo economic liberalization the MCH care in private sector women expand rapidly and there will be a significant improvement in the status of Neonatal services.