New Delhi : According to a report published recently, India has the highest number of deaths due to premature births, and ranks 36th in the list of pre-term births globally. The ranking included 199 countries.

The researchers, who analysed child mortality patterns across 100,000 households in the backdrop of a decade of increasing government investments in improving maternal care, say their findings underscore the need for even more expensive life-saving investments to address neonatal mortality.

The changes have occurred over the span of a decade when the Centre launched multiple initiatives to increase institutional deliveries. The proportion of women who give birth in clinics has increased from about 40 per cent a decade ago to over 80 per cent at present.

The researchers believe the gains on infections have been achieved through a mix of institutional deliveries, improved vaccination campaigns and the promotion of appropriate breastfeeding practices.

The increase in neonatal deaths from premature birth and low birthweight wasn’t uniform across India. These death rates rose in rural areas and poorer states but fell in urban areas and in richer states.

The mortality rates from premature births and low birthweight increased in six states – Bihar, Haryana, Madhya Pradesh, Rajasthan, Punjab and Uttar Pradesh.

The study by Jha and his colleagues is part of a so-called million death study initiated a decade ago in collaboration with India’s census office. Hundreds of trained census staff walked into over 1.3 million homes across the country, interviewing members about deaths in the households.

“You get the truth when you knock on doors and talk to parents,” Shally Awasthi, paediatrician and co-author of the study at King George Medical University, said in a news release. The researchers relied on data from 100,000 households, each of which had lost a child.

The study suggests India has, since 2005, avoided about one million deaths of children under five, a trend driven mainly by the reductions in deaths from pneumonia, diarrhoea, tetanus and measles.

“The precise reasons for the slight increase in deaths from premature births and low birthweight aren’t clear yet,” Rajesh Kumar, professor of community health at the Postgraduate Institute of Medical Education and Research, Chandigarh, said. “We need research to understand this trend seen only in some states and areas.”

Jha said it was possible that prematurity and low birthweight – which put neonates at risk of infections and mortality – may be rooted in maternal and prenatal factors such as the quality of prenatal care available to pregnant women, nutrition, anaemia and tobacco chewing.

“What is puzzling is that we see the mortality increase from prematurity and low birth weight only in some areas,” Jha said.

The researchers have suggested that India’s Newborn Action Plan launched three years ago should aim at early home visits by a health professional for all pregnant women unable to access healthcare facilities to identify those likely at risk of giving birth to premature or low birth weight babies.