Neonatal mortality rates have stagnated or worsened in multiple states in India in recent years and account for nearly 50 per cent of deaths in children under five years of age, researchers have said in a study.

Their study has found that nearly 50 per cent of deaths in children under five in India occurred within seven days after the child’s birth, both in 2016 and in 2021, alongside improvements in overall child mortality rates.

The findings, published in the medical journal JAMA Network Open, underline an “immediate need” for health authorities to focus on strategies to improve quality aspects of institutional deliveries, the researchers have said.

India’s proportion of institutional deliveries — births in healthcare facilities — has more than doubled from around 40 per cent in 2005-06 to 83 per cent in 2019-21.

The new study led by S.V. Subramanian, professor of population health at Harvard University, has suggested that reductions in neonatal mortality have not kept pace with the rise in institutional deliveries.

Subramanian and his colleagues used three decades of datasets from the Union health ministry’s National Family Health Surveys — the latest in 2019-21 — to analyse child mortality patterns after seven days, 30 days, a year, and five years of birth.

They classified deaths within seven days as early neonatal mortality, deaths between 8 and 28 days as late neonatal mortality, and deaths between a month and a year as post-neonatal mortality.

India’s overall under-five child mortality has decreased to 42 per 1,000 live births in 2019-21 from 50 per 1,000 in 2015-16 and 75 per 1,000 in 2005-06. And most states have seen decreases in mortality rates across all the child age groups.

But between 2016 and 2021, early neonatal mortality increased in nine states or Union territories, late neonatal mortality either remained stagnant or increased in 13 states, and post neonatal mortality increased in 12 states, their study found.

Early neonatal mortality rose in Haryana, Manipur, Meghalaya, Mizoram, Tripura, Uttarakhand, Delhi, Andaman and Nicobar and Daman and Diu, late neonatal mortality rose or didn’t improve in Andhra Pradesh, Bihar, Goa, Gujarat, Kerala, Maharashtra, Manipur, Meghalaya, Nagaland, Odisha, Punjab, Telangana and Andaman and Nicobar. Post-neonatal mortality rose in Bihar, Gujarat, Haryana, Karnataka, Manipur, Meghalaya, Nagaland, Telangana, Tripura, Bengal, Andaman and Nicobar and Chandigarh.

“While India has made substantial progress over the years in reducing the risk of mortality among young children, age-specific interventions may be needed to address mortality in different age groups,” Subramanian told The Telegraph. Early neonatal mortality may require improvements in quality of care in healthcare institutions while post-neonatal mortality would need a focus on ensuring vaccination and food.

The researchers’ call for urgent measures to address neonatal mortality comes against a backdrop of long-standing concerns among paediatricians and public health experts about neonatal deaths hampering progress towards infant mortality targets.

India’s National Neonatology Forum had in 2003 highlighted the need for intensified efforts to protect babies during the first four weeks of life as part of efforts to reduce infant mortality rates.

The health ministry has helped establish a network of newborn care facilities, including newborn intensive care units, sick newborn care units, and newborn stabilisation units in public health facilities across the country.