According to a recent journal article, it will be 2067 before newborn deaths among the poorest Nepalis have fallen enough to reach the global target set for 2030. That target, of 12 or fewer deaths per 1,000 live births, was attained by the wealthiest in Nepal four years ago, but the impact of COVID-19 may increase inequality and make it even more difficult for the country to reduce infant mortality.
If the pandemic shutdown is an opportunity to reimagine our societies, what should Nepal make of the widening gap in newborn deaths? Yes, overall trends are improving — both maternal and newborn health have made major gains in recent decades — but the poorest families are still lagging behind.
No society is free from inequality. Look at the US: the top 1 percent of families took home an average of 26 times as much income as the bottom 99 percent in 2015. In my home country of Canada, Indigenous people on average live 15 fewer years than others.
The study in the Maternal and Child Health Journal found that the mortality rate in Nepal of newborns (up to 28 days old) across all socioeconomic groups in 2001–2016 ‘shows significant disparities between different population groups, and that all these disparities either widened or remained constant over the 15-year period’.
A secondary analysis of data from the 2001, 2006, 2011 and 2016 Nepal Demographic and Health Surveys, the study added: ‘In 2016, women who had not received a tetanus vaccination had the highest risk of neonatal mortality, followed by women with no education. Other factors … were giving birth before the age of 20, household air pollution, belonging to a poorest quintile, residing in a rural area, and having no toilet at home.’
The authors suggests that a multi-sectoral approach will be needed to improve the neonatal death rate (23 deaths per 1,000 live births in 2015) among all groups. Noting the current decentralisation of health care to provinces and local governments they add: ‘The engagement of the education, healthcare, water and sanitation sectors and of local communities and leaders for the development of their areas will go a long way to overcoming social determinant to neonatal health and survival.’