Neonatal Mortality Rate (NMR) refers to the number of deaths of newborns within the first 28 days of life per 1,000 live births in a given year.
It is an important health indicator because a large share of infant deaths occurs during the neonatal period. NMR reflects the quality of maternal healthcare, institutional delivery, newborn care, nutrition, infection control and emergency obstetric services.
Meaning and Calculation
A neonate means a newborn baby in the first 28 days after birth.
The neonatal period is divided into:
- Early neonatal period: first 7 days after birth
- Late neonatal period: 8th to 28th day after birth
Most neonatal deaths occur in the first week of life, especially within the first 24–48 hours.
NMR is calculated as:
Number of neonatal deaths in a year ÷ Number of live births in the same year × 1,000
So, if 20 newborns die within 28 days per 1,000 live births, the NMR is 20.
Major Causes
Neonatal deaths are usually linked with complications around pregnancy, delivery and early newborn care.
Major causes include:
- prematurity
- low birth weight
- birth asphyxia
- neonatal infections
- sepsis
- pneumonia
- congenital abnormalities
- complications during delivery
- poor thermal care after birth
Many neonatal deaths are preventable through timely antenatal care, skilled birth attendance, institutional delivery, early breastfeeding, infection prevention and special newborn care.
India’s Status
India has reduced neonatal mortality over the years, but it remains a major public health concern.
According to the Sample Registration System Statistical Report 2020, India’s Neonatal Mortality Rate was 20 per 1,000 live births. This means around 20 newborns died within the first 28 days for every 1,000 live births.
The decline in NMR has been slower than the decline in under-five mortality. This is because neonatal deaths require stronger maternal and newborn care, not only general child health interventions.
States with weaker health infrastructure, higher poverty, poor maternal nutrition and lower access to quality delivery care generally have higher neonatal mortality.
Significance
NMR is important because it shows the quality of healthcare around childbirth.
A high NMR indicates problems in:
- antenatal care
- maternal nutrition
- institutional delivery quality
- emergency obstetric care
- newborn resuscitation
- infection control
- referral transport
- special newborn care units
Reducing neonatal mortality is essential for improving Infant Mortality Rate and Under-Five Mortality Rate.
It is also linked with Sustainable Development Goal 3, which aims to end preventable deaths of newborns and children under five.
Government Measures
India has taken several steps to reduce neonatal mortality.
Important interventions include:
- Janani Suraksha Yojana for institutional deliveries
- Janani Shishu Suraksha Karyakram for free maternal and newborn care
- Pradhan Mantri Surakshit Matritva Abhiyan for antenatal care
- Special Newborn Care Units
- Newborn Stabilisation Units
- Home-Based Newborn Care
- Facility-Based Newborn Care
- Rashtriya Bal Swasthya Karyakram
- LaQshya programme for labour room quality improvement
- MAA programme for breastfeeding promotion
These interventions focus on pregnancy care, safe delivery, newborn resuscitation, early identification of complications and referral-based newborn treatment.
Key Challenges
The main challenge is quality of care during and immediately after birth.
Institutional delivery has increased in India, but every institutional delivery does not automatically ensure quality newborn care.
Major concerns include:
- premature births and low birth weight
- maternal anaemia and malnutrition
- poor quality of care in some delivery facilities
- shortage of trained nurses and neonatologists
- delayed referral of sick newborns
- infection in health facilities
- weak follow-up after discharge
- regional inequality in newborn care services
The first 48 hours after birth are especially critical. If complications are not identified and managed quickly, newborn survival becomes difficult.
Conclusion
Neonatal Mortality Rate measures deaths of newborns within the first 28 days per 1,000 live births.
It is one of the most sensitive indicators of maternal and newborn healthcare quality.
India has made progress in reducing neonatal deaths, but further improvement depends on better antenatal care, maternal nutrition, skilled delivery, newborn resuscitation, infection control, special newborn care and strong referral systems.
