Neonatal mortality remains a major health challenge across the world, which involves neonatal sepsis and other related factors of prematurity. Though many strides have been done in reducing NMR, there is a need for more appropriate interventions and strategies directed towards addressing the rise in the escalation of AMR. Combating AMR will be critical in improving neonatal survival rates while giving each newborn a healthier start into life globally.

The newborn period is the key period for infant health, and the first 28 days of life are critically important-both for survival and as a base to set lifetime health and development. Neonatal deaths globally have witnessed a significant decline over the past couple of decades. The neonatal mortality count has significantly reduced dropping from a high of 5 million in 1990 to as low as 2.3 million as of 2022. However, this decline notwithstanding, neonatal mortality is still staggeringly high across low-and middle-income nations.

Neonatal mortality rates are 22 per 1000 live births in India. Neonatal sepsis and prematurity are the main causes of neonatal deaths in these tragic events. Recognizing the gravity of the issue the Indian government started the Indian Newborn Action Plan (INAP) in 2014. The goal is to take NMR down to the single digits by 2030. This initiative has brought in several key interventions, including antenatal care (vaccines, micronutrient supplementation), skilled birth attendance, clean birth practices, and neonatal resuscitation techniques. More promisingly, postnatal interventions, including early initiation of breastfeeding and skin-to-skin contact, have been proven to work well in improving newborn survival rates.

Despite these improvements, one of the biggest concerns in neonatal care today is the growing problem of antimicrobial resistance (AMR) which seriously threatens efforts to reduce neonatal mortality.

What is Antimicrobial Resistance?

Antimicrobial resistance occurs when microorganisms such as bacteria, viruses and fungi evolve over time and become resistant to commonly used antibiotics and other medications. This resistance makes infections more difficult to treat, increasing the risk of mortality and complicating treatment options. The World Health Organization has classified AMR as one of the most urgent global health threats since it not only causes death and disability but also places immense pressure on healthcare systems, significantly raising the economic burden.

The sources of AMR are many, including poor hygiene and infection control in healthcare settings, overuse and misuse of antibiotics. Contributing factors to this rapidly growing problem are antibiotic prescriptions for patient needs that do not require them and failure to complete antibiotic courses, as prescribed.

AMR and Newborn Health

For neonates, the risk is much more vital for AMR. Neonates are particularly prone to developing infections due to their rather weak immune systems. Neonatal sepsis, severe bacterial infection, is one of the leading causes of neonate deaths and it often manifests complications when it is because of drug-resistant pathogens.

According to Dr. Apoorva Taduri, Consultant Neonatologist, "Neonatal sepsis accounts for a significant proportion of neonatal deaths, and AMR is making it worse. MDR pathogens cause around 30% of neonatal sepsis mortality globally.

Maternal health and care are also factors influencing AMR in neonates. Over-prescription of antibiotics during pregnancy increases the risk of neonatal sepsis and the development of multi-drug-resistant pathogens in newborns. This calls for prudent use of antibiotics during pregnancy and at the time of delivery. In fact, studies indicate that indiscriminate use of antibiotics in mothers has a direct impact on neonatal health, which may eventually lead to resistant infections in newborns.

One of the major issues is that the drug-resistant bacteria are causing an increasing number of healthcare-associated infections in the neonatal care settings, which include NICUs. Infections by such bacteria prove to be challenging to treat; they require more advanced, expensive interventions, and the period of risk of mortality and morbidity is extended.

Counteracting AMR in Neonatal Care

To combat AMR and reduce neonatal mortality a multifaceted approach is necessary. Dr. Taduri emphasizes the continuation of the strategies outlined by the Indian Newborn Action Plan (INAP), specifically in reducing neonatal sepsis and improving infection control. However, to combat AMR more must be done to ensure proper use of antibiotics in both maternal and neonatal care settings.

Key strategies for reducing AMR in neonatal care are:

1. Improving Infection Prevention Practice: This implies, therefore, that more efforts would be made regarding stricter hospital hygiene standards, strict equipment sterilization after its usage and even maintaining adequate hand hygiene. Enhanced infection control practices greatly impact minimizing AMR pathogens distribution.

2. Antibiotic Stewardship- Teaching the healthcare providers how not to use antibiotics is a crucial thing in preventing overuse prescription. Antibiotic stewardship programs are designed to promote use of antibiotics only when truly required; appropriate drug, dose and length of treatment should be taken.

3. Improved access to WASH: Access to clean water and sanitation is a fundamental aspect of preventing infections in mothers and newborns. WASH interventions such as clean birthing practices, can reduce the risk of neonatal sepsis due to unsanitary conditions.

4. Maternal Health Strengthening: Proper maternal care, such as proper vaccination, antenatal steroids, and supplementation of micronutrients, can reduce the risk of prematurity and neonatal infection. Prevention of infection in mothers is the first step towards prevention of infection in newborns.

5. Early Diagnosis and Treatment: Early identification and treatment of neonatal infections are very important. This includes proper screening for sepsis and the use of appropriate antibiotics based on the local resistance patterns. It also involves ensuring that infants receive adequate neonatal care, such as those provided in Special Newborn Care Units (SNCUs).

The rise of antimicrobial resistance is a global health challenge that requires urgent action. Combating AMR requires a coordinated effort from governments, healthcare systems and communities worldwide. In neonatal care, addressing AMR is essential to further reducing neonatal mortality rates and ensuring that every newborn has the opportunity to thrive.

As Dr. Taduri concludes, "While we have made substantial progress in reducing neonatal mortality, the emerging risk of antimicrobial resistance creates a major challenge for our efforts. Combating AMR requires a global collective effort, with priorities on infection prevention, responsible use of antibiotics, and enhancement of healthcare practices to ensure a healthier future for all newborns."

Dr Apoorva Taduri is a Consultant Neonatologist at Fernandez Hospital

Egg freezing, to be sure, sounds incredibly promising to a woman in her early 30s: freeze your current eggs and get more choices in the future. There is, however, a crucial distinction that is lost amid all the excitement about advances in reproductive technologies. Egg freezing is not fertility freezing; it is a freezing of part of your fertility at a specific age. The distinction is critical.

Not only do fertility and the chance of having a healthy baby decrease with age, but the decline in the biological quality of a woman's oocytes, as well as their number, contributes to fertility and genetic problems as well. To be more specific, if a woman gives birth at a very young age, she is more likely to have a miscarriage, or her baby will have a chromosomal disorder. Vitrification is the name of the technique of freezing cells ultra-rapidly to quite a bit reduce damage caused by ice crystals and this is the technique which has made egg preservation so reliable.

But the freezer cannot revert your 35-year-old eggs to 25-year-old ones and ovarian reserve testing cannot tell for sure if a certain frozen egg will ever lead to a pregnancy.

And that, perhaps, is the most important discussion that India must have.

Indian women are not postponing motherhood for just one reason

Also read: How Age Affects Fertility And The Chances Of Success With IVF

Rarely in the Indian context is the delay of motherhood something to do only with career. For some women, it is finishing higher education, gaining financial independence or getting a foothold in the professional world. For others, marriage may be postponed due to shifting notions of compatibility, financial security, or personal choice. Women may get married younger but delay pregnancy to 'set up house, ' to help ageing parents, or simply to feel 'ready' to be a parent.

The image is further complicated by the truth. India remains caught between two very different ideas of womanhood. For many women, motherhood, at least for married women, remains essentially goodwife-hood, and a woman's transition into it takes place with surprising proximity to her married life. For others, the younger generations, having children wants to be informed by new states of control that women desire over their bodies, over if, when and how they find themselves to be mothers.

An unmarried woman faced with egg freezing may in this way have been faced with something beyond a medical choice; she may have been confronted with issues of marriage, family and social morality. For such women, egg freezing may so have been an option that is seldom present in ordinary fertility choices: a space in which the decision to reproduce need not have been inextricably linked to the decision to marry, the decision to have children at once.

Yet, this kind of autonomy is not open to all. The technology might provide greater flexibility over when to reproduce, yet its expense, the requirement for specialised fertility treatment and the demand for frequent serum monitoring mean that class still shapes who can actually access it. Which in turn makes egg freezing about a great deal more than reproductive biology. It's a story about access, exclusivity and who is able to buy a few extra years.

The uncomfortable economics of reproductive choice

Also read: Before You Start IVF, 7 Critical Factors You Must Consider

Marketing around egg freezing often talks of how powerful this process can be, yet that very power hinges on affordability. In India, one cycle of egg freezing costs roughly 1 to 1.5 lakh, while storage fees amount, at minimum, from 30,000 to 40,000 a year, with considerable variations according to clinics.

Though this amount can be looked at as a big expense for a young, financially well-off professional working in cities like Bengaluru, Mumbai or Delhi, it is still an investment that can be handled. Still, to a schoolteacher or a junior doctor or researcher, small business owner or a woman who is helping her parents, the same egg freezing procedure can represent several months of savings.

This creates an overlooked paradox: the technology that gives women greater reproductive autonomy may initially be accessible mainly to women who already possess greater economic autonomy.

And there is another inequality. Women living outside India's major fertility hubs may have fewer opportunities for specialist counselling and high-volume reproductive medicine services. The question, therefore, should not simply be whether egg freezing is available in India, but who can realistically access informed egg freezing and who cannot.

Freezing eggs is not the same as freezing a future baby

Also read: IVF: What Is The Right Age To Start, How Many Times You Can Try And What To Expect

Perhaps the greatest misconception is that a box of frozen eggs represents a guaranteed future pregnancy. It does not.

Eggs must survive warming, be fertilised—usually through ICSI—develop into viable embryos, implant and ultimately result in a live birth. At every stage there is attrition. Age at freezing matters because younger eggs generally have better reproductive potential. The American Society for Reproductive Medicine notes that outcomes appear better when planned oocyte cryopreservation occurs at younger ages, while also emphasising that available evidence is insufficient to promise a specific live-birth probability for an individual woman.

A 2025 review from Indian fertility specialists similarly stresses that freezing more than 20 mature oocytes before age 38 has been associated with an estimated 70% chance of one live birth, but this should not be interpreted as a guarantee for every woman.

This is why the phrase "egg insurance" can be misleading. Insurance protects against a defined risk under defined conditions. Egg freezing provides an additional reproductive option; it does not insure motherhood.

The paradox of waiting

There is an even subtler problem.

A woman may freeze her eggs at 30 and feel that the fertility question has been "taken care of." She may then postpone pregnancy until 38, 40 or 42 because she believes her frozen eggs have removed the urgency.

But pregnancy at an older age still involves an older uterus and a body with age-related changes. Frozen eggs preserve the biological age of the eggs—not the biological age of the woman who will eventually carry the pregnancy.

That distinction deserves far more attention in advertisements and counselling rooms.

Interestingly, relatively few women who freeze eggs eventually return to use them, according to the available literature. Some marry and conceive naturally; some decide not to have children; others may encounter circumstances in which their frozen eggs are never used. So what is being purchased? Perhaps not fertility. Time. Time to finish medical residency. Time to build a company. Time to become financially independent. Time to find a partner without treating marriage as a biological deadline. Time to decide whether motherhood is actually wanted.

For Indian women, that may be the real revolution.

However, the medical dialogue needs to remain straightforward – egg freezing can increase the options for reproduction, yet it does not mean eliminating reproductive aging. So the objective here is not to encourage every young woman to go through the procedure of egg freezing. Rather, it is necessary to make sure that each woman who decides to undergo the procedure understands all the implications.

As far as the most empowering technology is concerned, it is not necessarily the one that promises a guaranteed future. Rather, it is the technology which provides more opportunities without hiding any of its limitations.

The Food Safety and Standards Authority of India (FSSAI) has issued notices to Zydus Wellness, Nestlé India, Abbott Healthcare, Nutricia International and Mead Johnson Nutrition over advertising claims involving children's nutritional drinks and infant formula products.

The regulator has asked these brands to provide scientific evidence to support their claims about growth, immunity, concentration, and digestion, and questioned the promotion of infant milk substitutes on social media.

The notices, which were shared on social media on October 21, also named an Instagram influencer, Ira Fathima, over sharing a Reel recommending infant formula products. The action concerns compliance with food advertising rules and laws regulating the promotion of infant milk substitutes.

FSSAI Questions Complan's ‘2X Faster Growth’ Claim

FSSAI has asked Zydus Wellness Products to provide evidence for claims made on Complan's packaging, including “2X Faster Growth”, “Supports Concentration and Memory” and “Pro Immunity+ 34 Vital Nutrients”.

The regulator also questioned their promotional statements like “Grow Taller, Faster”, “Clinically Proven 2X Growth” and “Growth Comes in 4 Flavors”.

It said the claims appeared to violate the Food Safety and Standards (Advertising and Claims) Regulations, 2018, and sought scientific justification for the advertised benefits.

Zydus Wellness has maintained that Complan complies with applicable regulations and that its claims are supported by scientific evidence. The company said it had submitted a detailed clarification to the authorities.

Also read: FSSAI Proposes No Added Sucrose Or Fructose In Foods For Babies Up To Six Months: How Can It Affect Infant Health

Nestlé Asked To Substantiate Infant Formula Claims

FSSAI has separately questioned claims on two Nestlé India products, Lactogen Pro 1 Powder and NAN Excella Pro Stage 1.

For Lactogen Pro 1, the regulator asked to provide evidence supporting the claim that whey protein in the product is “easy to digest”.

On NAN Excella Pro Stage 1, FSSAI flagged the claim “5 HMOs helps support the normal immune system”.

The regulator said the statement could imply that the product supports a certain physiological condition, which may not comply with rules restricting such claims unless specifically permitted.

FSSAI also sought scientific substantiation for the whey protein digestibility claim appearing on NAN Excella Pro Stage 1.

Nestlé India said it had already submitted a detailed response to the regulator regarding the product-label issues.

In a statement dated September 18, the company said its products and labels had been approved by FSSAI's expert committee and that the statements were supported by scientific evidence.

Also read: Red Bull Vs FSSAI: Beverage Giant Can Retain The 'Energy Drink' Label; What Are Its Health Risks

Infant Formula Promotions On Social Media Also Under Scrutiny

In a separate notice, FSSAI flagged an Instagram Reel posted by Ira Fathima in which she recommended five infant formula products - NAN Pro 1, Aptamil Premium 1, Similac Advance 1, Enfamil A+ Stage 1 and Dexolac 1.

The Reel spoke about benefits of these products like balanced nutrition, stronger immunity, brain development and easy digestion to the products.

The regulator alleged that the promotion violated the Infant Milk Substitutes Act, 1992, as amended in 2003, and the Food Safety and Standards (Foods for Infant Nutrition) Regulations, 2020. These rules govern the advertising, marketing and promotion of infant milk substitutes.

The notices also named Abbott Healthcare, Nutricia International and Mead Johnson Nutrition India over their promotional content.

Abbott said it was neither involved in nor aware of the Instagram content before receiving the notice, and did not endorse the claims made in the Reel.

Should Parents Be Worried?

Parents should pay attention, but they do not need to panic. FSSAI's notices raise questions about particular advertising claims and infant formula promotions. They do not mean that the named products have been declared unsafe.

For Complan, the regulator has questioned claims like “2X Faster Growth” and “Supports Concentration and Memory”. Even though this does not establish that Complan is harmful, parents should not assume a drink will make their child grow twice as fast or improve memory based on advertising alone.

For infant formula, the notices is against claims about digestion and immunity, and promotional practices. They are not a blanket warning against using infant formula. If your baby needs formula, don't stop or switch it abruptly. Discuss these concerns with your paediatrician.

Digital technologies have transformed how children learn, communicate and access information. But concerns about mental health and online safety have prompted governments worldwide to consider restrictions on children's social media use. In India, Karnataka has announced a social media ban for children under 16. Other states, including Andhra Pradesh, Goa and Bihar, are considering age-based restrictions.

On October 15, the Supreme Court held that “the right to access and use the internet is a fundamental right of every individual.” A bench of Justices J B Pardiwala and K V Chandran added that children, “irrespective of their age, enjoy the same rights,” and that “the safety of our children and their freedom are not at odds with each other. Our children are entitled to both.”

The debate is not just about screen time. It also concerns how digital platforms are designed, how algorithms shape what children see and how these factors may affect their health and well-being.

A recent three-paper Series in The Lancet examines these issues through the concept of digital determinants of health: the digital systems, business models and design choices that influence health outcomes.

In an exclusive interview with HealthandMe, Dr. Salman Fitrat Khan, a member of the Youth Advisory Group for The Lancet Series on Digital Determinants of Health and a co-author of its umbrella review, “Associations of digital media use with health, behavioural and developmental outcomes in children and adolescents: an umbrella review and meta-analysis,” discusses how governments can protect children's mental health while safeguarding their digital rights.

Also read: Over 2 Hours of Daily Screen Time Linked to Depression, Obesity In Young People: Lancet

Q. What does this Lancet Series mean for children and adolescents in India, where smartphone and social media use is rising rapidly?

Dr. Salman: India has the world's largest youth population, with about 65% of its people under 35. Digital access and media use are also expanding rapidly. At this scale, even modest adverse effects of digital media could add up to a substantial public health burden.

India has an evolving regulatory framework for digital technologies and child protection. Existing safeguards include the Digital Personal Data Protection Act, 2023, which provides for verifiable parental consent for children, and the Protection of Children from Sexual Offences (POCSO) Act.

However, enforcement remains uneven, and requirements for child-friendly platform design and systemic risk assessment are less developed than in some other jurisdictions. Restrictions on social media use by children under 16 are also being considered at national and state levels.

Generative AI is already part of Indian children's lives. One consulting report found that 77% of children older than 10 had used it for schoolwork, although this is not a peer-reviewed finding.

A major challenge is the lack of research from low- and middle-income countries. Very few studies we reviewed came from these settings. Locally led research is therefore crucial to understanding how rising smartphone and social media use affects children and adolescents in India.

Q. Are parental screen-time limits enough, or should countries regulate platform design and recommendation algorithms? What measures do you suggest?

Dr. Salman: Parental limits alone are not enough. Current approaches place much of the responsibility on young people and families, even though many risks arise from systems largely beyond their control. No single measure, including age limits, is sufficient.

The Series identifies device screen-time limits as an example of “technological solutionism” and proposes a broader approach:

• Safer platform design: Require age-appropriate defaults, safeguards for high-risk features and assessments of potential harm before new features are widely rolled out.
• Protection from commercial exploitation: Ban behavioral advertising and commercial profiling of minors.
• Platform accountability and transparency: Require companies to assess and mitigate mental health risks associated with recommendation systems and engagement-driven design. Improve algorithm transparency and provide vetted researchers with secure, legally protected access to platform data.
• Age restrictions with safeguards: Design age-based limits that prevent exclusion and avoid broad identity-verification requirements.
• Ongoing evaluation: Assess interventions continuously and adapt them as evidence emerges, including to address unintended consequences.

Support for parents remains important through caregiver resources and digital literacy. However, these measures should complement structural reforms rather than substitute for them.

Read More: Social Media Bans for Kids Gain Ground Worldwide: Will They Work?

Q. Which digital features pose the biggest concerns for young people's mental health?

Dr. Salman: The Series does not rank these features, noting that platform design remains largely invisible in current research. However, it highlights several areas of concern:

• Engagement-maximizing design: Infinite scrolling, autoplay and hyper-personalized algorithms can encourage habitual use and have been linked to effects on attention, sleep and emotional regulation.

• Engagement metrics and recommendation systems: Likes and follower counts may fuel anxiety, while recommendation systems can lead users into increasingly narrow content streams.

• Notifications: Frequent notifications can interrupt attention and encourage reward-seeking behavior.

• Appearance-focused content: Such content may contribute to depression, anxiety and body dissatisfaction, particularly among girls and young women. The Series' umbrella review found an association between body-ideal content and poorer well-being.

• AI companions and generative AI: AI companions raise concerns about emotional manipulation, while generative AI can produce images of young people that may be used for exploitation and abuse.

• Data-driven advertising: Children's data can be used for commercial targeting, including advertising unhealthy products.

These concerns do not mean that every child will experience harm or that every feature has the same level of evidence behind it. The Series highlights the need for better research into how platform design affects young users.

READ: Is India Set To Implement A Social Media Ban For Children?

Q. How should parents distinguish normal digital use from problematic use?

Dr. Salman: The Series defines problematic digital use by its pattern rather than the number of hours spent online. It involves loss of control, preoccupation and continued use despite harm. There is no universally consistent definition of problematic use in research.

Warning signs include digital use that disrupts sleep, schoolwork or relationships, or displaces physical activity and face-to-face interaction. Late-night use can also be a concern.

Heavy use, however, can be entirely normal for teenagers, including when they communicate with peers or explore their identities. Some forms of digital engagement can be beneficial, particularly moderate, socially oriented use. For young children, educational content watched alongside a caregiver was associated with better outcomes.

Parents should avoid treating problematic use solely as a child's failing. This can overlook the role of platform design in shaping behavior. The Youth Advisory Group also described doomscrolling as a response to platform environments rather than simply a personal choice.

Q. What would you want policymakers and technology companies to change first?

Dr. Salman: Technology companies should prioritize two steps:

• Assess new products for potential harm before release.
• Share data and internal research with vetted researchers.

For policymakers, the Series recommends treating digital determinants of health as a core public health responsibility. This includes:

• Designating focal points within health ministries to coordinate with education and data protection authorities.
• Prohibiting third-party tracking of minors in publicly funded health and education systems.
• Auditing school platforms, youth health apps and major social media platforms used by adolescents.
• Involving young people as partners in policymaking, not merely as consultees.

Where regulatory capacity is limited, practical starting points include incorporating digital risks into school health surveys and adolescent health programmes.