NEW DELHI // The labour pains came in the middle of the night - within an hour, Rajjo Devi gave birth to her third child at home.
"I did not want to go to the hospital," said Mrs Devi, 24. "No one in my family has, and I wasn't going to be the first one to do so."
The boy, born in June last year, weighed 1.9 kilograms, compared with the World Health Organisation standard of 2.8kg for healthy babies.
When he died a day later, he became one of the estimated 300,000 babies who die within 24 hours of birth each year in India, according to the findings of a study released this month.
Most of the deaths are from preventable infections, said the report State of the World's Mothers, by the non-profit charity Save the Children.
A healthcare worker said Mrs Devi's baby was born with jaundice and a faint heartbeat, in addition to being underweight. The infant did not receive the immediate, critical medical care he needed, said Satyawati Singh, 65, who works in the clusters of slums around Azadpur, on the outskirts of New Delhi.
"We try to do the best we can," said Mrs Singh. "But sometimes it is too late."
India accounts for 29 per cent of worldwide newborn deaths, classified as death within the infant's first 24 hours, worldwide, the report said. The authors attributed the deaths largely to a lack of political will and funding to prevent them.
The report said South Asia, including India, Pakistan, Sri Lanka, Nepal, Afghanistan and Bhutan, accounted for a disproportionate number of first-day deaths. The region has 24 per cent of the world's population but recorded 40 per cent of the world's first-day deaths, according to the study, which examined 186 countries.
"Progress has been made, but more than 1,000 babies die every day on their first day of life from preventable causes throughout India, Pakistan and Bangladesh," said Mike Novell, the regional director of the charity.
The report identified three major causes of newborn deaths - complications during birth, premature birth and infections. Mr Novell said access to low-cost, life-saving treatment could bring down the number of deaths by as much as 75 per cent.
Chronic malnourishment of mothers is also a major factor, the report noted.
Afsana Begum, 24, who also lives in Azadpur and sells garlic for a living, has had three children. The only survivor is her 5-year-old son.
At 1.5 metres tall and just 37kg, Mrs Begum is underweight.
Three years ago she gave birth to a daughter who weighed 1.5kg. The child survived for just a month. A son born last June weighed 1.9kg and died after a month and six days, she said.
"They come out OK, but then I don't know what happens," Mrs Begum said.
Mrs Begum is now six months pregnant with her fourth child and Mrs Singh, the health care worker, has been urging her to keep a record of what she eats. She reminds Mrs Begum to eat fresh, nutritious green vegetables and eggs, the healthiest foods she can afford, and go for checkups regularly. "It is very hard to monitor the nutritional intake of a mother in these areas. If you push too much, they think you are asking them to spend money unnecessarily, then they will not seek proper medical help," Mrs Singh said.
Less than half of all Indian women give birth with the help of trained healthcare workers, which leads to infections and complications, according to the report.
In remote parts of the country, the nearest hospitals can be several kilometres away on bumpy roads, leading many to rely on poorly trained midwives.
But the bigger problem is a stubborn refusal to seek modern medical help.
Azadpur, where Mrs Begum and Mrs Devi live, has at least two government-run hospitals within a 10-kilometre radius where health care is offered for free, but women in the slums are reluctant to give birth there. They prefer to give birth at home, or at the home of the nearest midwife.
"Even after they lose a child or two, they will prefer giving birth at home," said Dr Veena Dhawan, who runs a mobile clinic that provides checkups for pregnant women in Azadpur. "Midwives are not trained to handle premature births, or a child born with an infection, but these women don't understand that."
The women are also afraid of overstepping the boundaries set by their mothers-in-law, said Dr Dhawan.
"Since she didn't go to a hospital to give birth, she doesn't think it is necessary for the daughter-in-law to do so either," said Dr Dhawan. "This is the sort of mindset we have to work to change."
Mrs Devi, whose newborn son died last June , is now nine months pregnant and plans to give birth at home again.
In spite of Mrs Singh's repeated visits, Mrs Devi remained set in her ways, preferring to follow the advice of her parents-in-law.
"I have never been to a hospital. I feel scared," Mrs Devi said. "I hear there is a rotation of doctors, sometimes even men, who come to look at you. I prefer being in the company of women when I give birth."
* With additional files from Agence France-Presse