19 May 2014

Africa: 'No Child Anywhere in the World Should be Born to Die'


By a host of metrics, women and their children have been getting healthier in recent years. Between 1990 and 2010, the annual number of maternal deaths dropped from more than 543,000 to 287,000.[1]

The child mortality story is just as impressive. Since 1990, under-5 deaths have declined by 47%. [2] Given the critical role that women and children play in securing a healthy, prosperous, and stable future for everyone, this is encouraging news.

But the progress for women and children also highlights the fact that mortality rates for newborns have remained stubbornly high. Each year, 2.9 million newborns around the world die within their first month of life.[3] More than one million die on their first day of life [4]. Newborns now comprise 44% of under-5 deaths, and as child mortality continues to drop, this proportion continues to climb.[5]

An analysis by the Institute for Health Metrics and Evaluation, published in the Lancet, shows that as many children die in the first week as during the period from 1 to 4 years.[6]

While the statistics about newborns are dire, they point to opportunity for improvement. Many of these newborn deaths could have been prevented with existing interventions. In short, these newborns are not dying because we lack the knowledge to save them; they are dying for a lack of attention and investment - because the world did not focus on saving newborn lives.

The Lancet Every Newborn series and accompanying Every Newborn Action Plan (ENAP) aim to stimulate attention and investment and place newborn health more prominently on the global agenda, alongside reproductive, maternal, and child health.

The series is both a call to action and a clear-cut case that a dramatic decrease in neonatal mortality is achievable with currently available interventions. Data from a systematic analysis of interventions across the continuum of care demonstrates that by 2025, it will be possible to save the lives of 2 million newborns each year and avert 73% of neonatal deaths.[7]

When it comes to saving newborns' lives, the evidence base clearly shows that a few inexpensive, proven interventions can go a long way. Examples of key interventions include immediate drying of the newborn, immediate and exclusive breastfeeding, chlorhexidine umbilical cord care, and kangaroo mother care (which involves skin-to-skin contact between a mother and a newborn to promote breastfeeding and regulate the baby's temperature, heart rate, and breathing).[8]

Despite the effectiveness of these interventions, many have failed to take hold. One reason that coverage remains so low is that more than 50 percent of women in developing countries give birth at home without a skilled attendant present.[9]

However, since the early 1990s, more women in almost every country around the world are choosing to deliver their babies in health facilities. [10] Provided they are properly staffed and equipped, facilities can provide the highest quality care during the crucial moments surrounding labor and delivery.

Encouraging women to seek that care, and continuing to emphasize the quality of care in facilities, is critical to advancing maternal and newborn health. In instances when women either cannot or choose not to go to a health facility for delivery, there are still ways to optimize outcomes for newborns.

When complications arise during labor and delivery or when a baby is born small or sick, a trained health worker can mean the difference between life and death. Countries such as Ethiopia and Nepal have demonstrated that building and maintaining a sizeable force of health workers with the skills to care for distressed newborns can drive significant gains.[11]

While this series focuses on newborns, it also underscores the importance of placing newborns within the larger continuum of care by linking their well-being to reproductive, maternal, and child health. For example, healthier women are more likely to have healthy pregnancies, and healthier mothers tend to give birth to healthier newborns.[12]

And increasing women's access to contraceptives to space their pregnancies safely would significantly improve maternal and newborn health. By meeting just a quarter of the current unmet need for family planning services, we could save the lives of 25,000 women and 250,000 newborns each year.[13]

The ENAP not only provides the evidence base for increasing coverage of existing interventions but also provides a policy roadmap for actually accomplishing this goal.

The priority action areasinclude supporting families to demand better newborn care; encouraging countries to exert leadership and increase their investments; emphasizing coordination between donors and funding platforms to maximize resources; and establishing clear, data-driven methods to track progress and hold countries accountable.[14]

While the death of a child is always a tragedy, this series does more than generate a sense of urgency; it gives a reason for optimism.

As the recent trends in maternal and child mortality have shown, when the world coalesces around a clear set of goals, it can rise to challenges previously thought insurmountable.

Once the international community declares that no child anywhere in the world should be born to die, we can ensure that future progress in maternal and child health will always extend to newborns.

This commentary was prepared for The Lancet by Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, and Agnes Binagwaho, Rwanda's Minister of Health.

[1] WHO, UNICEF, UNFPA, and The World Bank. Trends in maternal mortality: 1990 to 2010. http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf (accessed April 14, 2014).

[2] Child Info. Progress Towards Millennium Development Goal 4: Key Fact and Figures. http://www.childinfo.org/mortality.html (accessed April 15, 2014).

[3] IGME, UNICEF. Levels and trends in child mortality: Report 2013. http://www.childinfo.org/files/Child_Mortality_Report_2013.pdf (accessed April 15, 2014).

[4] Save the Children. Ending newborn deaths, ensuring every baby survives. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/ENDING-NEWBORN-DEATHS.PDF (accessed April 14, 2014).

[5] WHO. Every newborn: a draft action plan to end preventable deaths. http://www.who.int/maternal_child_adolescent/topics/newborn/every-newborn-action-plan-draft.pdf (accessed April 14, 2012).

[6] Lozano R, Wang H, Foreman KJ, et al. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 2011 Published online September 20.

[7] Bhutta, ZA, Das JK, Bahl R, et al, for The Lancet Newborn Interventions Review group and The Lancet Every Newborn Study Group. Every Newborn: What will it take to avert preventable newborn deaths and stillbirths and at what cost? Lancet 2014.

[8] Bhutta, ZA, Das JK, Bahl R, et al, for The Lancet Newborn Interventions Review group and The Lancet Every Newborn Study Group. Every Newborn: What will it take to avert preventable newborn deaths and stillbirths and at what cost? Lancet 2014.

[9] UNICEF.Maternal and newborn health.http://www.unicef.org/health/index_maternalhealth.html (accessed April 16, 2014).

[10] USAID. Levels and Trends in the Use of Maternal Health Services in Developing Countries. DHS Comparative Reports 26. https://dhsprogram.com/pubs/pdf/CR26/CR26.pdf (accessed April 14, 2014).

[11] Africa Progress Panel.Africa Progress Panel Policy Brief 2010. Maternal Health: Investing in the lifeline of healthy societies and economies. http://www.who.int/pmnch/topics/maternal/app_maternal_health_english.pdf (accessed April 15, 2014).

[12] Save the Children. Healthy mothers and healthy newborns: the vital link. http://www.prb.org/pdf/HealthyMothers_Eng.pdf (accessed April 14, 2014).

[13] Office of the UN Secretary-General's Special Envoy for Financing the Health Millennium Development Goals and for Malaria.http://www.mdghealthenvoy.org/health-areas/maternal-health/ (accessed April 15, 2014).

[14] Mason E, McDougall L, Gupta A, et al, for The Lancet. Every Newborn Study Group. Every Newborn: Delivering a healthy start in life. Lancet 2014.


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