A comprehensive new review, led by Professor Joy Lawn, at the London School of Hygiene & Tropical Medicine and Save the Children, UK, reveals the enormous burden that stillbirths and newborn deaths continue to exert, with nearly 8000 newborn babies dying every day (2.9 million deaths per year) worldwide.
The study is published in The Lancet as part of its Every Newborn Series, and provides comprehensive new data for 195 countries regarding neonatal deaths, stillbirths, rankings for countries, rates of progress and coverage of birth certification.
In addition to newborn deaths, the authors estimate that 2.6 million stillbirths (during the last 3 months of pregnancy) occur annually (around 7000 every day), yet these are yet to be included in global tracking by the United Nations, despite the fact that stillbirth shares many of the same causes as for newborn and maternal deaths.
An estimated 1.2 million women experience the loss of their baby during labour, after a full nine months of pregnancy. These babies, who may die just five minutes before birth, account for nearly half of all stillbirths, butdo not count in global data or have any global targets.
According to Professor Lawn, the study results highlight an important, yet largely unacknowledged, global problem: "In most countries stillbirths do not get birth or death certificates, which contributes to their invisibility; hence, most of the world's newborn deaths and almost all stillbirths enter and leave the world without a piece of paper to record their existence. The fact that the vast majority of these deaths - which have a huge effect on the women and families involved - are never formally included in a country's health registration systems signifies acceptance that these deaths are inevitable, and ultimately links to inaction."
While overall rates of newborn deaths have been declining since 1990, the rate of reduction between 1990 and 2012 (2.0% average annual rate of reduction) is much lower than that for children aged 1–59 months (3.4%), and also lower than for maternal mortality between 1990 and 2013 (2.6%).
Half of the newborn deaths worldwide occur in just five countries: India (779000), Nigeria (276000), Pakistan (202400), China (157000), and the Democratic Republic of Congo (118000), although global and national figures conceal huge variations within and between different countries.In 2012, eight of nine countries with neonatal death rates greater than 40 for every 1,000 live births were in sub-Saharan Africa; half of these countries were affected by conflict.
If current trends continue, it will be over a century before a baby born in Africa has the same chances of survival as a baby born in North America or Europe. This rate of decline in newborn mortality is three times slower than that achieved in high income countries, even before the advent of intensive care - and despite new innovations available now, such as simpler resuscitation techniques, feasible care for preterm babies, and simplified care of neonatal infections,which have the potential toincrease the pace of progress.
The study shows that globally, the time of birth remains one of the most risky periods for the survival of both mother and baby, with two fifths (40%) of all stillbirths and newborn deaths annually occurring on the day of birth, and nearly half (46%) of maternal deaths occurring in the same period.
The time of birth is also the most risky period for disability, which has substantial long-term effects on human capital and productivity. The analysis shows how these disabilities vary around the world, with the risk to babies of preventable disabilities (including blindness after preterm birth) nearly twice as high in middle-income countries, compared to high-income countries.
For the first time, the study analyses the causes of death in both the early (0-6 days) and late (7-27 days) neonatal period, finding that preterm birth is the major cause of death in both time periods, but that in the early neonatal period, intrapartum conditions (occurring during childbirth or delivery) are a significant contributor, and infections are dominant in the late neonatal period. A preterm baby is at least 11 times more likely to die if born in Africa than in Europe or North America.
"Our findings show that there is an urgent unmet need to provide timely, high-quality care for both mother and baby around the time of birth," says Professor Lawn.
"Each year one million babies die on their birth day - their only day. Without greater investments to improve birth outcomes, by 2035 there will be 116 million deaths, 31 million surviving babies and children with disabilities, and 68 million with lost development potential because of stunting. In the coming decades, improvements in child survival, development, and human capital depend on ensuring a healthy start for every newborn baby - the citizens and workforce of the future."