OPINION
Photo: UNICEF/Olivier Asselin
An infant receives a dose of oral polio vaccine during a routine immunization session, at the Henriette Konan Bedie Community Hospital, Abidjan, Côte d’Ivoire.
Africa: 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]
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