Each year, 4 million babies die in their first four weeks of life -- over 10,000 deaths a day. Most of these neonatal deaths go unrecorded and remain invisible to all but their families. Virtually all (99 percent) occur in low and middle-income countries, but most research and funding focus on high-tech care for the 1 percent of deaths occurring in rich countries.
The greatest risk of death is at the beginning of life: three-quarters of all neonatal deaths (3 million) occur within one week of birth, and at least 1 million babies die on their first day of life, many at home without any formal healthcare. Moreover, almost 40 percent of all child deaths occur in the neonatal period, with Africa and South Asia accounting for two-thirds of the total.
Unfortunately, child survival programs in the developing world have focused primarily on pneumonia, diarrhea, malaria and vaccine-preventable causes of deaths after the first month of life, while safe motherhood programs have focused on the mother. Prevention of newborn deaths has thus fallen between the cracks of programs focusing on mothers and older children.
This represents a tragedy that is as avoidable as it is immense. A recent series on neonatal issues in the British science journal Lancet estimated that between 41 percent and 72 percent of neonatal deaths could be prevented if simple interventions were provided effectively where they are needed most. In other words, up to 3 million babies needlessly die each year.
Well known, low-cost and low-tech interventions do not reach those most in need -- for example immunization against tetanus, exclusive breastfeeding, simple care for low-weight babies and antibiotics for infection. Such interventions are extremely cost-effective, and packaging these interventions together and linking them with other health programs reduce costs further.
Saving lives requires that mothers and babies in countries with the highest mortality rate be reached at the time of greatest risk. Currently, only about half of all women worldwide deliver with a skilled attendant present.
In sub-Saharan Africa, less than 40 percent of women deliver with skilled care; in South Asia, the figure is less than 30 percent. Latin America and Southeast Asia have rapidly increased coverage, but at the current rate of progress in Africa, 50 percent of women will still deliver without skilled care in the year 2015. In Ethiopia, a quarter of pregnant women in the highest income group use skilled care at delivery, compared with 1 percent of the poorest women.
Low-income countries have demonstrated that rapid progress is possible. Sri Lanka, Indonesia, Peru and Botswana all halved neonatal mortality during the 1990s. These countries' success has depended on sustained high-level political commitment to providing high-quality maternal and newborn care.
In particular, integrated planning is essential. In India, newborn health forms part of the national Reproductive and Child Health Program. In Ethiopia, newborn care is being incorporated into a new community-based healthcare program.
Of course, there is no "one-size-fits-all" solution. The numbers and causes of neonatal deaths, the capacity of the health system, and the obstacles faced differ between and within countries, as does support from policymakers and the availability of resources.
RSS