Study urges global action to prevent 5.5 million ‘invisible’ newborn deaths and stillbirths every year
 


Study urges global action to prevent 5.5 million ‘invisible’ newborn deaths and stillbirths every year

Counting births and deaths is an indicator of progress towards ending 3 million preventable infant deaths

May 20, 2014

Each year, 5.5 million babies enter and leave the world without being recorded and one in three newborns – over 45 million babies – do not have a birth certificate by their first birthday. Babies who are stillborn, born too early, or who die soon after birth are least likely to be registered, even in high-income countries. This lack of registration and official recognition reflects acceptance of these deaths as inevitable and is a key reason for slower progress in recent decades in reducing newborn deaths and stillbirths versus reducing maternal and child mortality.

Findings from the Every Newborn Series, published today in The Lancet, paint the clearest picture to date of a newborn’s chance of survival and the steps that must be taken to end preventable infant deaths. New analyses indicate that 3 million maternal and newborn deaths and stillbirths can be prevented each year with proven intervention – including the promotion of breastfeeding, neonatal resuscitation, kangaroo mother care for preterm babies, antenatal corticosteroids, and the prevention and treatment of infections. These interventions can be implemented for an annual cost of US$1.15 per person.

The research was led by Professor Joy Lawn, at the London School of Hygiene & Tropical Medicine and Save the Children, UK, with Professor Zulfiqar Bhutta at the Centre of Excellence in Women and Child Health, the Aga Khan University, Pakistan and Centre for Global Child Health, The Hospital for Sick Children, Canada in collaboration with more than 54 experts from 28 institutions in 17 countries. AKU was also represented by researchers Dr Jai K Das, Rehana A Salam and Arjumand Rizvi.

It provides the foundation for the forthcoming Every Newborn Action Plan, an evidence-based roadmap towards care for every woman, and a healthy start for every newborn baby, which will be launched in June 2014.

“Evidence and experience from some of the most improved, as well as the worst affected, countries shows that maternal and newborn deaths are preventable,” says Professor Bhutta. “Our research shows that 3 million lives can be saved by 2025 if achievable interventions are scaled up to nearly universal coverage. Improving care at the time of birth gives a triple return on investment – saving mothers and newborns and preventing stillbirths. Care of small and sick newborns is the next highest impact package, yet this has received little attention up to now, despite extremely cost effective solutions such as antenatal steroids and kangaroo mother care.”

A systematic assessment of challenges in eight high-burden countries – Afghanistan, Bangladesh, Democratic Republic of Congo, India, Kenya, Nigeria, Pakistan and Uganda – which together account for more than half of all newborn and maternal deaths revealed important differences as well as several common bottlenecks impeding progress. A team of global health experts, led by Dr Kim Dickson, at UNICEF, USA, undertook detailed consultations with more than 600 health professionals and policy makers in these countries to find that common problems were related to the health workforce, financing, and service delivery. Countries that have made recent, rapid reductions in newborn and maternal deaths – such as Malawi, Nepal, and Peru – have done so by expanding their skilled workforce (especially midwives and nurses), rolling out innovative mechanisms to reach the poorest families, and focusing on improving care for small and sick newborns.

“In Pakistan, the rate of neonatal deaths has not changed for almost three decades. But with the required focus on integrating community-based approaches to newborn care through the Lady Health Workers’ programme, and improved linkages and transfers to district referral facilities, we have the potential in a decade to save 158,000 newborn lives, 80 per cent of all annual newborn deaths,” said Professor Bhutta.

Rooted in the evidence presented in the Series, the Every Newborn Action Plan, co-led by the World Health Organization and UNICEF, will be presented at the Partners’ Forum hosted by the Partnership for Maternal, Newborn & Child Health in Johannesburg, South Africa on June 30. ENAP sets a framework to end preventable deaths for newborns and stillbirths by 2035 as part of the A Promise Renewed effort. It also provides interim targets for 2030 and will lead to practical standards for quality of care, improved measurement of births and deaths, and increased programmatic coverage with accountability for results.

“In 2012, under A Promise Renewed, Pakistan committed to ensuring an accelerated decline in child and maternal mortality, with a special focus on improving neonatal survival,” said Dr Tania Goldner, Chief of Health Section, UNICEF Pakistan. “Under the ENAP framework, the country has a unique opportunity to use the results of the health system bottleneck analysis to identify the needed solutions and actions to scale up newborn care interventions for improved newborn survival and to make child health more equitable across Pakistan.”

“The greatest opportunity exists in improving the quality of care. If every woman delivering a newborn in a facility receives recommended care, two million lives could be saved by 2020. Our analysis suggests that India, Nigeria and Pakistan would benefit the most in terms of absolute lives saved, and the top five countries would account for 57 per cent of the total reduction in global mortality,” said Dr Jai Das.

Ten riskiest countries for newborns:
 

Country

Neonatal mortality rate per thousand live births 2012

Sierra Leone

49.5

Somalia

45.7

Guinea-Bissau

45.7

Angola

45.4

Lesotho

45.3

Democratic Republic of the Congo

43.5

Pakistan

42.2

Mali

41.5

Central African Republic

40.9

Côte d'Ivoire

39.9

 

Ten countries with highest potential for lives saved:

 

Countries and territories

Lives saved estimates for newborns, stillbirths and mothers with high coverage of care by 2025

India

840,400

Nigeria

375,000

Pakistan

217,700

Democratic Republic of the Congo

139,000

Ethiopia

76,800

Bangladesh

76,100

Afghanistan

67,500

United Republic of Tanzania

65,800

Indonesia

56,100

Uganda

54,800

 

Ten countries where babies least likely to receive a birth certificate before their first birthday:

 

Countries and territories

Percentage of livebirths in 2012 registered by 1st birthday

Somalia

3

Liberia

4

Ethiopia

7

Bangladesh

9

Zambia

13

Chad

13

Guinea-Bissau

14

United Republic of Tanzania

15

Nepal

19

Pakistan

21

 

 

MEDIA CONTACT

Rida Turabi
Department of Public Affairs
Aga Khan University
rida.turabi@aku.edu
+92 21 3486 2931​​

STAY INFORMED

Follow AKU’s social media sites, news feeds.