Each year, four 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%) occur in low- and middle-income countries, but most research and funding focuses on high-tech care for the 1% of deaths occurring in rich countries.
The greatest risk of death is at the beginning of life: three-quarters of all neonatal deaths (three million) occur within one week of birth, and at least one million babies die on their first day of life, many at home without any formal healthcare. Moreover, almost 40% 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 primarily on the mother. Prevention of newborn deaths has thus dropped between the cracks of programs focusing on mothers and on 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% and 72% of neonatal deaths could be prevented if simple interventions were provided effectively where they are needed most. In other words, up to three 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 reduces costs further.
Saving lives requires that mothers and babies in the highest-mortality countries 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% of women deliver with skilled care; in South Asia, the figure is less than 30%. Latin America and Southeast Asia have rapidly increased coverage, but at the current rate of progress in Africa, 50% 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 to 1% 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.
The additional cost of maintaining essential newborn health interventions at 90% coverage in the 75 countries with the highest mortality is estimated to be a mere $4.1billion per year. This would supplement current spending of $2 billion, only about 30% of which is for interventions specifically aimed at newborns, while the majority is for interventions that also benefit mothers and older children.
Even with a weak health system, it is possible to achieve measurable mortality reduction. But the world needs to act now to generate the political will and financial resources needed to save the lives of up to three million babies who die each year simply because they are born without the basic care that is their right.
Indeed, to continue to fail the world’s at-risk children is to deliver a verdict of wanton inhumanity against ourselves, for we are a knowing party to an entirely preventable mass destruction of human life.