The best and worst places in the world for mothers and children

The birth of a child is usually met with celebrations and joy. But for more than one million mothers around the world every year, it is a day of mourning.

Save the Children estimates that more than one million children die each year on the day of birth. Another two million children do not survive their first month of life, says the 14th State of the World’s Mothers report.


Released around Mother’s Day every year, the report from Save the Children scores countries on the health and safety of mothers. This year, the index calls attention to child survival in addition to maternal health.

Nearly two-thirds of global newborn deaths occur in ten countries. They include larger nations like Nigeria, India, China and Indonesia as well as nations with high infant mortality rates such as Ethiopia, Afghanistan and Tanzania.

“Saving newborn lives will prevent incalculable suffering. It is also a vital piece of the global development agenda,” says Melinda Gates in the report introduction. “Children surviving and staying healthy means more children in school and able to learn, which in turn means productive adults who can drive sustained economic growth.”

Somalia bears the burden of the highest rate of first-day deaths for infants followed by the DR Congo, Mali and Sierra Leone. The same four countries also sit at the bottom of the 2013 Mothers’ Index with DR Congo last, just below Somalia, Sierra Leone and Mali. The links between maternal and newborn mortality are clear and the greatest risk resides squarely in sub-Saharan Africa. All countries at the bottom of the Index are in sub-Saharan Africa.

Newborn deaths falling at a slower rate as compared to child and maternal deaths.

Although the news for the United States is again not so great. European nations take up the top of the index with Australia rounding out the top ten. The United States is responsible for 60% of all first-day deaths, but only 38% of live births. The ranking of 30th puts the United States just ahead of Cuba (33) and behind the likes of Lithuania (26) and Israel (25). It is little improvement over a ranking of 31st in the 2011 index.

Amid the numbers emerges the connection of poverty. 98% of newborn deaths occur in developing countries. Further, the deaths are among the poorest families living in the countries. Better off mothers and children are surviving at much higher rates than their much poorer counterparts. The differences are stark in some countries. A child born in Bolivia to a poor family is 194% more likely to die on its birthday than a child born to one of the richest families. Bridging the gap can save lives.

If all newborns in India experienced the same survival rates as newborns from the richest Indian families, nearly 360,000 more babies would survive each year.

The good news is that many of the deaths are preventable, says the report. Preterm births, severe infections and complications during child birth are responsible for 80% of newborn deaths. Providing appropriate prenatal care to mothers and health services can save the lives of newborns as well as the mothers. A double win.

Reducing newborn deaths can be accomplished by making know solutions available. The report recommends solutions like using chlorhexidine to clean the umbilical cord and prevent infections, as well as providing steroid injections for women who go into pretem labor. A simple injection can help babies breathe, thereby reducing the likelihood of death during birth.

The best and worst places to be a mother

There are even no-cost solutions that can make an immediate difference. Newborns who are exclusively breastfed have a better chance of making it to the important fifth birthday. Coupled with the kangaroo method (providing skin to skin contact with the mother and child), there are ways to prevent newborn deaths. It is a topic that USAID is also taking seriously.

A meeting last year in Washington DC hosted by USAID made a call to action to change the course of preventable child deaths. The Obama Administration is making maternal and child health a priority area. The Fiscal Year 2014 budget released by the White House last month included a 12.3% increase in funding for maternal and child health programs as compared to the FY12 budget. Family planning would also receive a modest 1% boost in the proposed budget.

“We know that the more children’s lives we save, the more families choose to have fewer children. That’s been proven everywhere in the world including in India. And we know that that reduction in total birth rate helps countries achieve more stability and more broad based and inclusive economic growth. So it’s a long-term challenge and a long-term opportunity, said USAID Administrator Dr Raj Shah to the New York Times in March.

Protecting the health of mothers centers around the idea of empowerment, in the report. The authors recommend taking steps to improve the education of women and access to family planning. In both cases, the driver is ensuring that women have the right to choose. Education delays marriage to the point when women are at a point when their bodies can better handle childbirth. Access to family planning provides women the ability to determine when to have children. Choice allows for birth spacing, proven to help improve the health of mothers and their children.

“We must seize the opportunity to invest in this most basic, most enduring partnership – between a mother and her child – if we are to change forever the course of history and reduce newborn deaths,” implores Save the Children USA President and CEO Carolyn Miles.


About Author

Tom Murphy

Tom Murphy is a Maine-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]