A first ever Every Newborn Action Plan was endorsed by the 194 member countries that make up the World Health Assembly, an annual gathering hosted by the UN’s World Health Organization. The event held in Geneva last week saw advocates, including Melinda Gates, ply pressure on countries to take action on the issue of newborn health.
Right now, three million newborns die each year. Another 2.6 million infants are stillborn. There are some 75 countries who are performing poorly on newborn health, but almost half of all the deaths are concentrated in India, Nigeria, Pakistan, China and the Democratic Republic of Congo.
“The world is saving newborns at a much slower rate than children under five,” said Melinda Gates to the gathered delegates. “Progress requires working with other government officials, not to mention the private sector, civil society, religious organizations, and community leaders. And winning allies requires making a case that newborn health is more than just one priority among many.”
Her remarks followed the release of a newborn-focused collection of research and commentary in the British medical journal The Lancet. The researchers determined that nearly 3 million newborn deaths could be averted each year, by 2025. Doing so will require better health coverage, the scale up of known solutions, better data on births and deaths, and more attention on newborn health itself.
“What the data shows is that 71% of newborn deaths can be prevented,” said Joy Lawn, professor of maternal, reproductive and child health at the London School of Hygiene and Tropical Medicine, to Humanosphere. “It is not appropriate when 40% of child deaths are are during the neonatal period, but only 4% of funding mentions it.”
Nearly half of maternal and newborn deaths occur in the twenty-four hours that follow birth. Interventions taken as early as possible will help prevent many of the deaths. The good news is that many of the solutions are known and they are not complicated.
Examples of what works include supporting the nutrition of pregnant women, giving birth with a skilled birth attendant, chlorhexidine cord cleansing and kangaroo care (skin-to-skin contact between mother and child following birth). The application of chlorhexidine to the umbilical cord, following birth, can alone cause a 23% reduction in risk of neonatal mortality, say the researchers. All that can be accomplished for a few cents per child. However, few babies are receiving the extremely cheap care.
Another hurdle is the registration of births. Half of the babies born around the world do not have a birth certificate, meaning roughly 45 million children reach the age of one with out an official documentation of their birth. More troubling is the fact that 5.5 million babies die each year without a birth or death certificate. These children essentially do not count, as far as health facilities, health professionals and governments are concerned.
Lawn knows of the importance of a birth certificate, personally. The British pediatrician was born in the “bush of Uganda.” Her parents only had a piece of paper to record Lawn’s birth, but no birth certificate. They had to use that document as proof in order to register and record the birth of their daughter, Joy.
“The first obvious thing is if you are born in a health facility, you should get a birth certificate,” said Lawn, who remained optimistic. “The news out of this series is not doom and gloom, it is a big number that must be reduced.”
Reducing newborn deaths will require more investments from governments and donors. The research by Lawn and her colleagues determined that it would cost some $5.65 billion per year by 2025 to achieve the reality of nearly 3 million lives saved each year. She says that at roughly $1,900 per life saved, the cost falls well below the World Bank’s threshold for a cost-effective investment.
Another significant barrier is a lack of data. The data about health coverage is worse than that of worse than the births and deaths data, said Lawn. Knowing so little about what is being done makes it difficult to know what actions should be taken and what is working.
“Clearly, you will have trouble scaling up things that we do not have coverage data on,” said Lawn.
She also challenged herself and her fellow researchers to look beyond the health data, when it comes to newborns. A less explored topic is the socio-political influence on health outcomes. How do certain governance factors play a role on public health? Rwanda is a standout country, having managed to rebuild its health systems in the two decades following a genocide. It’s health systems benefit in part from the fact that it is led by the autocrat Paul Kagame.
Conversely, Malawi has struggled on the area of leadership and governance, but has managed to make giant health improvements. Over the past 20 years Malawi has been the largest reducer of newborn deaths in Sub-Saharan Africa. Progress can be achieved despite challenges of governance, but more needs to be know about what works in what circumstances.
“All of us have not done a good enough job at understanding why you have one country and you go over across the border and you have utterly different conditions. And it is not just about governance,” said Lawn.
Despite the positive sign that the World Health Assembly plan on newborn health was endorsed by member countries, progress remains slow. Lawn says that the UK’s Department for International Development, where she has served as an adviser, recognizes that most of their investments are in maternal health and family planning. There is talk about more focus on newborns, but action has been sparse.
The remarks by Melinda Gates at the assembly are an encouraging sign for newborn health advocates. The co-founder of the Gates Foundation made a public splash in 2012 with the London Summit on Family Planning. In the run up to and at the event Gates said that contraception is not a controversial topic. She campaigned for filling the family planning gap for 120 million women and girls in the world’s poorest countries by 2020. It helped galvanize attention to the issue. Lawn hopes that the newborn push will finally bring the same level of attention to yet another under-served population.