By Professor Joy Lawn, MARCH Centre Director
Newborns are newborn on the global agenda; yet over 5,000 newborn deaths could be prevented every day.
2.6 million newborn deaths happen every year, 7000 per day. For the first time in history we have a specific goal in the SDGs for newborn survival – that every country should reach a neonatal mortality rate (deaths in the first 28 days) of 12 or lower by 2030. The analysis for this goal came from our analyses in the Lancet #EveryNewborn series, and associated consultations in over 20 countries and all major regions led by WHO and UNICEF.
Data tell us that the main causes of newborn deaths are prematurity, birth complications and infections. Evidence shows that over 75% could be prevented with evidence-based care, especially at birth and for small and sick newborns. For the first time in history we can change this silent epidemic of deaths because now almost 80% of the world’s births are in hospitals where we can reach families with care, and innovations exist to allow rapid progress. There are few global health issues with such a high burden, yet so much potential for major impact, particularly if we shift gears to provide comprehensive newborn care.
Since newborns are still newborn on the global agenda, the big gap is for leadership and investment which is why I support UNICEF’s global petition demanding that world leaders prioritize quality healthcare for every mother and baby. This is the first time ever that UNICEF, led by Executive Director Henrietta H. Fore, have launched a global campaign focused on the newborn, and as a global leader in child health and survival, we are delighted that they are now taking a lead role in speaking up for the world’s most vulnerable citizens.
Looking back, this campaign has been over 30 years in gestation. The first “child survival revolution” was led by UNICEF and Jim Grant in the 1980s and 90s and placed child survival on the agenda of global leaders, particularly focused on immunisation. In the 2000’s and during the MDG era we witnessed a second phase of great progress for child survival with major reductions in child deaths from infections, notably malaria and diarrhea and to a lesser extent for pneumonia. To make more progress for child survival we must now apply that same level of investment and innovation to newborn deaths as almost HALF of child deaths are now for newborns. Preventing these (and also maternal deaths and stillbirths) means we must shift to universal health care with protected access to care for every woman and her baby, especially those who may face catastrophic costs if they have complications.
The Lancet #EveryNewborn series papers showed the data and evidence for quality care at birth as the time when most deaths occur and when most lives can be saved, and long-term disabilities averted. This strategy requires responsive health systems that are equipped with lifesaving commodities and staffed with health workers who can deliver high quality and timely skilled care, including emergency obstetric care and interventions for small and sick newborn babies.
But with only twelve years to go to reach SDG 3 and significantly reduce newborn mortality rates across the globe we still face many challenges. Over 30 countries, especially in Africa, need to more than double their rates of progress in order to achieve the target of 12 or less deaths per 1000 births. Newborn Essential Solutions and Technologies (NEST360) has been developed to half newborn deaths in hospitals with a package comprising of 17 affordable technologies and systems inputs. LSHTM measurement experts are working with Malawian, Tanzanian and American clinicians, biomedical engineers and business experts to make NEST360 a reality, leading to rapid change in under a decade.
The UNICEF #EverychildALIVE campaign is a positive step in the right direction and could be the beginning of a new child survival revolution that includes the newborn. We have been looking forward to this day since the first Lancet Newborn Survival series in 2005. More recently, The Lancet Every Newborn Series led to the Every Newborn Action Plan, which provides a road map of strategic actions for ending preventable newborn deaths and stillbirths. The #EveryNewborn plan, developed within the Every Woman Every Child framework, was endorsed by 194 member states of the World Health Assembly and was guided by the advice of experts and partners, including LSHTM researchers. Since 2014 great strides have been made towards reducing newborn mortality and we have witnessed active uptake and implementation of the Every Newborn Action Plan in more than 50 countries, with UNICEF playing a critical leading role in the process.
Newborns are a litmus test for universal health cover. A clear indicator of health cover effectiveness for the world’s poorest, as they can die within minutes of being born, and are often left out of insurance schemes.
Birth is a key moment for lifelong health and development and should be a time of celebration and joy for women and their families, but unfortunately for many it is a time of sadness. To end preventable newborn deaths we need a major push, now is the time and I look forward to leadership from UNICEF and countries around the world.
Follow Professor Joy Lawn on Twitter @joylawn