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Fatalistic outlook on "invisible" newborn deaths obstructs fight against infant mortality

Source: Thomson Reuters Foundation - Wed, 21 May 2014 04:16 GMT
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Filipino mothers rest with their newborns in the maternity ward of a government hospital in Manila, on May 9, 2014. REUTERS/Romeo Ranoco
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DAKAR (Thomson Reuters Foundation) - Every day, 15,000 babies enter and leave the world with no record of their ever having existed, while one in three newborns – more than 45 million babies – do not have a birth certificate by their first birthday, undermining the fight against infant mortality, experts say.

Research published on Tuesday in the Lancet medical journal showed Somalia, Liberia, Ethiopia and Bangladesh registered less than 10 percent of newborns by their first birthday. Chad, Guinea Bissau, Tanzania and Nepal registered less than 20 percent. 

“The lack of recording reflects the world’s acceptance that these deaths are inevitable. This fatalism, lack of attention, and lack of investment are the reasons behind lagging progress in reducing newborn deaths [and stillbirths],” said report author, Joy Lawn, at the London School of Hygiene and Tropical Medicine. 

The research found the rate of reduction in newborn deaths has been about half of that achieved for children under age five. Newborn deaths now account for a larger proportion of under-five child deaths – 44 percent in 2012, compared to 36 percent in 1990.

This week the World Health Organization’s annual decision-making assembly convenes to review the Every Newborn action plan, which is based on the Lancet findings and aims to end preventable deaths for newborns and stillbirths by 2035.

The action plan, which will be officially launched in late June, provides new interim targets for 2030, given that only 20 out of 144 countries are on track to meet the 2015 Millennium development goals on child mortality.

“Having explicit targets to reduce newborn deaths and stillbirths is crucial for saving the lives of mothers and their babies. Targets mean governments can be held accountable for the promises they make,” said Justine Greening, UK Secretary of State for International Development.

INVESTING IN CARE AT BIRTH

Some 3 million maternal and newborn deaths and stillbirths can be prevented each year with proven interventions such as breastfeeding, neonatal resuscitation and kangaroo mother care for preterm babies, as well as the prevention and treatment of infectious disease.

The study found these interventions can be implemented for an annual cost of $1.15 per person. Providing quality care during labour, birth and the baby’s first week would help save mothers and newborns, and prevent stillbirths.

“So far investment targeted to newborn health has been minuscule – nearly half (44 percent) of all deaths in children under five are in the first month of life, yet only 4 percent of donor funding to child health even mentions the word ‘newborn’,” Lawn said.

Without greater investments to improve birth outcomes around the world, by 2035 there will be 116 million newborn deaths, 31 million surviving babies and children with disabilities, and 68 million with lost development potential because of stunting.

South Asia and sub-Saharan Africa are the regions with the highest burden of newborn deaths, with India (779,000), Nigeria (267,000), and Pakistan (202,400) leading the ranks among countries, the report said.

These three countries also have the most births and have exhibited the slowest rates of progress in reducing deaths. In 2012, eight of the nine countries with neonatal death rates greater than 40 for every 1,000 live births were in sub-Saharan Africa; half of these countries were affected by conflict.

Quality care just before and immediately after birth would help avert 41 percent of newborn and maternal deaths. Providing special care for small and sick newborns would avert 30 percent of deaths.

“The increasing number of women who are giving birth at healthcare facilities presents the most immediate opportunity for action. This should clearly be an immediate priority,” said report co-author, Zulfiqar Bhutta from the Aga Khan University in Pakistan.

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