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| To place special emphasis on prenatal and post-natal care, essential obstetric care, and care for newborns, particularly for those living in areas without access to services |
The challenge
Newborns have the highest risk of death among all children. Each day, about 9,000 babies die within the first 28 days of life - the neonatal or newborn period. Most of them are born in developing countries and most of them die at home. Infections, asphyxia and preterm births cause 80 per cent of these deaths.
Improving neonatal survival is essential to achieve the Millennium Development Goal of reducing child mortality, MDG 4. Globally there are 3.3 million neonatal deaths each year, accounting for 41 per cent of all deaths of children under the age of five.
Global distribution of under-five deaths and neonatal deaths by direct cause, 2008
Deaths among children under five Neonatal deaths
Source: Child Health Epidemiology Reference Group (CHERG) estimates, 2010.
The vast majority of newborns – over 3 million every year – die in developing countries. Sub-Saharan Africa and South Asia bear the greatest burden: 80 per cent of all neonatal deaths occur in these two regions.
Most neonatal deaths occur in sub-Saharan Africa and Asia, where neonatal mortality rates are highest
Neonatal mortality rate (per 1,000 live births), by region, 2009
Source: The State of the World’s Children 2011.
Skilled care at birth is essential for the well-being of both mother and child. Furthermore, both must have access to emergency care because rapid response is required in the event of life-threatening complications at birth. For example, postpartum haemorrhage is a serious complication that can kill a woman in a matter of hours, and a newborn who is not breathing at birth could die in a matter of minutes.
Reachable life-saving interventions
Most deaths of newborn babies occur at home, among poor people, and are associated with inadequate maternal health care during pregnancy and childbirth. Lack of maternal health services such as antenatal care and skilled birth attendants are a large part of the problem. A large proportion of the babies who die could be saved with low-tech, low-cost interventions, which would also help save the lives of mothers and prevent stillbirths.
Key interventions for reducing neonatal mortality and morbidity
Source: Darmstadt, G. L. et al., ‘Evidence-based, Cost-effective Interventions: How many newborns can we save?’, The Lancet, vol. 365, no. 9463, 12 March 2005, pp. 977–988.
Cost-effective, feasible interventions for newborns include initiating breastfeeding within one hour of birth, ensuring proper cord care, keeping the baby warm and dry, recognizing danger signs and seeking help, and giving special care to infants with low birthweight.
The best way to ensure a continuum of care from pregnancy through early childhood is by integrating interventions in community-based programmes and linking them to other services within health systems. In addition to the key interventions described above, adequate nutrition for pregnant and nursing women is essential for the well-being of both mother and child.
Efforts to develop a core set of indicators to monitor these newborn care interventions are under way. But more work is needed to finalize these indicators for inclusion in household surveys.
UNICEF addresses newborn health within existing programme areas, such as immunization, nutrition, maternal health, prevention of mother-to-child transmission (PMTCT) of HIV/AIDS, and prevention and control of malaria. The promotion of home-based newborn care has also been recently recommended jointly by the World Health Organization (WHO) and UNICEF as a strategy to improve survival.
Home visits for care of the newborn
WHO and UNICEF recommend that care be provided by a skilled attendant during and immediately after birth, irrespective of where the birth takes place. When appropriate, home visits can deliver effective elements of care to newborns and increase newborn survival. This strategy has shown positive results in high-mortality settings by reducing newborn mortality and improving essential newborn care practices.
During home visits the following key interventions should be supported and promoted:
• Early and exclusive breastfeeding
• Assistance to keep the baby warm – promotion of skin-to-skin care contact
• Umbilical cord and skin care
• Assessment for danger signs and counselling on their prompt recognition and care seeking by the family
• Birth registration and timely vaccination according to national schedules
• Identification and support to newborns who need additional care (low birthweight, mother HIV-infected); if possible, provision of home treatment for local infections and feeding problems
As the core principle underlying maternal, newborn and child health is to deliver a ‘continuum of care’, indicators related to newborn health should be seen within this context.
Continuum of care: Coverage of key neonatal survival interventions in the developing world, 2009 or latest period available
Notes: * Calculated for total low- and middle-income countries. ** The aggregate value for intermittent preventive treatment of malaria refers to Africa only.
Source: UNICEF global databases, 2011.
References
The Lancet Neonatal Survival Series, March 2005.
The Partnership for Maternal, Newborn and Child Health.
Countdown to 2015 Decade Report (2000-2010) with country profiles: Taking stock of maternal, newborn and child survival, WHO and UNICEF, 2010.
Child Health Epidemiology Reference Group of WHO and UNICEF, ‘Global, Regional, and National causes of Child Mortality in 2008: A systematic analysis’, The Lancet, vol. 375, no. 9730, 5 June 2010, pp.1969–1987.
WHO/UNICEF Joint Statement, Home Visits for the Newborn Child: A strategy to improve survival, WHO, 2009.