Lancet Launches Every Newborn series: Where We’ve Been and Where We Need to Go
This week The Lancet released its series: Every Newborn. The publication was purposefully timed concurrently with the Sixty-seventh annual session of the World Health Assembly (WHA) in Geneva. The WHA sets priorities, policies and budgets for the WHO and newborn health champions want to make sure that the newborn is not forgotten this year.
The last Lancet series that focused on newborn health, specifically neonatal survival, was in 2005. Nine years later, progress on newborn health indicators are minimal and sufficient financial and political commitments are still lacking. Neonatal mortality has declined at a much slower rate than both maternal and child mortality in the last ten years. This series recommends a mortality goal of 12 stillbirths and 12 neonatal deaths per 1000 livebirths by 2030. As priorities and targets are developed for post-2015, they need to reflect not only neonatal survival, but health. A healthy newborn means a healthy child.
The five papers that make up the Every Newborn series have a common focus: facility-based care is critical for neonatal health and survival. The majority of neonatal deaths occur in the first 24 hours of life. Access to critical life-saving services for mothers and newborns are often only available in a facility. In the series article, “Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?” the authors estimate that 113,000 maternal deaths, 531,000 stillbirths, and 1.3 million neonatal deaths could be saved annually by 2020 if quality facility-based care could be provided to every mother and newborn. This intervention would cost only USD$0.9 per person per year.
When priorities are set to improve child health and survival, often the newborn is forgotten. One reason for this is that the majority of newborns and almost all stillborn babies are never accounted for—no birth certificate, no sign they ever existed. Often these deaths are viewed as inevitable, even though they are mostly completely preventable. Every year, 2.6 million babies are stillborn with almost half occurring during a mismanaged labor. An additional 3 million newborns die of causes often preventable—infections (0.6 million), intrapartum conditions (0.7 million), and preterm birth complications (1 million). As of 2013, neonatal deaths account for a greater proportion of under-5 mortality than they did in 1990, 41.6% compared to 37.4% respectively.
So if these problems are preventable, why aren’t we preventing them? In the series article, “Health-systems bottlenecks and strategies to accelerate scale-up in countries,” a systematic assessment was done and identified common factors for 2465 identified bottlenecks. These common factors were limited financing, health workforce, and service delivery.
In order to address these bottlenecks the authors suggest a three-pronged solution. First, the skills and numbers of health care workers must increase through workforce planning, task sharing, and incentives for rural health workers. Second, financial resources and systems must be scaled-up such as health insurance, conditional cash transfers, and performance-based financing. Lastly, strong leadership is needed to encourage innovation and community empowerment.
As the WHA convenes and post-2015 targets are developed, make your voice heard amongst champions like Melinda Gates. Join us on twitter and Facebook to join in the conversation and advocate for #EveryNewborn.
Categories: Maternal Health