This post is part of the Maternal and Newborn Integration Blog Series, which shares themes of and reactions to the “Integration of Maternal and Newborn Health: In Pursuit of Quality” technical meeting.
Around the world, countries are achieving Millennium Development Goal (MDG) 4 and 5—to reduce child and maternal mortality—yet we see little change in the number of newborns who die every year. This fact is one that Dr. Dunstan Bishanga, Chief of Party for USAID’s Maternal and Child Survival Program in Tanzania, emphasized at the “Integration of Maternal and Newborn Health: In Pursuit of Quality” technical meeting last week when he said, “Looking at MDG 4 and 5,… there is no indicator for newborn, it is assumed that by improving, reducing under-five mortality rate and infant mortality rate you will definitely be addressing newborn health, but this may not be true.” This is a reality he has seen firsthand in his country of Tanzania.
In Tanzania, under-five mortality (U5MR) and infant mortality have decreased by 58% and 56%, respectively, from 1990 until 2010. Projections show Tanzania likely meeting MDG 4 by 2015 with a goal U5MR of 64 and an IMR of 38.
Yet, neonatal mortality—death in the first month of life—has only decreased by 32%, from 38 in 1991 to 26 per thousand live births in 2010. This makes neonatal mortality 32% of the U5MR and 51% of the IMR in 2010, compared to 20% and 33%, respectively, in 1990.
This stalled progress is likely due to low visibility and lack of measurement of neonatal health in the MDGs.
We have seen it in countries like Tanzania, and also in countries like Ethiopia, [MDG 4] has been attained with no progress on newborn health… so what does that tell us? It tells us that we don’t have valid indicators to measure newborn health progress. That’s why we are achieving MDG 4 without attaining the reductions in the targets for neonatal mortality.
Newborn health has often been an “orphan” topic, with neither the child health nor the maternal health community measuring and taking accountability for neonatal mortality. As these weaknesses have been realized, newborn health has taken a spotlight this year with The Every Newborn Action Plan endorsed by the World Health Assembly in May. This action plan lists five strategic objectives:
- Strengthen and invest in care during labour, birth and the first day and week of life
- Improve the quality of maternal and newborn care
- Reach every woman and every newborn; reduce inequities
- Harness the power of parents, families, and communities
- Count every newborn—measurement, programme-tracking and accountability
Inherent, then, in this plan is maternal and newborn health integration. Since the timing and delivery of key newborn health interventions often coincide with both the timing and delivery of maternal health interventions, speaking about maternal and newborn health simultaneously in strategy, implementation, monitoring, and evaluation is logical.
A Paradigm Shift
One way to make the global community accountable for newborn health is to change technical guidance from global entities, which have a tremendous impact on what is implemented at the country and community-level. Bishanga affirmed this impact when he said, “In countries like Tanzania where I come from, often they adapt global technical guidance, and [if] the people that get involved [in global policy] have a paradigm shift, then it is easier to make changes at the implementation level.”
So what might this global paradigm shift look like? Clearly measuring newborn health along with maternal health in the post-2015 development goals. Bishanga shared:
[In] the next phase you know, if it was possible, we need to really see that the newborn, even if it is an integral part of maternal and child health care, it needs to stand out and be measured clearly because that will lead even to the planning and implementation to have concrete and specific interventions that will be affecting the indicator for newborn health and neonatal mortality and enhance having a clear focus and attention to newborn health work.
Global Experts Paving the Way
Identifying a potential need and opportunity for improved maternal and newborn health, the Maternal Health Task Force and Save the Children’s Saving Newborn Lives convened experts at the “Integration of Maternal and Newborn Health: In Pursuit of Quality” technical meeting to address this problem and others related to integration.
Dr. Bishanga attended and shared his reaction to the proceedings of the two-day meeting.
This was a great meeting, I like the fact that it has brought together people from different background; we have people from the field where the programming happens, we have people from donor community, we have people from policy level, from some ministries and the United [Nations] agencies. And I think also we have global experts in terms of maternal health and newborn health. Most of the time you find that these people meet in their own spheres; you have maternal health experts meeting on their own making strategies and newborn experts meeting on their own. But this kind of meeting brought them together. And the most impressive thing is that both groups appreciate… the need to have integrated care for the mother and the newborn. And that is where things start because these are the people that get involved in global policies, global technical documents and all that. If we have contemporated, and all of us do agree that we need this thing to happen in this way, then I believe that it will bring change.