Yesterday, the Lancet released its Every Newborn series, presenting the most up-to-date picture on progress and remaining challenges on decreasing newborn and maternal deaths around the world. The series continues from Lancet’s Neonatal Survival series, which was released in 2005, and is comprised of five papers:
- Who has been caring for the baby?
- Progress, priorities, and potential beyond survival
- Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?
- Health-systems bottlenecks and strategies to accelerate scale-up in countries
- From evidence to action to deliver a healthy start for the next generation
The Series lays out the grim reality of newborn and maternal health and survival. Progress has been achieved – since 1990, under-5 and maternal deaths have been halved globally largely due to the Millennium Development Goals – but despite the progress, 2.9 million newborn babies die and 2.6 million are stillborn every year. Though maternal mortality rates have declined 45% since 1990, there still were an estimated 289,000 maternal deaths in 2013 – nearly 800 per day. The issue of newborn and maternal mortality remains a largely unfinished agenda, and an issue that deserves and gravely needs more global attention and prioritization urgently.
According to the data presented in the Series, preterm births continue to rise, and while under-5 mortality has received notable attention globally, the issue of stillbirths remains largely ignored and invisible. In addition, as highlighted in the series,
Most newborns and nearly all stillborn babies enter and leave the world without a record of their existence
This means that most of the babies who lose their lives within the first 28 days after birth and almost all stillborn babies are never registered, and never receive birth certificates. Additionally, preterm babies are less likely to be counted or registered, even in wealthy countries. This points to low expectations towards the babies’ survival, and social acceptance towards neonatal and stillborn deaths as something that is inevitable and maybe even a natural part of life. Women’s and babies’ lives are too often viewed as expendable, and these deaths treated as unpreventable – but, as stated by Professor Bhutta, one of the Series’ authors:
Our research shows that three million lives can be saved by 2025 if achievable interventions are scaled up to nearly universal coverage, and improving care at the time of birth gives a triple return on investment saving mothers, newborns and stillbirths.
The Series presents several concrete suggestions for dramatically improving the health and survival of mothers and newborns around the world, drawing also from the Every Newborn Action Plan. The fifth paper in the Series presents a path towards action, underlining the importance of the following shifts that need to take place at global, national and local levels:
- Intensification of political attention and leadership
- Promotion of parent voice, supporting women, families, and communities to speak up for their newborn babies and to challenge social norms that accept these deaths as inevitable
- Investment for effect on mortality outcome as well as harmonisation of funding
- Implementation at scale, with particular attention to increasing of health worker numbers and skills with attention to high-quality childbirth care for newborn babies as well as mothers and children
- Evaluation, tracking coverage of priority interventions and packages of care with clear accountability to accelerate progress and reach the poorest groups
Maternal and newborn deaths are not inevitable – and they are never, ever acceptable. Low cost and low-tech solutions can have a huge impact on child and maternal survival. As noted by one of the Series’ authors, Professor Joy E Lawn,
The fact that a vast majority of these [stillbirths and newborn] deaths – which have a huge effect on the women and families involved – are never formally included in a country’s health registration systems signifies acceptance that these deaths are inevitable, and ultimately links to inaction.
There’s simply no more time for inaction, because every day that passes means hundreds of women lost to preventable maternal deaths, and thousands of newborn deaths and stillbirths that could have been avoided. Research shows that the day of the birth is often the most dangerous for both the mother and the baby. The day of a child’s birth should be the happiest, most joyous and miraculous day for the mother, the baby and the other parent – and it should never, ever end in the untimely death of the mother or child.
Without healthy mothers and healthy babies, we cannot build healthy and prosperous societies. If protecting and saving the lives of mothers and babies isn’t worth all of our energy, time and attention – I really don’t know what is.
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