Addressing Critical Knowledge Gaps in Newborn Health

Blog

By Amy Boldosser-Boesch on May 22, 2015
Cameroon, Malawi, Peru


Panelists give remarks at the Sharing Strategies for Integrating Maternal and Newborn Care: Strengthening the continuum side event in Geneva. Photo: PMNCH

This blog was co-written by Amy Boldosser-Boesch, Interim President and CEO of Family Care International (FCI) and Mary Kinney, Specialist with Save the Children, Saving Newborn Lives.

The global health community gathered on Tuesday evening, May 19 to recognize the importance of integrating maternal and newborn care and to celebrate the release of the Every Newborn Action Plan (ENAP) Progress Report May 2015 and Strategies Toward Ending Preventable Maternal Mortality (EPMM). The side session at the 68th World Health Assembly Integrating maternal and newborn care: Strengthening the continuum was standing room only as a panel of champions for integration of maternal and newborn health took the stage. Co-sponsored by the Governments of Malawi and Cameroon, this event was planned with the support of a wide range of partners.*

Opening the event, Rajiv Bahl, Acting Director MCA, WHO, noted the how the unacceptable levels of maternal and newborn mortality and stillbirths impede the realization of healthy and sustainable societies. Yet 15 of the 18 countries, with the greatest burden of deaths and mortality rates, have taken concrete action. As moderator, Robin Gorna, Executive Director of the Partnership for Maternal Newborn & Child Health, underlined the importance of hearing from countries on success factors particularly through improving the quality and coverage of care through integrated strategies and programmes. She reflected on the synergies between these two strategies advancing efforts: ENAP discussed and endorsed at the World Health Assembly in 2014; and the EPMM launched this year at World Health Assembly.


The Minister of Health of Cameroon, Mr. André Mama Fouda, the Minister of Health of Malawi Ms. Jean Kalilani and the Minister of Health of Peru Mr. Anibal Velásquez Valdivia spoke at the side event. Photo: PMNCH

Three Ministers of Health shared perspectives on how implementation of the Every Newborn Action Plan together with maternal health interventions had improved health outcomes for mothers and babies in their countries. Cameroon’s Minister of Health, André Mama Fouda, noted that improving newborn health and preventing stillbirth is integrally linked to improving women’s health throughout the lifecourse. The Minister raised one of the key themes of the evening-the role of midwives in providing these essential, quality and integrated maternal and newborn health services. He noted he was happy and proud that new midwives were being trained in his country. Malawi’s Minister of Health, Jean Kalilani, highlighted efforts to increase access to family planning, reduce the age of marriage, and address cervical cancer as key strategies to reduce maternal mortality. These strategies will be linked to Malawi’s soon to be launched national Every Newborn Action Plan, developed in response to the government’s realization that Malawi was leading the world in pre-term births. Peru’s Minister of Health, Aníbal Velásquez Valdivia, discussed his country’s Comprehensive Health Insurance Scheme, which includes free access to basic health care for children younger than 5 years and for pregnant women, while giving priority to vulnerable populations living in extreme poverty.

UNFPA, UNICEF and WHO representatives then shared how they are working across the continuum of care to strengthen care for women, newborns and children. Her Royal Highness Princess Sarah Zeid noted that over half of all maternal, newborn and child deaths occur in fragile and humanitarian settings, and the need for urgent action to provide quality care to women and babies in those settings. Calling for every birth to be counted, she also made a plea for greater attention to stillbirths and the enormous impact on women and communities. While panelists and audience members shared the specific perspectives from across governments, donors, healthcare professionals, advocates and youth, the core message was strikingly the same: health outcomes for mothers, their newborns and children are inextricably linked but strategies and programs to improve RMNCH are often planned, managed and delivered separately, and this must change. Kate Gilmore, Deputy Executive Director of UNFPA, called for an end to fragmented programs that separate the mother and child and challenged all in attendance to finally put women and children at the center of all development programs. Nina Schwalbe, Principal Adviser, Health, UNICEF, reminded us that we can’t take care of the child if we don’t take care of the mother.


Kate Gilmore, Deputy Executive Director of UNFPA makes remarks during the side event. At right is Her Royal Highness Princess Sarah Zeid of Jordan. Photo: PMNCH

Concluding the session, Marleen Temmerman, Director RHR, WHO, used photos of the reality on the ground as a sobering reminder that ending preventable maternal and newborn deaths and stillbirths requires action now by everyone, everywhere.

As we prepare for the launch of the new Global Strategy for Women’s, Children’s and Adolescents Health and the Sustainable Development Goals, there is an increased focus on reaching every woman, newborn, child and adolescent everywhere. The event, and the ENAP and EPMM strategies, demonstrate the importance of an integrated approach to improving quality services, a growing commitment to work and investment across the continuum of care, and propose complimentary targets to get us there. As a global health community success will rely on supporting an integrated approach in research, policies, health services, and advocacy for maternal and newborn survival — one that helps to finally put an end to the preventable deaths of women and their babies.

*Supporting partners included:

By Leith Greenslade on May 20, 2015
Africa, Asia

The news that a handful of corporations comprised 40 percent of the new commitments made at the launch of the Every Newborn Action Plan in 2014 caught the attention of many in the global maternal and child health community. As a neglected area of global health - why was newborn survival attracting such corporate interest?

Less than one year later, on May 14th 2015, the first report to attempt to capture the full scale of corporate investments in newborn survival was released, revealing 48 companies and associations with substantial investments in newborn heath and development across 70 countries.

The Ultimate Investment in the Future: Profiles of Corporate Engagement in the Health and Development of Newborns, a joint-venture of GBCHealth and the MDG Health Alliance in support of the UN Secretary-General’s Every Woman, Every Child movement, profiles 48 corporate newborn investments in an easy-to-read digital format, describing each commitment, its geographic impact and its relation to one or more of the five strategic objectives of the Every Newborn Action Plan.

Companies profiled range from the largest multinationals to start-up social businesses from the pharmaceutical, healthcare, banking, consumer goods, energy, food and beverage, communications, tourism, materials, retail and technology sectors. All of them are investing time, money and talent in preventing, diagnosing and treating the major causes of newborn death and disability.

The report finds that the majority of corporate commitments profiled are well aligned with the first three strategic objectives of the Every Newborn Action Plan to target investments in childbirth and the first week of life (1), to improve the quality of care (2), and to improve access to care for the most vulnerable women (3). In contrast, corporate investments to harness the power of parents, families and community (4), and to improve vital registration of births and deaths and general data quality (5) are lacking.


Photo: © ayzh

Newborn deaths and stillbirths now comprise the single largest reservoir of mortality in the world, responsible for an estimated annual 2.8 million newborn deaths and 2.6 million stillbirths. Seven out of every ten deaths now occur in just 15 “hotspot” countries - India, Nigeria, Pakistan, China, the Democratic Republic of Congo, Ethiopia, Bangladesh, Indonesia, Angola, Kenya, Tanzania, Afghanistan, Sudan, Uganda and the Philippines.

Company investments profiled in the report are generally well-targeted to several of the hotspot countries but more investment is needed in other high burden centuries, especially Pakistan, the Democratic Republic of Congo, Indonesia, Angola, Afghanistan and Sudan.

During the launch of the report, hosted by the UN Foundation, 10 companies whose work is profiled were invited to share details of their flagship newborn investments, including ayzh, Chevron, GlaxoSmithKline, Johnson & Johnson, McCann Health, Masimo, Medela, Novo Nordisk, and Philips.

Newborn investments by these companies range from reducing the risks of diabetes in pregnancy (Novo Nordisk), infection at the time of birth (ayzh), and mother-to child-transmission of AIDS (Chevron), to developing better medicines and devices to prevent, diagnose and treat the leading threats to newborn health including pulse oximetry (Masimo), fetal monitoring (Philips), breastfeeding supportive technologies (Medela), and chlorhexidine for umbilical cord care (GSK).


Photo: © designthatmatters

Other companies are investing to strengthen health systems by training birth attendants and midwives (Sandoz), and community health workers (J&J), and transforming the quality of communications to educate and empower women and their families to make better health decisions and health workers to provide better care (McCann Health). Several companies are active across all of these areas simultaneously.

Many of these companies are members of the Every Woman, Every Child movement - a growing and desperately needed multi-stakeholder movement to advance the health of the world’s most vulnerable women, newborns, children and adolescents and achieve global development goals. Newborns are a particular priority as only seven countries have managed to reduce newborn deaths to the levels required by the Millennium Development Goals and in 25 countries newborn deaths have actually risen since 1990, 22 of them in Africa.

As a result of the slower progress, newborn deaths and stillbirths now comprise 60 percent of all child deaths and are the major barrier to achievement of the new Sustainable Development Goal to end preventable child deaths by 2030, which will be officially launched in September 2015.

The great value of The Ultimate Investment in the Future: Profiles of Corporate Engagement in the Health and Development of Newborns is that it demonstrates the impact that corporations are having on newborn health and development and the vital role the private sector will continue to play in the implementation of the Sustainable Development Goals. The report identifies the areas where additional investments are needed - both the focus areas and the countries - so that companies can deepen their impact on newborn lives saved.

But perhaps most importantly the report will facilitate greater collaboration for newborn health and development by inspiring corporate actors to join forces with other stakeholders for greater impact. Increasingly, the United Nations, governments, non-government organizations and civil society can learn from these corporate investments and discover new and more cost-effective ways to support their expansion.


Photo: © BHP Billiton

 

Special thanks to Nisa Patel from GBCHealth and Natalie Africa from the UN Foundation for their thought leadership and partnership in the conceptualization, execution and dissemination of The Ultimate Investment in the Future: Profiles of Corporate Engagement in the Health and Development of Newborns and to Zubaida Bai from ayzh, Carol McCauley from Chevron, Pauline Williams from GSK, Joy Marini from Johnson & Johnson, Joe Kiani from Masimo, Andrew Schemer from McCann Health, Jan-Willem Scheijgrond from Philips, Fiona Cook from Sandoz, Paul Bolla from Medela, and Charlotte Ersbøl from from Novo Nordisk for their participation in the launch.

Leith Greenslade is a Vice-Chair at the MDG Health Alliance, a special initiative of the Office of the United Nations Special Envoy for Financing the Health Millennium Development Goals to accelerate achievement of the health-related MDGs by mobilizing governments, non-government organizations, academic institutions and corporations to accelerate global progress in support of Every Woman, Every Child, an unprecedented movement spearheaded by the United Nations Secretary-General to advance the health of women and children.

By Rima Jolivet on May 18, 2015

This blog was originally published by the Maternal Health Task Force. Written by Rima Jolivet.

In an important development for the global maternal health community, the long-awaited Strategies toward Ending Preventable Maternal Mortality (EPMM) will be launched at the 68th World Health Assembly, at an event hosted by Cameroon and Malawi and co-sponsored by the contributors to the Every Newborn Action Plan.

This event marks the culmination of over two years of consensus work and collaboration with multiple stakeholders that began in January 2013. The EPMM Working Group—led by the WHO in partnership with MHTF, UNICEF, UNFPA, USAID, Family Care International, Maternal Child Survival Program (MCSP), and White Ribbon Alliance—has stewarded the process to gather key inputs and consult widely with a broad range of stakeholders to develop the ambitious yet feasible targets for ending preventable maternal deaths within a generation, and to identify the strategic priorities and actions necessary for achieving this vision. The strategies are presented in full in the EPMM report that has been recently published by the World Health Organization. The EPMM targets were included as part of the Every Newborn Action Plan resolution at last year’s World Health Assembly.

The EPMM targets and strategies are grounded in a human rights approach to maternal and newborn health, and focus attention on eliminating significant inequities that persist, resulting in disparities in access, quality, and outcomes of care within and between countries. The strategy emphasizes effective planning for high-functioning maternal health systems that are equipped to identify the immediate and underlying causes of maternal deaths and to develop evidence-informed, context-specific programme interventions to avert future deaths.

Both the EPMM and ENAP strategies informed the technical working paper on “Effective Interventions and Strategies for Ending Preventable Maternal and Newborn Mortality and Stillbirths”, which fed into the updated United Nations Secretary-General’s Global Strategy for Every Women’s, Children’s and Adolescent’s Health. This technical paper is slated to be published in the British Medical Journal as part of a series of papers that support the Secretary-General’s updated strategy. The “zero draft” of the full “Global Strategy 2.0” is currently open for public comment, through June 5, 2015.

The EPMM Strategy will be launched in conjunction with the one-year anniversary of the passage of the Every Newborn Action Plan resolution and with it the launch of the ENAP Progress Report. To mark the occasion of these significant achievements, an event at the 68th World Health Assembly will showcase a combined strategic approach using the EPMM and ENAP frameworks to accelerate progress and feature examples from country champions of successful models of integration at national policy and point-of-service levels.

By Melinda Cruz on May 15, 2015
Australia, Colombia, Sweden

Kangaroo Care with my middle son Dillon at 10 days old. Photo: Miracle Babies Foundation

This blog was originally published in LinkedIn. Written by Melinda Cruz and co-written by Naomi Rohr.

International Kangaroo Care Awareness Day - click here for photos and activity across the day.

Kangaroo Care - yes it has a cute name and yes, it provides some of the most beautiful pictures you’ll ever see but Kangaroo Care for premature and sick babies has immeasurable health benefits for both baby, mum and dad and everyone needs to get on the bandwagon.

So what is it? Kangaroo Care is the act of holding a preterm baby skin to skin.

A premature baby’s body is simply not yet ready for the physical world. Everything our body automatically does and we take for granted is an almost impossible struggle for a baby born weeks before it is due and they need all the help they can get. Their tiny fragile bodies need help to breathe, regulate body temperature and accept feeds, and their tiny bodies need to rest as much as possible.

Mother Nature already provides the perfect method to tackle all these needs and more. A method that completely compliments modern medicine and best of all, it’s free. So, why are we not seeing more of this?

The concept is not new. Kangaroo Care was encouraged in the late 1970's in an effort to reduce the high death rate (70%) of preterm babies being seen in Bogota, Columbia. Babies were dying from respiratory problems, complications due to infection and a lack of human contact. Studies found that babies who were held skin to skin with their mothers for long periods during the day, not only survived, but thrived.

And this is echoed by many other studies right around the world that have demonstrated the many benefits of Kangaroo Care. Here are just some.

Kangaroo Care:

  • regulates baby’s heart and breathing rates
  • maintains baby’s body temperature
  • earlier hospital discharge
  • improves oxygen saturation levels (which indicates how well oxygen is being delivered to the baby’s organs and tissues)
  • decreases incidence of infections
  • has positive effects on brain development
  • encourages baby to spend more time in a deep sleep
  • increases baby’s weight gain
  • babies are alert for longer periods
  • improves breast milk production, promotes frequent breast feeding, and increases the chance of successful breastfeeding
  • builds parental confidence
  • increases parental bonding and closeness with their baby and can ease feelings of separation and depression.

And did we mention that it’s not just for mums … dads can (and should) do it too. Having a baby born early or sick is one of the most heartbreaking and traumatic times a parent can go through. There are so many aspects of the entire experience that are removed from the fairy tale you imagine, so when parents are provided with the knowledge that they have the power to positively contribute to their baby’s outcome, the whole experience can change. A win for everyone.

In the recently published Every Newborn Action Plan coordinated by UNICEF and the World Health Organisation, Kangaroo Care was listed alongside breastfeeding as one of the top methods of helping to reduce the global death toll of babies born premature and while there are differing opinions on whether we do it well for a developed country like Australia, we still have a long way to go to meet the gold standard of Kangaroo Care in action at a neonatal unit in Uppsala, Sweden. The unit at The University Children’s Hospital, Uppsala oversees the provision of continuous Kangaroo Care throughout the baby’s entire hospital stay where the parents continuously hold their baby 24/7. The hospital supports their philosophy to keep parents and their babies together at all times in many ways including offering specially designed clothing to allow baby’s to receive Kangaroo Care and parents be mobile at the same time, to providing procedures such as blood tests and inserting naso-gastric tubes whilst being held in safety and comfort against their chests of their parents.

Today on International Kangaroo Care Awareness Day, Miracle Babies Foundation launched Australia’s first Kangaroo-a-thon. Our goal, is to encourage all the Neonatal Intensive Care Units (NICUs) and Special Care Nurseries across the country to actively promote Kangaroo Care and log as many hours of Kangaroo Care holding (including modified holding) in a 2 week period. The Foundation would like to see as many hours of brain developing, neuro-protective, attachment building, and immunity boosting good times and are pleased that so far more than 10 units have taken up the challenge.

You can follow their progress in the coming weeks online at miraclebabies.org.au And, as for some of most beautiful photos you’ll ever see, jump onto social media using #kangarooathon #miraclebabies and #kangaroocare. You’ll be blown away.

It is not a magic bullet, we know that, but we should be allowing Mother Nature to help increase a premature or sick baby’s chance for a survival and better outcomes. The perfect complement to the amazing care our babies are already receiving.

Kangaroo Care – cute name, beautiful photos, life-saving.

By Summer Aronson on May 13, 2015
Haiti

Photo: Midwives For Haiti

This blog was originally published by Midwives For Haiti. Written by Summer Aronson.

Each day, 800 mothers in the world die from mostly preventable causes during pregnancy or childbirth and 99% of these deaths occur in developing countries. In other words, it is mostly the poorest women in the world who die from causes that we know how to prevent.

In Haiti, where the maternal and infant mortality rates are highest in the Western Hemisphere, mothers face three critical barriers to maternal care: lack of prenatal care, lack of transportation, and lack of skilled birth attendants. These barriers are acutely critical for rural women. Midwives For Haiti’s Mobile Prenatal Clinic address all three.


Photo: Midwives For Haiti

The Mobile Prenatal Clinic visits twenty remote villages in the Central Plateau of Haiti. The midwives carry their supplies and medications in old suitcases, which are strapped atop an all-terrain vehicle, and travel up to two hours over rutted roads, rivers, and streams to reach the women who would otherwise not have access to care. The team sets up in churches, schools, community buildings, or sometimes under a tree, and gets to work while expecting and newly delivered mothers wait patiently for the health care they know will make a difference for themselves and their babies surviving childbirth, or not.

Every Haitian mother knows a woman who has died from pregnancy or birth complications. Magdala Jean, a graduate of Midwives For Haiti who now works on the mobile clinic, says “Too many women are dying in birth. My cousin died because of eclampsia [a treatable complication]. I want women to have loving care and support.” In Haiti, the focus is on survival and hope that mother and baby will live through the many complications that are brought on by poor nutrition, malaria, worms, early hypertension, lack of prenatal care, lack of transportation and a lack of skilled birth attendants.

Photo: Cheryl Hanna-Truscott

By bringing comprehensive prenatal and postnatal care to rural women by skilled, compassionate providers (all graduates of Midwives For Haiti’s training program), the Mobile Prenatal Clinic closes a critical gap in care for very poor women. This care includes providing vitamins and iron supplements, maternal and fetal health assessment, lab testing and treatment for anemia, worms, malaria, sexually transmitted infections and referrals for HIV. Mothers also receive extensive education on the importance of nutrition, breastfeeding, danger signs of pregnancy and when to seek help. Every woman receives a chart and her health is followed throughout her pregnancy. Very ill mothers receive emergency transport to a medical facility.

The project is working. The Mobile Prenatal Clinic provides over 6,000 patient visits annually. Last year alone, the midwives transported 25 mothers for life saving emergency medical care. For the rural women of these 20 remote villages, the care these traveling midwives provide can literally mean the difference between life and death.


Photo: B.D. Cohen

We know how to end preventable deaths of rural mothers and babies. We know that it costs money to bring maternal care to these women. It costs $10 per patient visit to run these clinics in rural Haiti. With solutions like this, it is no longer a question of how, but why? When we hear the statistic that 800 mothers die each day while bringing life into the world, we must remember that it is mostly rural, poor women who are dying. And we need to ask ourselves, are the lives of these women worth saving? Midwives For Haiti has answered with a resounding “Yes.”

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Midwives For Haiti relies on private donations to keep the Mobile Prenatal Clinic on the road all year round. Make a tax-deductible donation by May 29 to help them earn a matching grant and cover the annual cost of this life saving project. Each dollar donated will be matched, please give now.