A newborn baby at the Lugube Primary Health Center in Nigeria. Photo: PATH/Evelyn Hockstein
On June 30, Pauline Irungu, PATH’s senior policy and advocacy officer in Kenya, took part in the launch of the Every Newborn action plan in Johannesburg, South Africa.
Since the launch of the Every Newborn action plan, I feel more optimistic than ever about the future of newborn health, globally and in Kenya. At the Partnership for Maternal, newborn & Child Health Partners' Forum in Johannesburg last month, I joined hundreds of advocates, each deeply invested in the health of the world's women, children and newborns. We gathered to discuss the final months of the Millennium Development Goals (MDGs) and potential new health targets as the world transitions from the MDGs to the Sustainable Development Goals.
A key goal is to reduce the number of preventable newborn deaths. Over the past two decades, improvements in newborn death rates have failed to keep pace with improvements for older children. There is a growing commitment among the global health community to address this failure, and an understanding of what needs to be done to save these young lives. As a major, worldwide, first step, the landmark Every Newborn action planoutlines a strategy to prevent 2.9 million newborn deaths and 2.6 million stillbirths each year.
Where do we go from here?
Attention to newborn health is especially necessary in sub-Saharan African countries, which are making the slowest progress in reducing newborn deaths. I’ve already seen a dramatic increase in commitment to newborn health in Kenya as global initiatives like the MDGs, the Every Newborn action plan, and the UN Commission for Life-Saving Commodities for Women’s and Children’s Health have raised the profile of newborns and highlighted countries’ lagging progress toward health goals.
Photo: PATH/Evelyn Hockstein
On behalf of PATH, I’ve been collaborating with partners and the Kenyan government to push forward two groundbreaking initiatives. The first is the Maternal and Newborn Health Scale-Up Strategy and Implementation Plan, which is set to become Kenya’s first policy to focus on key interventions for the three leading causes of newborn deaths: prematurity, sepsis, and birth asphyxia. The second is the development of maternal, newborn, and child health legislation that provides a legal framework to prioritize reducing the deaths of women, newborns, and children. Among other key provisions, the legislation will institutionalize the tracking of newborn deaths, which will help Kenya identify—and fix—gaps in its health system.
As a member of the Every Newborn Political Advocacy Working Group, which seeks to coordinate advocacy action and push for country-level policies that support the plan, I am excited to see Kenya make such strong commitments to newborn health.
Photo: PATH/Evelyn Hockstein
Action through innovation
Moving forward, we will need to harness the motivation I witnessed in Johannesburg and direct it toward technological, social, and systems innovations that can contribute to the end of preventable deaths. Kenya, for example, needs creative methods to get all mothers to give birth in health care facilities (40 percent still don’t). We also need inventive ways to keep babies warm in places with limited electricity, to transport newborns from remote locations to health care facilities, to develop technologies to help newborns breathe, and to ensure the financial sustainability of maternal, newborn, and child health services.
Watch Pauline Irungu speak about the importance of innovation for newborn health at the Partners' Forum.
PATH is working on health innovations that promise to drive down newborn and maternal deaths. More than half of premature babies struggle to breathe, which is one of the reasons premature birth is the leading cause of newborn death. PATH is advancing an affordable bubble continuous positive airway pressure device that can save lives by gently flowing pressurized air into babies’ lungs. We’re also working on solutions for postpartum hemorrhage and—two of the leading causes of maternal death. Five of these groundbreaking newborn health innovations will be featured at USAID’s Saving Lives at Birth: A Grand Challenge for Development event from July 30 to August 1 in Washington, DC. These tools will save the lives of newborns as well as women, because babies are less likely to survive when their mothers don’t. According to the action plan, investments in quality care at birth could save the lives of millions of babies and women who die needlessly each year.
Though we—the global health community—have much work to do to end preventable newborn deaths, I am energized about global commitments and the motivating force of the Early Newborn action plan. This motivation will be critical to create real and lasting change for the world’s newborns.
Gadagadei village, in the state of Odisha, is inhabited by Juangs, one of a number of tribal groups in India that are counted as being particularly vulnerable. It is remote, surrounded by forests, and has poor communication and transport links. With limited access to services, Gadagadei village – and many others like it – has suffered the death of newborns and mothers who might otherwise have been saved.
Not all strategies to prevent newborn deaths have to be high-tech. Community interventions that promote simple preventive practises and encourage families to seek treatment at the right time are just as important. Early and exclusive breastfeeding, keeping babies warm, and taking prompt action when faced with a health problem, for example, can make all the difference. Postnatal home visits and participatory women’s groups have been so successful in cutting maternal and newborn deaths that they are being recognised in the World Health Organisation and Unicef’s Every Newborn Action Plan, which renews commitment to reducing newborn deaths and stillbirths.
New impetus is certainly needed: 2.9m newborns die every year, another 2.6m are stillborn, and 289,000 women die annually from complications of pregnancy and childbirth. Most of these deaths occur in low and middle-income countries and, crucially, most can be prevented. Progress has been steady but slow: mortality in children under five fell by almost a half between 1990 and 2012, while mortality in newborn infants fell by 37%. And many of these deaths occur among the poorest families in rural settings like Gadagadei.
A series of studies in India, Bangladesh, Pakistan and Ghana have shown that postnatal visits can reduce neonatal mortality by supporting families to adopt essential newborn care practices and linking them with health facilities when required. And Gadagadei village was one of the villages included in a randomised controlled trial of participatory women’s groups led by Ekjut (in India) in partnership with University College London.
These groups involve a cycle of meetings supported by a female facilitator, in which women identify and prioritise common maternal and newborn health problems, decide on locally appropriate strategies, before putting them into action and then evaluating the results. In the case of Gadagadei, maternal malaria and low birth weight were two key problems facing the mothers and babies.
Once they had identified these problems, they mobilised the community to fill in small bodies of stagnating water where mosquitoes could breed, and conducted peer education to encourage community members to sleep under bed nets. They created a childbirth fund to pay for transport and treatment in the event of an emergency, such as when a woman became infected with malaria. They established a village drug depot, so that group members and other women could access drugs to prevent malaria, and other drugs such as iron tablets and oral re-hydration solution, to address its consequences.
The group also recognised the role of nutrition in preventing the birth of small babies and ensuring good growth. Members established a collective kitchen garden, where they grew seasonal fruits and vegetables for consumption by pregnant women and new mothers. Men also began attending the women’s group meetings. This led them to understand that pregnancy and childbirth were not necessarily only women’s concerns, and to them showing their support by volunteering to perform in a street play about the issue to the entire village and outside visitors.
Initially women in the Gadagadei village group didn’t show much interest in attending because they were busy with daily chores. Discussions about mother and child health were thought unimportant because problems in pregnancy and childbirth are considered routine. But eventually, they began to realise just how many lives could have been saved.
Through collective problem-solving and action, these types of groups have been able to bring down newborn deaths in Gadagadei and many other villages, showing that women are not just passive recipients of health messages, but that their active engagement can make a real difference to survival.
This is backed by research conducted by a number of organisations linked here and over the past decade in places including Nepal, Mumbai, Bangladesh, and Malawi. This has shown that in rural areas where more than 30% of pregnant women attended group meetings, newborn deaths fell by 33% and maternal deaths by 49%.
UCL research estimates that with at least 30% of pregnant women participating, such groups could prevent an estimated 36,600 maternal deaths and 283,000 newborn deaths if scaled up in countries with medium to high mortality rates. Reaching every mother and every newborn starts with a plan, and women must be at the centre of it.
Thanks to Suchitra Rath and Nirmala Nair (Ekjut) for sharing the story of Gadagadai village. The research described in this article was led by the Perinatal Care Project (Bangladesh), MIRA (Nepal), Ekjut (India), SNEHA (Mumbai, India), MaiMwana and PACHI (Malawi), in collaboration with UCL.
Photo: Susan Warner/Save the Children
Joan Constantino,19, left, is measured by community health worker, Nemia Rios while at Save the Childrne's Infant Youth Child Feeding (ICYF) health assessment program in Estancia, Iloilo, Philippines. She is holding her 19-day-old daughter Juriana Rill.
The uptake of Kangaroo Mother Care (KMC) has made the Philippines a regional leader in the intervention, which helps preterm and low birthweight babies. The country has also made steady progress in reducing the child mortality rate since 2009. Despite that, postnatal care for mothers, newborn, and in particular preterm babies, must accelerate.
The new “Unang Yakap” program, meaning First Embrace, is a campaign of the Philippines’ Department of Health (DOH), in cooperation with the World Health Organization (WHO), to adopt the Essential Intrapartum and Newborn Care (EINC) guidelines for the safe and quality care of mothers and their newborns. Once those guidelines have been set in place, the government aims to increase the coverage of quality care services across the country.
Furthermore, the government has been proactive in its involvement in the Every Newborn action plan process. The plan calls for a sharpening of existing country programs and policies which will scale up the quality and coverage of care around the time of birth.
The commitment by the government to scaling up care with new and updated guidelines and action with these two initiatives will only help to improve the health outcomes for mothers and newborns around the time of birth.
In recent years, Cambodia has received international praise for improvements in maternal and child health. The Ministry of Health (MOH), however, has recognized that tremendous challenges still persist in the area of newborn health. In particular, preterm birth—a live birth that occurs before 37 completed weeks of pregnancy—remains a prominent issue due to its direct link with high rates of mortality and morbidity among newborns. With the country’s preterm birthrate at 10.5%1 and a neonatal mortality rate of 27 deaths per 1,000 live births, Cambodia’s MOH has committed itself to improving newborn health and decreasing newborn mortality.
This week, numerous officials from the Government of Cambodia, USAID, MCHIP and other stakeholders attended a national dissemination meeting in Phnom Penh to share the results of an MCHIP supported study that calls for increased coverage of antenatal corticosteroids (ACS) in the management of the country's preterms. ACS are one of the most effective interventions for improving preterm survival, reducing death by 31% by augmenting maturation of the premature fetus’ lungs.
Dr. Tung Rathavy and Dr. Keth Lysotha—Director and Deputy Directory, respectively, of the National Maternal Child Health Center (NMCHC)—were in attendance, along with USAID’s Sheri-Nouane Duncan-Jones (Director, Office of Public Health and Education), and USAID/Cambodia’s Robin Mardeusz (Maternal and Child Health Team Leader, Office of Public Health & Education).
The lessons learned from the intervention have substantial implications for reducing the country's newborn mortality. Directed by the MOH, NMCHC, and the sub-technical working group on maternal child health, the study sought to improve the quality of care given to pregnant women at risk of imminent preterm birth in six different Cambodian facilities. (Human Development Research Cambodia (HDRC) worked closely with NMCHC on local research, and MCHIP provided overall technical support).
The intervention called for increased coverage of dexamethasone—the most commonly found ACS—to these women in order to reduce complications of prematurity among preterm newborns. The drug is recommended for women with preterm labor, because it is known to improve health outcomes for premature newborns by reducing the chances of related complications if administered before birth.
In just a short time (less than one year), the overall coverage rates of dexamethasone in the facilities across Cambodia dramatically increased from 34.9% at baseline to 86.1% at endline. Rapid increase in utilization even took place at facilities that had limited knowledge and use of the drug prior to the intervention. Dexamethasone is inexpensive and widely available in hospitals throughout Cambodia, so with increased guidelines and technical supervision, the neonatal intervention was able to produce substantial results even in the most limited facilities. The coverage was only for those women who were at risk of imminent preterm birth.
These results are promising because they demonstrate that when strong technical leadership and clinical governance in facilities are combined, the ability of simple, evidence-based interventions—such as increasing the rate of administration of dexamethasone—can be effectively scaled up Cambodia. Providers could alter their behaviors and increase utilization because strong buy in from facilities and increased technical support created an environment that was conducive for implementing correct practices.
The dramatic increase in coverage of dexamethasone in such a short period of time is an incredibly encouraging outcome. With continued emphasis on stronger clinical guidelines and additional technical supervision, increases in the utilization of ACS could be replicated more extensively in other facilities within Cambodia. If the MOH sustains its commitment to scale-up the use of dexamethasone and other interventions for preterm birth, major progress towards reductions in neonatal mortality and morbidity are possible.
This blog was originally published on World Moms Blog. Elizabeth Atalay traveled with the International Reporting Project on a New Media Fellowship to report on newborn health. This post was part of a series of stories from the ground. Read posts from fellows Jennifer James and Nicole Melancon.
We had just spent the night at the source of the Blue Nile River. Lake Tana sits in Bahir Dar, Ethiopia, and as our caravan of Land Cruisers wove through the countryside from Bahir Dar to Mosebo I took in deep gulping breaths of sweet fresh Ethiopian air. The lush colors of our surroundings looked to me like they had been enhanced in Photoshop in the way that everything seemed to pop. How could I feel this emotional connection to place that was never mine? A place I had never been?
Though this is my first time in Ethiopia, the verdant landscape brought me back to other rural parts of Africa I’d traveled through in my youth, similar topographies that had stayed with me ever since. This time I’d returned to the continent as a new media fellow with the International Reporting Project to report on newborn health. World Moms Blog Editor Nicole Melancon of ThirdEyeMom is a fellow on the trip as well, and last week wrote about our initial overview of maternal and newborn health in Ethiopia. Now we were heading to one of the villages housing a Health Post, which serves the local and surrounding population of approximately 3,500 people.
Mosebo Village is part of Save The Children’s Saving Newborn Lives program, and as such is looked to as a model village in the Ethiopian Government’s plan to reduce maternal and newborn mortality. Mosebo is a rural agrarian community that produces wheat, teff and corn. There I met seven-year-old Zina whose mother, Mebrate was about to give birth. Through our translator Mebrate estimated her age to be around 26, and told us that Zina was her first child. For economic reasons she and her husband had waited to have a second. When she had Zina, Mebrate had gone to her parent’s home to give birth, as women in Ethiopia often do. It is estimated that 80% of Ethiopian mothers will give birth in their home, often without a trained health care attendant. Towards the end of Mebrate’s first pregnancy she went to live with her parents as her family instructed, until after the baby was born. In that way her mother could help her deliver, could care for her and the baby, and feed her the traditional porridge after birth. Although there were no complications during her delivery, sadly, many young mothers giving birth at home are not as fortunate. The time period during and around birth are the most vulnerable for the lives of both the mothers and babies. The Saving Newborn Lives Program aims to reduce maternal and newborn mortality beginning with awareness programs and antenatal care on the local level at Health Posts like the one we visited in Mosebo.
We had met Tirgno and Fasika, the two Health Extension Workers at the Mosebo Health Post earlier that day as they showed us the two room interior, and explained their role in improving maternal and newborn health. They work to raise awareness in the community about the importance of antenatal care, and the potential dangers of giving birth at home for both mother and child. Newborn health is interdependent with maternal health, and the most prevalent causes of newborn mortality, infection, Asphyxiation, pre-maturity or low birth weight, and diarrhea can often be avoided with proper care. These days in Mosebo after receiving antenatal care at the Health Post women are then referred to the regional Health Center for deliveries.
Zina shyly smiled when we ask her how she felt about having a new sibling, she stood straight and tall listening intently as we asked her mother about the babies’ arrival. When Mebrate goes into labor this time, with her second child, she will embark on the walk along rural dirt roads for around an hour to the nearest Health Center to give birth.
Elizabeth Atalay was reporting from Ethiopia as a fellow with the International Reporting Project (IRP). This is a promotion of the original post written for World Moms Blog. You can follow all IRP reports by World Moms Elizabeth Atalay & Nicole Melancon at #EthiopiaNewborns
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The Healthy Newborn Network Blog provides timely information and insights from the global newborn health field and seeks to promote dialogue on important newborn health issues. The blog is a platform for the HNN Editors and guest contributors to post commentaries on current happenings in the newborn health field. The content of each post and comments expressed on the HNN blog are those of the individual contributors and do not necessarily represent the views and opinion of the HNN or its Partner Organizations. >>Read a note on leaving comments
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