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on April 25, 2013
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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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The following post was written by Gary Darmstadt, Amie Newman and Wendy Prosser, originally posted on Impatient Optimists. It is part of a Blog Series leading to World Prematurity Day on November 17, discussing prematurity and highlighting the actions needed to prevent and reduce preterm birth, the leading cause of newborn deaths. Join us as we discover that everyone has a role to play.
Portrait of Grace Ngoto and her daughter Tuntufye in Malawi. Watch their story below. Photo: Living Proof and the ONE Campaign.
Lucky. That’s how I feel about my children being born in a hospital with the best available technology, information, and resources, just in case something went wrong during delivery or immediately after birth. In the case of my second daughter, by the time of her discharge on the third day of life, she had already had an echocardiogram and consultation with a physician that confirmed the source and offered a reassuring prognosis for a heart murmur, which years later, is now completely resolved.
More than a million babies each year are not as lucky. They are born too early (preterm)–and without access to the kind of health care that could save their lives.
But we have the know-how and the impetus to change this.
A new report released last week, Born Too Soon: The Global Action Report on Preterm Birth, notes the astounding occurrence of 15 million preterm births around the world each year and the fact that the number of babies born before 37 weeks of pregnancy is going up.
In low-income settings, one million babies are dying each year of complications of preterm birth because they do not have access to known, life-saving interventions. Interventions that are both feasible and cost-effective. An estimated three out of every four preterm deaths could be avoided today with known interventions that do not even include a high-tech, extravagant NICU (Neonatal Intensive Care Unit).
In a world that has the most advanced technologies to date, as well as communication and transportation systems that reach the most rural areas of the most forgotten countries, how do we continue to allow this to happen?
This report challenges us to do more to care for those babies who are born early. We have been talking a lot about achieving lasting impact at scale within the Family Health division of the Gates Foundation, and the challenges that come with that. One of the “A-ha!” moments that came out of a recent convening of global experts in spreading innovations last year was, “Don’t build a Cadillac when a Kia will get the job done.” Simply put, if someone needs a reliable and cost-efficient car to get from one place to the next, a Kia will work; a Cadillac is not necessary.
A number of simple life-saving interventions already exist but are not available to mothers and frontline health workers in many places around the world because the global community hasn’t done enough to adapt and spread their use.
Kangaroo Mother Care, for example, provides warmth, food, love, and life-saving protection from infection, as does exclusive breastfeeding for babies up to six months of age; clean delivery practices include use of soap to wash hands and a clean utensil to cut the umbilical cord, just to name a few.
We know these interventions work, are highly cost-effective, and should be available to every mother of every pre-term baby in the world—but they aren’t.
In the longer term, prevention of preterm birth will be the answer. But because much is still unknown about why babies are born too soon, we don’t have the answers yet, as the report points out. Our inability to prevent preterm births is one of the largest solution gaps that exists in public health.
Meanwhile, while new approaches are being discovered and developed, this report challenges the global health community to be innovative to accelerate progress to reduce the number of preterm babies. The report also makes clear the good news that the world is coming together increasingly to give preterm babies a chance at survival.
Survival of a preterm baby should not depend on the luck of the draw. I hope this new report, the first ever of its kind on preterm birth, generates interest, attention, and nothing less than the will of the world to change the lives of babies born too soon.
Watch the story of Tuntufye, who was born premature in Malawi. Kangaroo Mother Care successfully helped her mother Grace when Tuntufye was born pre-term, weighing only 1.8 pounds:
The women come one by one. Some bring blankets and some little brown sacks to sit on. They spread the blankets and the sacks neatly in front of the house. One of them starts counting the heads and figuring out who is not yet there. After a few more minutes of chattering in groups, loudly calling for the ones who have not yet arrived, and asking the younger ones to settle down, the meeting starts. Today’s meeting is about children’s nutrition. A role play generates a lively discussion about the nutritional value of fruit and vegetables in the village and the community vegetable patch.
I am witnessing a monthly meeting by the Chandrajarkie village women’s group, which is organised and monitored by the village women. I’m here because I want to understand how the group has achieved a public health and social breakthrough: a massive reduction in neonatal mortality, and a huge step forward in the self-confidence of women.
Chandrajarkie Village in Jharkhand, one of India’s poorest states, is over 100km from Ranchi, the state capital. The hills and forests of Jharkhand, whilst beautiful, exacerbate the difficulties of ensuring essential services reach these remote areas. The poverty is stark. Illiteracy is high in Jharkhand even in comparison to neighbouring states. The social, economic and cultural dynamics of India – where caste, class and patriarchy are fused with raw poverty and geographical isolation – have kept poor, rural women down for far too long.
But in a place where the national and state government have failed, these women’s groups have risen to the challenge, with only minor help from experts who were involved at the drafting stage of mother and new born manuals, and in the monitoring and evaluation of the process. Women’s groups provide social, emotional and occasional financial support to see that women are looked after during and after pregnancy, and share information about how to care for infants. As a result, they have helped cut down neonatal mortality in their communities by 45%. This reduction, detailed in the Lancet, is in comparison with women who did not participate in the groups, even though their access to healthcare services was the same.
The effect on women’s mental health was also impressive, with a 57% reduction in the moderate maternal depression among women who attended the groups. Substantial improvements in home care practices were also demonstrated – mothers were more likely to have birth attendants wash their hands, use a safe delivery kit and a plastic sheet, boil the threat used to tie the cord and then cut it cleanly. The proportion of mothers practicing exclusive breastfeeding was also higher among women who had participated in the trail. There may have also been some contribution to a reduction in maternal deaths, which were markedly lower among women who had participated in the women’s groups.
Archana Kumari from Kumharriding village is a shining example for these exemplary women’s group’s achievements. Archana is 17 year old and expecting her second baby in a month’s time. Archana was married when she was 13 years old and gave birth to her first born at the age of 14 at home. She didn’t know then about the health facilities or schemes she could access. Now, as a member of the local Women’s group, she has learnt from the other women about taking iron tablets, tetanus injections, sanitation, nutrition, preparations for delivery, and why an institutional delivery is safer. She is more confident now too. This time, Archana will deliver her baby in a hospital. She has contact details of a delivery van to book for a ride to the hospital.
But she is much more than a beneficiary. The role and the ability of young women in South Asian cultures have been hugely underestimated, and it is about time we take a good look at how they are changing not only their own lives but also other around them. Like the other women in her group, Archana is a leader. By letting every pregnant woman in her village know her story, she is empowering them with knowledge and inspiring them to re-imagine what is possible. Through the group and through her example she is saving and changing lives. I feel like I’ve seen the future, and she is called Archana.
Photo: Sanjana Shrestha/Save the Children
This Saturday, May 5th, marks the 20th International Day of the Midwife. As the Healthy Newborn Network celebrates the achievements of midwives worldwide, we thought it was more than appropriate to highlight midwives who work on the frontlines of newborn health.
Pushpa, a midwife and auxiliary nurse in Bardiya, Nepal shows a grandmother how to help her low-weight granddaughter grow bigger and stronger through kangaroo mother care (KMC). Kangaroo Mother Care is an essential tool to help preterm and low-weight babies survive and thrive.
In Nepal, Save the Children trains local women to deliver basic lifesaving care to mothers and children in their communities. Even where doctors and nurses are out of reach, midwives and community health workers are helping dramatically lower child mortality rates. By training and supporting more frontline health workers, even more children’s lives can be saved.
The following post was written by Joy Lawn, Mary Kinney and Christopher Howson, co-editors of Born Too Soon: The Global Action Report on Preterm Birth. It is the first post of an HNN Blog Series that will lead to World Prematurity Day on November 17 discussing preterm birth and highlighting the actions needed to prevent and reduce preterm birth, the leading cause of newborn deaths. Join us as we discover that everyone has a role to play.
Born Too Soon: The Global Action Report on Preterm Birth released this week, carries a foreward by Ban Ki Moon, the UN Secretary general, and brought together more than 100 experts representing almost 50 agencies, universities, organizations, and parent groups. This report highlights the first ever country estimates of preterm birth rates and identifies solutions for prevention of preterm births and to save the lives of premature babies. The 40 logos on the report are a clear signal of increasing global attention.
Prematurity is now is the second-leading cause of death in children under the age of 5 after pneumonia. Global progress for child survival and health to 2015 and beyond cannot be achieved without addressing preterm birth. Yet prematurity is also a huge burden in rich countries. Born Too Soon is an ACTION report and removes any excuse for missing the enormity of the problem, and sets out actions to take. We all have a role to play.
5 headline messages:
15 million babies are born too soon every year
Based on the first ever national estimates of preterm birth for 184 countries, in the year 2010, more than 1 out of 10 babies are born too soon, an estimated 15 million preterm (or babies born before 37 weeks of gestation). More than one million of those babies die shortly after birth and many of those who survive will face lifelong physical, neurological, or educational disability, at great cost to families and society.
Preterm birth affects families all around the world. Over 60% occur in Africa and Southern Asia, but high rates are also seen in some high-income countries, such as the United States, where 500,000 preterm babies are born each year. Behind every statistic is a personal story. For some it is a story of survival, for many it is survival sometime with the reality of a lifelong disability and sadly for some it is a story of loss.
Preterm birth rates are rising
Of the 65 countries with time trends estimates 1990-2010, only 3 countries have shown a reduction in preterm birth rates.
Prevention of preterm birth must be accelerated
Reducing preterm birth rates involves reducing risks before and during pregnancy and at birth. Family planning, identification and treatment of infections, as well as prevention of malaria, all hold promise, especially in low-income settings. In high-income settings, these risks are less common and increasing rates are linked to older women having babies, increased use of fertility drugs and the resulting multiple pregnancies; also to increasing caesarean sections that are not always medically indicated, as well as lifestyle challenges such as obesity, smoking and diabetes. Often no cause is identified. Vigorous and strategic investment in research is needed to identify new solutions.
Premature babies can be saved now with feasible, cost-effective care
Historical data, new lives saved modelling analyses and experience in middle-income countries show that an estimated 75% of preterm baby deaths could be prevented without neonatal intensive care. But the most startling gap highlighted in the report is the survival gap for preterm babies depending on where they are born. In low-income countries, more than 90 percent of extremely preterm babies (younger than 28 weeks or more than 3 months early) die within the first few days of life, while less than 10 percent die in high-income countries.
This 90:10 survival gap means these babies are not just born too soon – they are born to die, with even their families not knowing there are highly effective solutions that could save their lives. Kangaroo Mother Care and antenatal corticosteroids have the highest impact on saving the lives of premature babies. If universally available, antenatal steroid injections for mothers in premature labor could save almost 400,000 lives of babies a year, and Kangaroo Mother Care could save another 450,000 lives each year. Urgent action is needed to close this gap.
Everyone has a role to play
The momentum behind this report has led to the first ever globally agreed upon goal to halve the number of babies dying from preterm birth by 2025. This can be achieved but requires preterm birth to receive attention around the world, policymakers to invest and implement and the voice of affected parents to be heard.
This report has shocking new data and moving personal stories of loss. Yet it is also a story of hope in the significant opportunities for change, especially as we approach the final sprint for the MDG 4 target and aim to maintain momentum beyond 2015. Over 30 organizations have given specific commitments to preterm birth to Every Woman Every Child, and will be held accountable by this framework. Everyone has a role to play and together we can make each statistic, each story count for change. How can you support your family and friends who are affected? Do you have a story to tell? A commitment to make? What will you do?
As the three editors of this report and on behalf of the many involved in Born Too Soon, we throw out a challenge that by World Prematurity Day on November 17 2012, policymakers, professionals and parents all over the world will see this important challenge of preterm birth and that together we will have clear plans for real change for the 15 million babies born too soon and their families.
Learn More:
Complete Blog Series on preterm birth:
In many parts of Kenya, by the time a woman in labor arrives at a hospital, she and her baby are often already in trouble. There are many factors that can contribute to this situation – cultural and family pressures to give birth at home, lack of understanding about the telltale signs that labor is taking a turn for the worse, or a long journey to a clinic that puts additional hardship on a woman’s body and on her baby. Many times, even the fare to pay for the bus or taxi ride to the hospital is not available! Once at the hospital, what happens in the first moments after birth can quickly make the difference between life and death.
One in 10 newborns globally will experience birth asphyxia, or difficulty breathing at birth, and prolonged obstructed labor is a significant cause. Interventions to save a baby’s life can be as simple as warming the baby and rubbing its back or feet to stimulate it to breathe. But skilled birth attendants are present at only 44 percent of births in Kenya, and training for the skills to revive a newborn has not been widely available – even to health care workers in the very hospitals where women turn for help.
Just last week I met with health workers from remote rural mission hospitals in Kenya who have experienced how important those first moments after birth are – and how terrible the silence is when a newborn does not draw breath and begin to cry. They lament that nurses posted to rural hospitals are often newly trained and have not yet learned the skills needed to intervene. In an emergency where the mother’s life is at risk, there isn’t always time to find someone who knows how to help the baby breathe. With no intervention, one in 10 of those infants will die. A few miles from my village home is a small rural clinic where pregnant women from my village will visit at the onset of labor. It would be most reassuring to know that the health workers at such a clinic would have the requisite skills that could lead to better outcomes. These skilled workers could dramatically reduce infant mortality for attended births in the country.
Next month Helping Babies Breathe, a program designed and led by the American Academy of Pediatrics (AAP), will make an exploratory venture to scale up in Kenya and put these practical, simple skills into the hands of health workers across the country. AAP, in partnership with Johnson & Johnson, has identified a team of health care leaders from the Ministry of Health and major Kenyan health associations to begin a conversation about how to improve education and stop birth asphyxia in Kenya. Together, these stakeholders will discuss plans for bringing neonatal resuscitation into mainstream medical training.
The first meeting of this group will take place the same week that Mother’s Day is celebrated in many countries – I can think of no more fitting of a Mother’s Day gift for a new mother than a chance to hear her baby breathe. We look forward with great anticipation as we bring these partners together.
Rene Kiamba is Manager of Corporate Contributions, Johnson & Johnson, Nairobi, Kenya