Addressing Critical Knowledge Gaps in Newborn Health


By Ian Hurley on August 8, 2014
Malawi, Nepal, Nigeria, Uganda

Innovators share their projects at The Saving Lives at Birth DevelopmentXChange 2014. Photo: Ian P. Hurley/Save the Children

“Innovation is the highway, impact is the destination.” Grand Challenges Canada CEO Dr. Peter Singer echoed this statement while speaking to newborn and maternal health innovators at the Saving Lives at Birth DevelopmentXChange 2014 in Washington, DC.

31 seed grantees, 40 seed grant finalists, 10 transition grantees and 11 transition grant finalists were on hand to present their projects at the morning marketplace and to see what new grantees would be getting support under the fourth round of funding at the afternoon forum. Organizers received over 500 applications from 60 countries for the fourth round. 

Rice University's BreatheAlert, a high-performance, low-cost method to reduce death due to apnea of prematurity is demonstrated at the 2014 DevelopmentXChange. Photo: Ian P. Hurley/Save the Children

The Saving Lives at Birth partnership was launched in 2011 by the U.S. Agency for International Development (USAID), the Bill & Melinda Gates Foundation, the Government of Norway, Grand Challenges Canada, and the U.K. Department for International Development (DFID). It was founded to seek out innovative approaches to address the more than 1.6 million newborn deaths, 1.2 million stillbirths and 150,000 maternal deaths that occur within the first 48 hours of life. To date, they have funded 59 potentially game-changing innovations that have come from academics, students, faith leaders, businesses, universities and more.

An example of one of those innovative projects is chlorhexidine for umbilical cord care in Nepal by JSI Research & Training Institute, Inc. It was a first round grantee in 2011. With over 60% of women giving birth at home, newborn infections are now the third-leading cause of newborn deaths in Nepal. The antiseptic gel, which costs roughly 23 cents and is made locally in Nepal, helps to prevent that infection. It has since been scaled-up in 45 of the country’s 75 districts. Dr. Leena Khanal, Project Manager of the Chlorhexidine Navi Care Program said that chlorhexidine has helped to save 2700 newborn lives as a result of the Saving Lives at Birth grant.

USAID Administrator Dr. Rajiv Shah gives welcoming remarks at the 
Saving Lives at Birth Forum. Photo: Ian P. Hurley/Save the Children 

The afternoon’s forum event was highlighted by USAID Administrator Raj Shah’s talk with Dr. Paul Famer, Co-Founder of Partners in Health about innovation and the need for health equity. Several innovator projects including the now famous Odon Device, the Augmented Infant Resuscitator (AIR) from Uganda, Rice 360’s bubble CPAP device from Malawi, and a project by DPRC aimed at further empowering Islamic scholars in Northern Nigeria to promote MNCH among local health providers were presented.

Dr. Susan Wandera Kayizzi, Deputy Country Director for Amref Health Africa in Uganda, talks about the WE CARE Solar Suitcase at the 2014 DevelopmentXChange. The innovation is a transition grantee. Photo: Ian P. Hurley/Save the Children

The 30 Round 4 award nominees were then introduced and came up to the stage to accept their award, filling it up almost to capacity in the process. It consisted of 26 seed grants and 4 transition-to-scale grants. This year’s awardees cut across newborn and maternal health and showcased groundbreaking ways to help improve the chances for newborn and maternal health survival during the most critical time of life.

The Healthy Newborn Network was among the partners at the Development XChange. The blogs below are from a series written by the innovators themselves.

By Jennifer James on August 7, 2014

Photo: Paolo Patruno

This blog was originally published in Impatient Optimists. Written by Jennifer James.  

Did you know that breastfeeding rates have stalled at around 40 percent worldwide or only one in three infants less than six months of age is exclusively breastfed?

Through August 7, World Breastfeeding Week will be recognized by breastfeeding advocates, parents, experts, and global health organizations with the theme: Breastfeeding:  A Winning Goal – for Life! This year’s theme highlights the critical importance of breastfeeding to achieving the Millennium Development Goals, especially MDG #4 that set a goal of decreasing child mortality by two-thirds by the end of 2015.

Photo: Paolo Patruno

These statistics may be hard to believe especially given how beneficial breastfeeding is to the survival and health of newborns and children, but they are accurate and need to be dramatically improved for the sake of the health of newborns and children the world over.

  1. Breastfeeding Saves More Newborns: Breastfeeding within the first hour after birth will save the lives of over 800,000 newborns according to data from a 2013 Save the Children report: Superfood for Babies: How Overcoming Barriers to Breastfeeding Will Save Children’s Lives.  Hundreds of thousands of newborn deaths could be wholly prevented if breastfeeding is initiated within the crucial first hour after delivery when colostrum is produced by mothers for their newborns’ fragile immune systems.
  2. Breastfeeding Protects Against Disease: Breastfeeding reduces the chances that babies will die of pneumonia or diarrhea, two of the leading causes of deaths in children under the age of five.
  3. Breastfeeding Prevents Malnutrition and Wasting: Did you know that breastfeeding provides essential vitamins and minerals that keep babies and children healthy throughout their lives? It also reduces the chances of a child becoming malnourished or wasted.
  4. Exclusive Breastfeeding Can Prevent Close Pregnancies: When mothers exclusively breastfeed they have a reduced chance of becoming pregnant again within six months of their previous deliveries. While this is not fail-safe the World Health Organization says breastfeeding provides 98 percent birth control protectionduring the first six months of exclusive breastfeeding.
  5. Breastfeeding Makes Women Healthier: The World Health Organization says women who breastfeed have a reduced chance of contracting ovarian and breast cancer. Breastfeeding also helps a woman return back to her pre-pregnancy weight faster and reduces her risk of obesity.

The World Health Assembly set a goal in 2012 to achieve at least a 50% exclusive breastfeeding rate globally by 2025.  In order to achieve that, the rate of exclusive breastfeeding must grow across all regions by at least 2.5 percent each year. The current rate of growth is only 1.8 percent.

One way to achieve this is through a consistent emphasis on the benefits of breastfeeding across the globe. That is why in its 22nd year, World Breastfeeding Week continues to be crucial to the global breastfeeding movement.

Photo: Paolo Patruno

How Can You Get Involved in World Breastfeeding Week?

Events are being held through August 7 in over 170 countries. Find an event near you on the World Breastfeeding Week’s pledges page.

All photos are courtesy of Paolo Patruno. His photos about maternal and newborn health in sub-Saharan Africa can be seen at

By Chelsea Cooper on August 6, 2014
Africa, Asia, Middle East

Photo: Jhpiego

This blog was originally published by MCHIP. Written by Chelsea Cooper.  

This is a question that many women find themselves asking after childbirth. In fact, breastfeeding, return to fecundity, and postpartum family planning (PPFP) are all closely intertwined.  Exclusive breastfeeding delays a woman’s postpartum return to fecundity and is a critical aspect of the Lactational Amenhorrea Method of family planning (LAM), which requires that women exclusively breastfeed, have a baby less than six months, and have not had a return of menstruation. 

The theme for this year’s World Breastfeeding Week—“Breastfeeding: A Winning Goal - For Life!”—asserts the importance of increasing and sustaining the protection, promotion and support of breastfeeding.  Promotion of LAM and timely transition to another modern FP method can help to advance these goals during the Millennium Development Goal countdown and beyond.  

Evidence from the Healthy Fertility Study in Bangladesh has shown that LAM has a positive effect on the duration of exclusive breastfeeding: length of exclusive breastfeeding was 25% higher at six months among LAM users compared with non-LAM users.  And evidence from Jordan demonstrates that women who use LAM are twice as likely to use FP at one year postpartum (compared with women who are only breastfeeding). 

Observations have shown that almost all healthy newborns placed skin-to-skin immediately after birth are able to locate the nipple without assistance and spontaneously attach and suck. Moreover, studies have suggested early skin-to-skin contact and early initiation of breastfeeding is likely to enhance chances of continued breastfeeding at 1-3 months of age.  

Breastfeeding is practiced and valued by most mothers in developing countries. And the vast majority of women in the first year postpartum want to delay or avoid another pregnancy altogether. Why, then, do substantial gaps in exclusive breastfeeding and postpartum contraceptive use remain?

USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) and the SPRING Project co-facilitate the Maternal, Infant, and Young Child Nutrition and Family Planning (MIYCN-FP) Working Group, which serves as a forum for sharing learning and resources on this topic.  The Working Group has reviewed existing scientific and programmatic literature and has noted a number of factors which influence the practice of optimal MIYCN and FP behaviors. These include:

  • Perceptions about the role of breastfeeding in preventing return to fecundity:  Findings from Egypt, Yemen and other countries reveal that women may think that they are protected from pregnancy for as long as they breastfeed (even beyond six months), or if they are only partially breastfeeding.  It is important to ensure that women understand that they are only effectively protected from pregnancy by breastfeeding for as long as all three LAM criteria are met, and that they should transition to another modern FP method before the criteria are no longer met in order to ensure continuous protection.
  • Knowledge and perceptions about breastfeeding: Program learning has revealed gaps in knowledge about optimal breastfeeding practices and the benefits of exclusive breastfeeding and continued breastfeeding.  In Kenya, for example, MCHIP found that it was important to specify that exclusive breastfeeding involves feeding the child only breastmilk with no other foods, water or other liquids, even during “hungry times” (when food is less plentiful).  Correct practice of exclusive breastfeeding affects the effectiveness of LAM if mothers are trying to use it as a FP method.
  • Knowledge and perceptions about postpartum return to fecundity: Program learning from numerous countries has revealed that women often wait until their menstruation returns to use a modern FP method, even if they say they are using LAM (Uganda, Guinea and Bangladesh LAM Barrier Analyses). In Bangladesh, through the Healthy Fertility Study, a narrative story (“" href="">Asma’s Story”) was incorporated within home visits and community mobilization meetings to reinforce the importance of starting a modern FP method before menses return. 
  • Knowledge/retention of LAM criteria and cues to transition among postpartum women: Most women who report using LAM do not meet the criteria for correct LAM practice (Fabic and Choi, 2013). New opportunities to reinforce the LAM criteria and cues to transition should be further explored, such as through LAM Champions or using an e-Health approach.
  • LAM knowledge, perceptions, and counseling practices among health providers: In some settings, health providers do not routinely counsel on LAM, often due to lack of knowledge or misconceptions about the method’s efficacy.  It is important to ensure that health workers are properly oriented (and supervised) on LAM counseling, and to provide them with job aids to help standardize counseling messages.
  • Monitoring and follow-up of LAM users: LAM use is often not tracked in FP registers, and health workers are not proactive in following up with LAM users to encourage a timely transition to another modern method before the woman is at risk. Tracking LAM within FP registers and conducting proactive follow up may help to improve timeliness of transition to another modern method.

A recent study in Egypt revealed that women who are given emergency contraception along with LAM counseling are significantly more likely to initiate regular contraception within or shortly after the first six months postpartum when compared with those in the LAM-only group (30.5% vs. 7.3%) (Shaaban et al, 2013).  

Remaining barriers to optimal breastfeeding, timely postpartum contraceptive uptake, and optimal practice of LAM and transition need to be addressed to improve PPFP and MIYCN outcomes.  New and innovative strategies for communicating about maternal and infant nutrition, LAM, and postpartum return to fecundity should be considered.  It is time to reflect on previous communication approaches and to “think outside the box”—beyond the traditional LAM messages—to focus on designing dynamic, strategic approaches that address barriers and motivate women and health providers.  

By Rae Galloway on August 4, 2014
Middle East

Photo: Dr. Ali Assabri

This blog was originally published by MCHIP. Written by Rae Galloway

If exclusive breastfeeding in the first six months of life prevents malnutrition, a subsequent pregnancy (as long as menses has not returned), and potential death from infections, why aren’t more women worldwide choosing to do so? Babies who are not exclusively breastfed have a one- to two-fold greater risk of dying than breastfed babies (with the risk varying by the type of illness). And the risk of mortality is even greater (a two- to four-fold increase) when children receive food and other liquids in addition to breast milk, or are not breastfed at all (a two- to 14-fold increased risk of dying).  

While rates are higher in some countries than others, the unfortunate truth is that fewer than half of children are exclusively breastfed in most countries. In Yemen—which has one of the lowest rates of exclusive breastfeeding in the world—preliminary results from a recent national survey found that only 10% of infants are exclusively breastfed in their first six months. 

To uncover the factors impeding optimal maternal, infant and young child nutrition and family planning practices, including exclusive breastfeeding, USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) in partnership with the Ministry of Public Health and Population conducted formative research on the subject in two ecological zones of Dhamar Governorate. The study results illuminated a clear need among mothers, fathers and other family members for accurate information on how best to feed young children, as well as what women should eat during pregnancy and lactation. 

For example, within the study sample: 

  • Not one child under six months was being exclusively breastfed.
  • Not one child 6-23 months had been exclusively breastfed.
  • One infant had received only water, which the mother had provided to promote speech development, believing that “water lubricates the jaw to make speech easier.”
  • Most mothers had introduced food or animal milk prior to six months, feeling their breast milk was “not enough.” Mothers often made the decision that their breast milk was insufficient because their baby cried after nursing, or other family members advised them that their baby needed additional food. 
  • All infants received liquids before six months—with animal or powdered milk, water and juice being the most common liquids given.
  • More than half of babies younger than six months received food with crushed, sugary biscuits made into a paste with water or milk being a popular food to give to babies, even as young as one month of age.
  • Some mothers gave food because it filled their baby’s stomach, reportedly making them cry less and easier to manage.

In reality, breastfeeding practices in the sample were not optimal, which contributed to inadequate breast milk supply and hungry, unhappy babies. Sub-optimal practices included infrequent feedings, short duration of feedings, feeding from only one breast, and not feeding babies at night time. These practices led to decreased breast milk supply and the introduction of liquids and food, which further reduced breast milk production. Introduction of liquids and foods increases risk of infection, which in turn increases risk of malnutrition and mortality. Half of the women reported some problem with breastfeeding—such as pain, redness, engorgement and cracked nipples—but women were able to manage these problems themselves or seek treatment for them.

To improve infant and young child feeding, including exclusive breastfeeding, MCHIP is developing a package for health facility and community workers to use when counseling mothers. Because of the importance of family planning to the health, nutritional status, and survival of women and children, this package also will include messages about using the lactational amenorrhea method (LAM) in the first six months and transitioning to modern methods of family planning thereafter.

By Ian Hurley on August 1, 2014

Photo: Jonathan Hyams/Save the Children

Hawa, successfully gave birth to a baby boy, 20 minutes old, at a Save the Children supported clinic in Peterstown, Margibi county, Liberia. Hawa is an inpatient at a new Maternal Waiting Home built by Save the Children at Peterstown clinic. The Maternal Waiting Home provides pregnant women with a place to stay, at the clinic, in their final week before delivery to ensure they get the proper professional care they need. Save the Children works with the county health team in Margibi, Liberia, enabling clinics to provide antenatal and postnatal care services, immunisation programmes and delivery of babies, as well as supporting nutritional feeding programmes with other partners.

Hawa stayed in the Maternal Waiting Home at Peterstown Clinic Margibi County Liberia for two weeks before giving birth. She lives in Ansa Town, about three hours walk from the clinic. This is her third child, she has two boys aged five and three. She delivered them at home in her village, before women were encouraged to come to the clinic. Now women like to come to the clinic, because they can stay at the home and feel safer. Two of Hawa's friends are also staying at the clinic and waiting to give birth. She says "We are taken care of here, we are treated well, we feel at home." 

Today marks the start of the annual World Breastfeeding Week. Coordinated by the World Alliance for Breastfeeding Action, this year's theme calls for the protection, promotion, and support for breastfeeding as we draw close to the 500 day mark for the Millennium Development Goals. Events are planned in over 170 countries.  

To coincide with World Breastfeeding Week, a new breastfeeding brochure, Early Initiation of Breastfeeding, was release to provide an overview of why breastfeeding is important and what some of the challenges to wider implementation are. It was developed by WHO and UNICEF along with 15 other organizations. 

Breastfeeding also features prominently in the recently launched Every Newborn action plan. Under Strategic Objective 2, it calls for rectifying the shortage of breastfeeding counsellors. The plan also places emphasis on the role of the private sector in protecting and supporting exclusive breastfeeding and conforming to the provisions of the International Code of Marketing Breastfeeding Substitutes. Importantly, Every Newborn sets the nutritional goal of 50% exclusive breastfeeding in all countries by 2025. As countries work to sharpen their existing health plans to meet the coverage goals of Every Newborn, lets work to support them and improve their efforts to scale up this critical intervention.