A common experience in social circles is to field questions like, “What do you do?” “Where do you work?” Where did you go to school?” It turns out that one of the most telling questions about you is “Where in the world were you born?”
Every day close to 370,000 babies are born around the world wide-eyed and eager to start their journey through life. However, their chances of survival and their ability to thrive and succeed greatly depend on where in the world they were born. More and more global attention has been given to preventing newborn deaths, but very little if any has been given to those newborns who survive with disabilities, and the long-term impact on health and human capital.
Babies born into families living in high-income countries (around 30,000 a day), have little chance of death or disability. High quality care is the standard and intensive care units, in case, for example, the baby needs assistance taking his or her first breath or is born prematurely, are readily available.
Similar to babies born in high-income countries, the vast majority of newborns in middle-income countries (around 93,000 a day) are born in hospitals, but they enter into a very different reality.
Access to intensive care units is not universal and there are fewer guarantees that they’ll receive high quality care – as there are not always defined protocols in place. Although newborn deaths have dramatically declined in these countries – with over 50 countries halving the rates over the past 20 years – increased survival is also linked to increased rates of babies born with disabilities. The tragedy in these statistics is that the disabilities are mostly preventable by providing access to the high-quality care and intensive care units available in higher-income countries.
In a world which is often out of sight and mind of many of the world’s most advantaged, babies born into low-income countries face a myriad of challenges.
Approximately 110,000 babies a day are born in hospitals or clinics and 137,000 a day are born at home and virtually invisible with little to no access to a qualified health worker let alone an intensive care unit.
In this world the challenge is not necessarily a high number of babies born with disability but rather high mortality rates; the most vulnerable to disability, by and large, fail to survive the newborn period. The vast majority of these deaths are preventable with proven, effective interventions such as neonatal resuscitation, chlorhexidine cleansing of the umbilical cord at the time of birth, holding a premature newborn skin-to-skin (kangaroo mother care), immediate and exclusive breastfeeding, and antibiotics to combat infections.
It is for the very reasons stated above that I am so excited that the highly respected journal, Pediatric Research, has published a supplement that highlights the burden of disabilities and attempts to dispel the myth that saving newborn lives comes at the expense of an inevitable generation of children with disabilities. For the first time the series of articles will present systematic estimates of impairment, bringing together the work of almost 50 authors representing 35 institutions from 12 countries.
It is our hope that this will start an ongoing conversation with physicians, public health professionals, parents, governments and civil society to focus not only on strengthening the quality of care for newborns, but also on ensuring that as we are successful in reducing newborn deaths we also engage as intently and comprehensively in reducing preventable disabilities.
We want newborn health to soon be considered part and parcel of a wider agenda that includes reproductive, maternal and child health, and nutrition, and that we’ll collect more nuanced data on outcomes that takes into account the longer-term effects of disability. Only then we will truly be on a path to ensuring a world in which where you are born is simply interesting conversation, but does not determine your fate.
World Prematurity Day is November 17. If you'd like to get involved, please follow #WorldPrematurityDay on Twitter or share your own story (and read others) on Facebook here.
Hawa, twenty seven, and her son Jackson, two weeks. Liberia. Photo: Jonathan Hyams/Save the Children
For millions of parents across the world, the day their child is born ends in loss. For many, this loss comes as a result of a premature birth, when a baby develops complications during or after labor.
But it doesn’t have to be this way. The international community, working alongside governments, local partners, hospitals, communities, families, and parents, are proving that change is possible now.
Here are 4 reasons why:
1: We know why newborns are dying – Until recently, the causes behind the staggering number of newborn deaths were unknown. Today we know that around the world nearly 3 million babies die every year during their first 4 weeks of life, and one third of them don’t survive their first day. That is over 2,800 babies every day who don’t make it to day two. We also know that more than 80% of these lives are lost to only 3 causes: a mother and baby experiencing complications during childbirth – like the inability to start breathing within the first minute of life, developing complications from being born too soon, or infections that if left untreated turn deadly fast.
2: We can prevent most deaths – Knowing the causes of newborn death has been critical to galvanizing experts and governments around extensive research into how to address this. As a result, we now know that the majority of newborn deaths are largely preventable and treatable. Over 2/3 of these deaths can be averted with better access to quality health care.
The last decade has seen a number of advances in the understanding of what works to end preventable mortality. Solutions range from preventive strategies to management and treatment of complications, and have been proven effective in challenging settings. For example, administering antenatal steroids (at a minimum cost of $0.51 per dose) to a mom in preterm labor, helps her baby speed up lung development, reducing the risk of newborn death by more than 50% in low-resource facilities. Coupling that with essential newborn care for babies who are born too soon, including exclusive breastfeeding and skin to skin contact, dramatically increases a baby’s chance of surviving and thriving.
3: We have proof it works – Some countries have made dramatic progress in addressing newborn mortality, and many more are committing to do so. In the last 10 years, 77 countries reduced their newborn mortality rate by over 25%. More than a dozen of these countries are low income countries where the greatest numbers of newborn deaths occur. They have worked to integrate newborn health within their national systems and programs, and towards reaching every mother and every newborn. Several countries including Nepal, Bangladesh, Ethiopia and Malawi have achieved Millennium Development Goal 4 for Child Survival ahead of schedule, in part thanks to concerted efforts to tackle newborn mortality.
Despite all of this, change has been slow. Some countries have stalled in making further progress, and investment in programs that benefit mothers and newborns is lagging. Accelerating newborn survival has become increasingly significant in our battle to end preventable child mortality.
4: The time is now – With the looming 2015 deadline to meet the Millennium Development Goals, we cannot wait to address newborn deaths. Today, newborns account for over 44 percent of deaths among children under 5. This means in order to continue making progress, we must look after newborns. Nations and stakeholders have begun a movement for an Every Newborn action plan, setting the roadmap for accelerated change. It is your turn to join us.
Join us this week in honor of #EveryNewborn across the world. As experts gather in Ethiopia for women’s reproductive rights, think about the 1.1 million newborn deaths that can also be averted with access to family planning. As stakeholders gather in Brazil to advocate for a stronger global health workforce, think about supporting those fighting against all odds for newborns.
And join thousands of associations, societies, professionals, private sector organizations and individuals to mark World Prematurity Day on November 17, bringing attention to the global challenge of premature birth.
Some of the global discussions taking place include (click here for more details):
On Friday Nov 15 (12-2 pm CET), the South African and UK Permanent Missions in Geneva, Switzerland will co-host an event presenting the Every Newborn action plan.
A discussion this Friday Nov 15 (10-11:30 AM EST) will be held at the United Nations Headquarters in New York, co-hosted by the Permanent Mission of the Republic of Zambia and USAID. View the live webcast at www.webtv.un.org.
A technical symposium in Washington DC next Tuesday Nov 19 (9-12 noon EST) will focus discussion on what the international community can do to improve the effective delivery of preterm interventions around the time of birth. Click here to register online.
A 24-hour Global Twitter Relay beginning Friday Nov 15 and running through Saturday will engage millions using the hashtag #WorldPrematurityDay. Join the Healthy Newborn Network (@HealthyNewborns) and partners – share your story, ask your questions, join the movement!
Kangaroo Mother Care (KMC) was initially developed in Bogota 35 years ago when there was a shortage of incubators for preterm babies. When practiced in hospitals, it consists of continuous skin-to-skin contact, establishing breast feeding, early discharge, and close-follow-up. KMC is widely recognized to promote physiological stability, facilitate breastfeeding, keep a baby warm, reduce the risk of serious infections and reduce the mortality of hospitalized, stable premature infants by about 50 percent. This practice is also a wonderful way to promote bonding between infants and their parents, and may have lasting neurodevelopmental benefits.
In spite of these benefits, however, some key challenges have prevented KMC from being adopted widely across the globe. First, even where mothers receive training on KMC, socio-cultural, resourcing, and experiential barriers – such as a lack of support for the mother from the family and community – make practicing KMC difficult. Second, guidelines for KMC recommend initiation of the practice in the health facility, which means that the large portion of infants born outside of these health facilities may not have access to this practice. Even for mothers who deliver their babies in facilities, we have a long way to go to ensure that most premature babies have access to quality KMC services and support.
If universal KMC coverage was achieved, it is estimated that it could save the lives of more than 450,000 preterm newborns each year. However, despite global recognition of its inherent benefits and potential to improve newborn health, KMC is still struggling to catch on – with less than one percent coverage globally and no universally agreed upon indicator to measure uptake or impact.
It was for this reason that the Gates Foundation together with Save the Children / Saving Newborn Lives recently brought together more than 20 organizations representing governments, multinational organizations, non-governmental organizations, donors, civil society and academic institutions to garner support, enthusiasm, and build upon synergies to launch efforts to scale-up of KMC. Specifically, convening participants met to take stock of KMC globally, set a course for accelerating adoption and align as a community on a clear path forward.
We came together motivated to fundamentally shift our thinking and strategic approach to take KMC to scale, and in the process realized that we had much more in common than we originally thought. We all agreed that any efforts to promote a practice that is both feasible for mothers and effective for promoting its health benefits for their newborns must put the mother and her baby at the center.
We must better understand local social and cultural contexts, so that we can better work with mothers, families, communities, traditional leaders, health practitioners and governments to create an environment that empowers and supports the practices of KMC as a norm. We all agreed that going forward and reaching scale was critically dependent on our ability to effectively integrate KMC into reproductive, maternal, newborn and child health (RMNCH) and nutrition programs with a collaborative and coordinated global effort that includes governments, civil society, nonprofit organizations, communities, families and most importantly mothers.
Paramount to our success will be our ability to unify around clear goals, targets, and indicators. KMC is not a “poor person’s alternative” to good medical care, but represents a powerful evidence-based, standard-of-care for premature babies.
We are more convinced than ever that now is the time to act as a cohesive and inclusive group of stakeholders. We are rallying around what we have identified as the next steps necessary to reach our ambitious, yet attainable goal, of global coverage.
One of the clear next steps is a “Consensus Statement”, forthcoming from the group who attended the meeting. This will outline our agreements on the path forward and call for concerted and comprehensive action to accelerate and “bend the curve” of the spread of this powerful, life-saving intervention.
We remain optimistic that together, guided by shared principles, goals and a path forward we can create a world where mothers holding their babies skin-to-skin and exclusively breastfeeding is the social norm, fully supported by their families and communities, or any health professionals they may encounter.
This blog was originally published in Health Policy and Planning Debated. Written by Sanghita Bhattacharyya.
From conception through to birth, a child’s health is very closely linked to its mother’s. The pre-delivery phase is a particularly important stage in the continuum of care. Good information and care during the antenatal period links the pregnant woman with the formal health system and increases her chance of accessing a skilled attendant during delivery.
The recent paper on antenatal care (ANC) interventions and neonatal survival in India by Singh et al. looks at the most important antenatal care interventions for a baby’s survival. The World Health Organization recommends at least four ANC visits during pregnancy. Indian guidelines suggest that along with a minimum of three ANC visits, a woman should receive two tetanus toxoid (TT) injections and consume 90 or more iron–folic acid (IFA) tablets.
Using a large-scale population-based dataset, the District Level Household Survey round 3 (DLHS-3), the authors examined the association between specific ANC interventions and neonatal mortality. In terms of preventing neonatal mortality, the authors found that two TT injections formed the most important component of the ANC package, and they highlight the need to prioritise this intervention. The authors also report that India’s recommended number of three ANC visits, has a similar protective effect on neonatal mortality as four or more visits.
ANC visits are crucial for providing counseling to mothers about the care they should take during pregnancy and also in preparation for childbirth. We know that such counseling can play a significant role in averting morbidity and mortality of both mother and newborn. It follows, therefore, that re-enforcing these messages with more visits is not necessarily a bad thing. But how much emphasis should we place on the quality of counseling?
Some of the issues that form part of the consultation during ANC visits include making a plan for transportation to a health facility during labor, recognizing the danger signs of serious health problems during pregnancy, childbirth or soon after, and identifying and making arrangements for a blood donor if needed. It is important to reiterate these points during ANC visits to enable pregnant women to recognize obstetric complications when they occur and seek care from skilled providers, without delay.
So, how can we measure and assess the quality of counseling provided during the ANC visits, and whether it is effective? Currently available data sources often do not capture this aspect of effective counseling.
I won’t venture into the effect of IFA supplementation on neonatal mortality, as the paper concluded that further discussion and research is needed. However, I would like to mention that almost 58 per cent of pregnant women in India are anemic and it is estimated that anemia is the underlying cause for 20–40 per cent of maternal deaths in India. So, we need to think about the best way to prevent iron deficiency, whether that is through measures such as increasing iron intake through dietary diversification and food fortification with iron, or through iron supplementation.
What is the ideal antenatal care package? Should it be comprehensive or do we need to prioritize certain services?
This blog was originally published by MCHIP. Written by Dr. Qamaru Zaman Jamali.
Photo Left: Master trainers become familiar with job aids and practicing with simulators during the training. (Photos courtesy of Jhpiego.)
The “Golden Minute” has arrived in Pakistan. A key concept of the Helping Babies Breathe (HBB) training, this evidence-based neonatal resuscitation curriculum for resource-limited settings addresses one of the most common causes of neonatal death: birth asphyxia.
To better meet the needs of every baby born in Pakistan, the Maternal, Newborn and Child Health (MNCH) Services Project, Component 2a of USAID/Pakistan’s MCH Program, introduced HBB to the country this summer. The first activity—to prepare trainers who can teach skilled birth attendants in 10 districts in Sindh province—was conducted for 17 core trainers from the Provincial MNCH Program, Aga Khan University (AKU), and MCHIP staff. Using the NeoNatalie clinical simulator and job aids to master newborn resuscitation skills during the HBB training.
HBB can save lives and give a much better start to many babies who struggle to breathe at birth. This is great news for providers and families in Pakistan, a country where almost 7% of global newborn deaths occur.
(Photo at left: Using the NeoNatalie clinical simulator and job aids to master newborn resuscitation skills during the HBB training.)
"The Golden Minute is the key concept of the HBB. Within one minute of birth, a baby should be breathing well or should be ventilated with a bag and mask,” said Dr. Ayaz Hussain of the MNCH Program.
The two-day HBB training emphasized skilled attendance at birth, assessment of every baby, temperature support, stimulation to breathe, and assisted ventilation as needed—all within the first minute of life.
Day one focused on clinical skills. MCHIP's Iram Anayat felt "the peer-to-peer learning, pictorial job aids, simulators, and mannequins used during the training made learning very easy.” The second day refreshed trainers’ facilitation skills.
Dr. Zameer Suhag, a participant from AKU commented: “Given that birth asphyxia as one of the major contributors to the perinatal mortality in Pakistan, the low performance of skilled birth attendants in resuscitation skills highlights the need for enhanced training in resuscitation skills to all skilled birth attendants (SBAs). The HBB educational program would enhance resuscitation skills of SBAs in the province by practicing with NeoNatalie in every health facility."
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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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