Addressing Critical Knowledge Gaps in Newborn Health


By Arefin Islam on May 10, 2013

The newborn period is probably a complicated time for a baby and its parents. Lack of knowledge in caring for newborns properly may be an important factor behind the largest share of child death in Bangladesh by newborns, which is during the first 28 days of life.

Newborn care is essential in helping to prevent many causes of newborn deaths. Particular focus needs to be given to accessing quality emergency care for sick newborns, care for low birth weight babies and essential newborn care for all newborns so that they don’t fall sick and if they do, the right treatment can be provided.

The WHO estimates that approximately one to five percent of babies will require resuscitation at birth and many of them may die or suffer long-term disabilities if not resuscitated in the first minute of life (the Golden Minute). In Bangladesh, 10% of the babies born suffer from breathing difficulties or birth asphyxia, which can be addressed using a simple bag-mask resuscitation technique. Often oxygen and other complex techniques aren’t necessary to save most of these newborns.

Save the Children in Bangladesh has been rolling out the Helping Babies Breathe (HBB) training curriculum specially to address this newborn complication since August 2011. Currently, 15,594 health workers  from public, private and NGOs have completed traninig. A total of 30000 caregivers across country are set to be trained. Additionally, this training has also been incorporated in pre-service and in-service curriculums.


By Angela Rodman on May 10, 2013
North America

The State of the World's Mothers report, released by Save the Children, presents new data on the staggering toll of newborn deaths on the first day of life. The report also shares stories from mothers and families affected by this tragedy, in the United States and around the world. This is one of those stories, by mother Angela from Oregon. She tells the story of her daughter Charlotte, who would be celebrating her third birthday next week. Originally published in her blog, cross-posted with permission.

A couple months ago I connected with the non-profit Save the Children. They put out a "State of the World's Mothers" report every year with a specific focus. The focus this year: newborn health.
You can find the full report HERE and a little bit about my experience with infant loss in the sidebar on page 58. (Charlotte's story is in USA Today as well as The Huffington Post. Find those articles HERE and HERE)
A few facts from the report:


  • "The US ranks as the 30th best place to be a mother."
  • "The US has 60% of all first-day deaths, but only 38 percent of live births."
  • "Newborn deaths now make up 43% of child deaths (under 5)."
  • "When first-day deaths in the United States are compared to those in the 27 countries making up the European Union, the findings show that European Union countries, taken together, have 1 million more births each year (4.3 million vs. 5.3 million, respectively), but only about half as many first-day deaths as the United States (11,300 in the U.S. vs. 5,800 in EU member countries)."
Charlotte's death was not preventable but many of the deaths occurring in the US and around the world are. The report details the problems, but it also outlines cost effective solutions.
It breaks my heart that so many of these deaths are preventable. In the US, many newborn deaths are linked to premature birth. Women need access to health care - including information about nutrition and the importance of breastfeeding - and quality prenatal as well as postpartum care for themselves and baby.
Charlotte's third birthday is in one week. By sharing our story I hope to prevent pain and loss for future mothers and fathers. I would appreciate it if you would help by visiting the Save the Children website to learn how you can take action, sharing the State of Our World's Mothers report, the article from USA Today and this post. I can't buy Charlotte a present, or bake her a cake, or ask her what kind of birthday party she would like, but I can raise awareness about neonatal loss so other families can have all the moments parents expect to with their children.
Will you help me?


By Elizabeth Romanoff Silva on May 9, 2013
Ethiopia, India
In light of the release of the State of the World’s Mothers Report 2013, Surviving the First Day, it’s important to highlight that in order to help babies survive childbirth and their first day of life, the link between maternal and newborn health cannot be understated. Because a baby’s health and survival is critically linked to the health of the mother, maternal health is a precursor for newborn survival. And a mother’s age is significant.
It’s estimated that about 16 million adolescent girls give birth every year. Most of these births happen in low- and middle-income countries. World Health Organization statistics indicate that one in five girls has given birth by the age of 18, and that figure rises to more than 1 in 3 girls in the poorest regions of the world. Often, once a girl becomes a mother, we classify her as a woman. She is able to give birth before she is fully grown and before she is fully mature, but giving birth does not transform a girl into a woman. And this difference means a lot to her health, and to the health of her baby. Too often maternal health indicators include the term “women of reproductive age, between 15-49 years old” is used. Yet, a 15-year-old girl is not a woman. And when she becomes pregnant, grouping her with women disregards that both she and her baby are at a greater risk for adverse health conditions and death due to her young age. 
Did you know…
If we act on these greater risks for pregnant girls, we can make sure they have the extra support they need from healthcare providers and community health workers. This will help girls to cope with the physical aspects of motherhood in better health, to understand sources of better health through changed behavior, and to overcome practical problems in access to health services. But if we really want to make sure mothers and babies don’t have these extra risks, we have to work to prevent adolescent motherhood. As The State of the World’s Mothers 2013 highlights, improving education, nutrition and family planning for girls and women are the most effective interventions in preventing high-risk pregnancies and saving mothers’ and babies’ lives.
Keeping girls in school, especially after they reach adolescence, is one of the most effective ways to reduce risks for both mothers and newborns. When girls are able to stay in school and delay marriage and pregnancy, statistics show that they tend to have fewer pregnancies, safer deliveries and feed their children more nutritious food, thus raising healthier children. Improving nutrition for adolescent girls is another way to improve maternal and newborn health outcomes, since undernourished girls can grow up to be stunted and suffer from an anemia deficiency. It is estimated that 55 million adult women in developing countries are stunted as an effect of malnutrition during childhood. Underweight mothers tend to have undernourished babies. Promoting a healthy and balanced diet for girls and women will lead to improved outcomes for mothers and babies. Finally, providing family planning options and information for adolescent girls and women, so that they can decide when to become pregnant and how many children they wish to have, leads to delayed pregnancy, birth spacing that is healthier and leads to better health outcomes for mother and newborn.
Focusing additional resources and care on adolescent girls and their babies as a vulnerable group will help accelerate the decline in both maternal and neonatal mortality. Since Save the Children’s Nike Funded Girl Initiative for Results and Learning began in the May 2011, Save the Children has implemented more than 75 projects in more than 15 countries that directly benefit adolescent girls and work to improve their: safety and wellbeing, access to education, healthcare, economic opportunities, and will have lasting effects for themselves, their offspring, and their communities.
This article was written by Andrea Burniske, GIRL Project Director at Save the Children, and Elizabeth Romanoff Silva, Consultant to the GIRL Project at Save the Children.

By Gary Darmstadt on May 7, 2013

This blog was originally published by Impatient Optimists. Written by Gary Darmstadt.

Where is the best place on earth to be a mother? Save the Children’s report, State of the World’s Mothers, released today gives us the answers. You will also find the extreme opposite—the worst place in the world for mothers and children. In both cases, the report makes clear that the state of the world’s mothers is about the state of the world overall. As Melinda Gates notes in the foreword to the report, when we invest in women, we invest in the health and lives of children and improve the human condition.  The health of women and children are inextricably linked.

This is the 14th annual State of the World’s Mothers report which sheds light on these issues, but this year breaks them  down even more, for the first time specifically revealing the risks during those critical 24 hours after birth (the "first moments", notes the report) – the birth day. It’s a day  when mothers should be celebrating but, unfortunately, it’s also a day in many countries where mothers and newborns face the greatest threats to survival.

“It’s a day when mothers should be celebrating but, unfortunately, it’s also a day in many countries where mothers and newborns face the greatest threats to survival.”

We have the opportunity to save millions of lives if the global community comes together on behalf of mothers and newborns.

This report gives us hope that it is possible to give a newborn a better chance of survival. It highlights four simple, life-saving treatments that if taken to scale could save more than one million newborns each year: 

  • Umbilical cord cleansing to prevent infections using chlorhexidine
  • Helping babies who are born early to breathe using antenatal corticosteroids; resuscitation devices to help babies breathe at birth when necessary; and injectable antibiotics to treat newborn infections.
  • Kangaroo Mother Care which keeps the baby warm encourages breastfeeding and fights infection.
  • Early and exclusive breastfeeding is also one of public health’s best buys and would save many more babies.

It’s equally important to ensure that we continue to focus on safe care for women during pregnancy and childbirth and to increase the number of health workers in regions of the world where there are shortages.

“This report gives us hope that it is possible to give a newborn a better chance of survival.”

The release of this report and this information is monumental, considering that a decade ago we barely understood the causes of newborn mortality and were intimidated by what was perceived to be a need for highly specialized care for a newborn. We now know that is not true.

It is heartening for me to see this inspired commitment to newborn health and the critical connections made between the health of women and newborns. This report, coming on the heels of the Global Newborn Health Conference and paving the way for the Women Deliver Conference, keeps mothers and newborns front and center, a place they deserve to be.

A healthy start to life paves the way for a healthy childhood with more opportunities for a good education, which then leads to healthy, productive adults, contributing to stronger economies and having healthy babies themselves. It’s a virtuous cycle, with healthy newborns at the nexus of the continuum.

We now have the opportunity to ensure that each baby born around the world has the pleasure of celebrating his or her first birthday, then the fifth, then the tenth, and on into adulthood. We have the chance to rally on behalf of women and girls as well. Now is the time to focus on saving the lives of our mothers and newborns.   

By Michael McGrath on May 7, 2013

This blog was originally publish on the EVERY ONE Campaign.

It is simple math – Stronger mothers mean stronger children.

When a mother is physically well-developed, well-nourished and has a supportive social structure around her, she is more likely to be educated, marry later, be financially stable and make healthier choices for her children.

The result? Children who are more likely to go to school, have better learning outcomes, eat more nutritious food and contribute more effectively to their country’s economy when they grow up.

The key to driving this change begins with empowering women in communities. In Bangladesh, girls marry very early both because of dowry payments are less for younger brides, and because of the fear of harassment of unmarried girls. Early marriage means girls stop going to school, fail to reach their educational potential and are forced to work and have children early.

Across the South Asia region, early child marriage and childbearing is by far the most prevalent in Bangladesh, where 66 per cent of women are married before age 18 – half of those by age 15. About 40 per cent of women give birth before their 18th birthday.

As girls are not fully developed in their teenage years, they are more likely to die from pregnancy complications. In fact, early pregnancy is the biggest killer of teenage girls worldwide, with one million dying or suffering serious injury, infection or disease due to pregnancy or childbirth every year, according to Save the Children’s ‘Every Woman’s Right: How family planning saves children’s lives’, launched in June 2012.

The risk of death cannot be understated for girls who are bearing children. Girls under age 15 are five times more likely to die in pregnancy than women in their 20s. Girls age 19 and below are still twice as likely to die in pregnancy as women in their 20s.

The government of Bangladesh recognises this, making it illegal for parents to marry off children under age 18. However, without a supportive environment that motivates parents to wait for longer before marrying their daughters off, child marriage rates will remain at this intolerable level.

Marrying later is just half the battle. In addition to allowing girls to develop fully into women before childbirth, women also need access to family planning services. A baby born with less than a two-year space from an older sibling is twice as likely to die before their first birthday as a baby with more than a two-year age gap from an older sibling in Bangladesh.

Across the world, 222 million women who don’t want to get pregnant don’t have access contraception. This year, an estimated 80 million unintended or mistimed pregnancies will occur in developing countries. Frontline health workers are essential to advice women on family planning, protecting both women and their children.

Bangladesh’s reduction in maternal and child health has been a story of success in South Asia, on track to achieving UN MDG child and maternal mortality reduction targets, but 133,600 children still die before their fifth birthday and 1-in-170 women run a lifetime risk of dying in childbirth or from pregnancy complications. Reducing early child marriage and childbearing while increasing women’s access to modern contraceptives and family planning services not only empowers women to make better choices for themselves and their families, it also helps prevent thousands from dying needlessly each year. It is simple math.