Addressing Critical Knowledge Gaps in Newborn Health


By Patrick Crump on October 11, 2013

Above: Fartun, 13, attends a Save the Children-supported alternative education program in the Dollo Ado refugee camp in Ethiopia, which gives children the opportunity to attend school and catch up. Photo Credit: Jonathan Hyams for Save the Children

Today, October 11, marks the International Day of the Girl Child.  It is a day established by the United Nations to recognize girls’ rights and draw attention to the unique challenges girls face around the world. And there is much to celebrate. More girls are in school today than ever before and girls and boys are enrolled at equal levels in primary school globally. Both child deaths and maternal deaths have fallen by nearly half since 1990. Save the Children and others are reaching more newborns, children and mothers with known interventions to prevent and treat the most common causes of child and maternal death.  The world can now see a day on the horizon when no child needs to die of preventable causes.

But much work remains to be done, and it’s becoming clearer that poor health outcomes are both a reflection and result of women’s and girls’ low status in society. Approximately one third of the world’s girls are married before the age of 18. Child marriage puts girls at risk of becoming pregnant when they’re still children themselves and before their bodies are ready. More than 15 million of the 135 million live births worldwide are among girls aged 15-19, and problems associated with pregnancy and childbirth are a leading cause of death. The global community has at its disposal a set of simple, high-impact, evidence-based solutions to the major causes of maternal and infant death, and making these available to those most in need has been at the heart of Save the Children’s work in maternal, newborn and child health for over 20 years. And yet we realize that the deeper causes that lead to early pregnancy and increase maternal and neonatal risks require holistic investments in girls long before they become mothers. Save the Children’s State of the World’s Mothers Report 2013 highlights three effective interventions to prevent high-risk pregnancies that can save the lives of mothers and babies: female education, nutrition and voluntary family planning.

Save the Children has learned that empowering girls requires not only investing in girls, but helping families, communities and governments to understand the value of girls. Ensuring that more girls enroll in school and stay in school delays early marriage and childbirth. Educated girls are more likely to delay marriage and childbirth, and grow up to be mothers who are healthy, well-nourished and economically empowered. Educated women tend to have healthier pregnancies and safer deliveries. Their babies are more likely to survive childbirth, the first day and month of life.  Evidence suggests that children born to educated mothers are twice as likely to survive past the age of five. Save the Children believes that a focus on girls and their rights, providing girls with equal access to opportunities and services is the key to ending maternal and newborn mortality, and to lifting today’s girls and future generations out of poverty.

We’re honored to be a signatory of The Girl Declaration, a call to action launched today to place girls at the heart of international development efforts. The Girl Declaration is based on overwhelming evidence that girls not only face discrimination in much of the world, but they are the most powerful potential drivers of change in their families, communities and countries. On the Day of the Girl, we are proud to be one of the many organizations raising our voice on behalf of girls everywhere, and not just today, but everyday. Find out more about the Girl Declaration and hear the voices of the girls who helped to create it here. To learn more about our programming at Save the Children, visit our website.

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By Ian Hurley on October 10, 2013
South Africa

Photo: Anne-Sophie Helms/Save the Children

There’s good health news coming out of South Africa. AIDS, the official journal of the International AIDS Society, just released a new paper examining neonatal and child deaths in South Africa from 1990-2011.

The authors estimated that under-five mortality decreased by 6 to 10 percent per year since 2006 and the proportion of under-five deaths resulting from AIDS fell between 11 and 24 percent. The study examined to what extent HIV services, including Prevention of Mother-to-Child Transmission (PMTCT), played a role in accelerating these declines.

Also, this past April, one of the country's health facilities was featured as part of the first-ever Global Newborn Health Conference, which took place in Johannesburg. This conference brought together health experts and government health officials from around the world to discuss barriers to improving newborn survival. The hospital visit was a learning opportunity for media from across Southern Africa and beyond to see the improvements in care South Africa is now providing mothers and newborns.

"Opaque and conflicting messages have been replaced by data that can be used for action and accountability”, notes Kate Kerber, lead author of the study. South Africa's efforts to improve HIV care and health outcomes for newborns and children is commendable and can serve as a model for other countries with high burdens. This focus though should not wane and will only serve to help continue this progress.

By Kathryn Boryc Smock on October 8, 2013

This blog was originally published by Jhpiego. Written by Kathryn Boryc Smock and Sandra Cossa.

 Maputo, Mozambique—Sandra  Bento Nuvunga, the mother of  two boys, knows the fears and  joys that come with being an  HIV-positive parent. Her own  personal journey began in 2006  when, pregnant for the first time,  she learned that she also carried  the virus that causes AIDS.  Despite her shock and dismay,  she rallied her beleaguered spirit  and enrolled in prenatal care and  treatment at Chamanculo  General Hospital, even as the  father of her unborn child  abandoned her.

 Sandra went on to give birth to a  healthy baby boy who would test  negative for HIV, the best news  any mother could receive. Her  experience and the high quality  of care she received at  Chamanculo led Sandra to join  the facility as an “expert patient  activist” who helps women living  with HIV to maintain their health  during pregnancy and give birth  to HIV-free children.

“PMTCT [prevention of mother-to-child transmission] is such an important program,” Sandra said recently, reflecting on her experience. “There is no sadder thing in life than a mother learning that her baby is HIV-positive.”

In 2013, when Sandra became pregnant again, she returned to Chamanculo. By then, the hospital had become part of the National Model Maternity Initiative, an approach that emphasizes the fundamental rights of the mother, newborn and families. The initiative is sponsored by the Mozambican Ministry of Health with support from the U.S. Agency for International Development’s flagship Maternal and Child Health Integrated Program (MCHIP). Jhpiego, which leads the MCHIP global award, has been working in Mozambique since 2004 to prevent the needless deaths of women and their families. In partnership with the government, Jhpiego focuses on maternal and child health, HIV/AIDS, tuberculosis and infection prevention, developing innovative solutions to today’s health challenges and ensuring access to quality health services.

The Model Maternity Initiative promotes birthing practices that recognize a woman’s preferences and needs and focuses on humanistic care and the scaling-up of high-impact interventions, including a strong focus on PMTCT. More than 270,000 women have received HIV counseling and testing for PMTCT and their test results at Model Maternity Initiative facilities. During the period April to June 2013, 95 percent of pregnant women presenting at their first antenatal care visit were tested for HIV.

In addition, more than 26,000 HIV-positive pregnant women have received antiretroviral therapy to reduce the risk of mother-to-child transmission. During the period April to June 2013, 96 percent of HIV-positive pregnant women were on antiretroviral drugs at the time of delivery, with 91 percent of these on a three-drug regimen.

In addition, clients receive counseling on healthy birth spacing and family planning options following the birth of their baby—including the option of postpartum family planning for HIV-positive mothers. Since April 2011, 643,869 family planning consultations have been carried out at facilities involved in the Model Maternity Initiative. As a result of these services, 230,313 women (HIV-positive and HIV-negative) received a new family planning method, and 339,129 women continued to use a family planning method of their choice.

Sandra, who now counsels patients on antiretroviral treatment, recognizes the important role patient activists can play in educating women and their partners on maintaining a healthy lifestyle to prevent transmission of HIV to an unborn child. She candidly recalls her own experience learning that she was HIV-positive. “It wasn’t until I arrived home that I started to think on what the positive result meant for me,” she says. “I spent two months at home crying, and even thinking about taking my own life.”

After a long period of reflection, she pulled together the strength to return to Chamanculo General Hospital and start prenatal care again, determined to do what was best for her baby. She repeated the HIV test, had her CD4 count measured and began taking antiretroviral therapy. She gave birth to her son on November 9, 2006, and named him Eugio, meaning “intelligence.” Eugio received nevirapine when he was born, but at this point in the epidemic it was not possible to know his status until his first birthday.

“I was sure that he was HIV-positive because he stopped gaining enough weight around seven months,” Sandra explains. “This period was the most difficult in my life—waiting and wanting to know his status, but at the same time not wanting to know because I didn’t want a positive result.”

On Eugio’s first birthday, in 2007, she took him for his HIV test. The result was negative, and the young mother rejoiced. She became pregnant again in 2010 and re-enrolled in prenatal care at Chamanculo.

“They [the nurses] treated me so well at the hospital,” she says, and in April, she gave birth to another baby boy, Mamisse. This time, she did not need to wait a whole year to learn his HIV status. In May 2010, she took him for testing and learned that he, too, was negative.

Mamisse and Eugio are now three and seven years old, both healthy, energetic little boys. Eugio loves toy cars and going to school, while Mamisse keeps Sandra busy chasing him around. Sandra continues her work with Chamanculo General Hospital, a real-life example of the benefits of PMTCT.

“I like to share my story with others and show that you can lead a healthy life by adhering to treatment,” she says.


Sandra Bento Nuvunga (pictured above) thanks the Model Maternities Initiative for its help in preventing transmission of HIV to her youngest son. Photo: Jhpiego

By Regina Obeng on October 3, 2013

Photo: Jane Hahn/Getty Images for Save the Children

Regina Obeng, pictured right above, has provided care to newborns for over 20 years in Kumasi, Ghana. She was the recipient of the first International Neonatal Nursing Award in 2010, and has used the recognition to continue being a powerful advocate for newborns. 

I wish to congratulate the 2013 winners of the International Neonatal Nursing Excellence Award. I had the honor of receiving this award sponsored by the Council of International Neonatal Nurses (COINN), Save the Children and the Neonatal Nurses Association of South Africa (NNASA) in 2010. It is wonderful to see these other nurses also getting honored for their excellent work in the face of challenging odds.

I have worked at the neonatal unit of Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, for over 20 years saving babies. Our ward is crowded, with about 350 to 400 newborns cared for each month. Even though there are many challenges facing our profession in the care of these babies, as nurses, we cannot accept newborn deaths as inevitable and must strive to improve all efforts in caring for and saving these delicate and vulnerable lives. One of our roles is to serve as a voice for babies and their mothers, speaking up for more space and places for mothers to stay, better supplies and, especially, more knowledgeable staff and ways to retain them.

Awards like the one I received in 2010 can help turn these requests into reality by putting neonatal nursing and the urgent need to save newborns on the international stage. My award in has certainly helped me to achieve many goals. Since 2010 I have achieved the following:

Further training

After receiving the award three years ago in Durban, South Africa, I had the opportunity to meet the then Minister of Health in my country. We discussed the needs of newborns and recognition of nurses caring for them. Since there is no accredited training in advanced neonatal nursing practice in Ghana, like many low-income countries, the Minister nominated me for a three week maternal and neonatal care training which was sponsored by the Arab League of Nations in Cairo University Faculty of Nursing- in Egypt.

Greater awareness about needs for newborns

The recognition I gained from receiving the award gave me a stronger voice in Ghana to raise public awareness about the issues facing mothers and newborn babies, particularly prematurity.

I also had an opportunity to present the award to the Asantehene, the King of the Ashantis at a grand ceremony attended by other paramount Chiefs and other dignitaries at the King’s palace in Ghana.  The program was featured prominently in the media to also create more awareness on neonatal care.

The Nurses and Midwives Council of Ghana featured me on the 2011 calendar which also put a focus on neonatal nursing as a specialty.

Developments in national policies and curriculum

My meeting with the Chief Executive Officer/Registrar of Nurses and Midwives Council of Ghana led the Council to later invite me to be an assessor and clinical examiner for the nurses and midwives council in Ghana.  Through these new connections, I was invited to participate in the preparation of the final draft policy on neonatal care by the Ghana Health Service and the Ministry of Health. I was also given the opportunity to be part of a team to plan and develop a curriculum for Paediatric Nursing School, which is in the pipeline at Kwame Nkrumah University of Science and Technology Nursing Faculty in Kumasi.

Improvements to our facility

The award opened the gate for me to interact with visitors, some of which donated various items and machines for the care of newborns. For example, the wife of the King of the Ashantis, the Asantehene, Lady Julia, donated 25 bags of diapers, Electrical Kettle and Fan for the Mother and Baby Unit of the hospital and some chocolate for the workers. Doctors and nurses from Newcastle University and hospital donated three biliblanket phototherapy machines for the treatment of jaundice with three boxes of billi pad vest, six ear thermometers, 10 digital clinical thermometers various sizes of air way, and knitted caps for the newborn. Families from United Arab Emirate also gave knitted caps for the preterm. The King of the Ashantis, the Asantehene is donating a piece of land and working in collaboration with other development partners to put up a modern Children’s Hospital in Kumasi. KATH bought four radiant heaters, four incubators and three infusion pumps for the Mother and Baby Unit of the hospital. I have personally bought and donated an oxygen cylinder and a wheel (mobile oxygen) to four hospitals within the Kumasi Metropolis.

Generally we are receiving more calls for help in neonatal care from nurses/midwives, parents and health workers because of the greater attention and improvements to the facility. More hospitals are bringing their nurses to the Komfo Anokye Teaching Hospital where I work for further training.

Personal achievements

Winning the International Neonatal Nursing Excellence Award in 2010 contributed to my getting an award as the best senior nurse and the overall best worker for 2010 at KATH. In addition, I have gained promotion to the grade of Deputy Director of Nursing Services and posted as the Nurse Manager for Child Health Directorate in KATH.

I have also had the privilege of getting featured in international journals and reports. The prestigious medical journal, The Lancet, published my profile in December 2010, and my story was featured in the Journal of Neonatal Nursing. Born Too Soon: The global action report on preterm birth also used my story as an example of recognizing health workers for their dedication in difficult circumstances.

It is my prayer that some of my nurses who show much interest in newborn care are given the support and help they need to pursue further studies to improve on their knowledge and skills in dealing with neonatal care. This will go a long way to expand the capacity and provision of improved neonatal care in my country.

Watch a short interview with nurse Regina Obeng:

By Shannon Pryor on September 26, 2013

Photo: Dickens Ojamuge/Save the Children Uganda

Under the motto “Your Future. Your Choice. Your Contraception”, World Contraception Day 2013 focuses on empowering young people to think ahead and build contraception into their future plans, in order to prevent an unplanned pregnancy or sexually transmitted infection (STI).

Today, September 26th, is World Contraception Day. You might wonder, how is empowering young people to think about their future, their choices and contraception linked to healthy newborns? 

A growing body of evidence, reinforced by the new supplement The Lives Saved Tool in 2013: new capabilities and applications published this month in BMC Public Health, highlights the connections between the use of contraception for healthy birth spacing and newborn health, particularly for adolescent girls. Every year, approximately 16 million adolescent girls between the ages of 15 – 19 years give birth.  For some of these adolescents, pregnancy and childbirth are wanted, but for many others, they are not. We also know that complications from pregnancy and child birth are a leading cause of death among adolescent girls aged 15-19 years in low and middle income countries, and that the effects of adolescent childbearing impact the health of their infants. Perinatal deaths are 50% higher for mothers younger than 20 than for moms aged 20-29. 

Globally, 220 million women have an unmet need for contraception for both spacing and limiting births. Unmet need is defined as the proportion of currently married women who do not want any more children but are not using an effective contraceptive method —women who want to use a method but are unable to use one for many reasons, including limited access to Family Planning (FP) services, cultural or religious objections, fear of side effects, and lack of knowledge, among other reasons. In sub-Saharan Africa, South Central Asia, and Southeast Asia, more than two-thirds of women younger than 20 who want to avoid a pregnancy have an unmet need for family planning.  

All of this evidence highlights the importance of developing specific strategies to reach adolescent girls to delay their first birth until age 18, and if already parents, to space their next pregnancy by at least 24 months. It is why #familyplanning must continue to be an important part of the conversation for #everynewborn

What type of strategies might be included in the Every Newborn Action Plan to reach girls to delay first birth and to space next pregnancy if already parenting? WHO Guidelines on Preventing Early Pregnancy for Poor Reproductive Outcomes Among Adolescents in Developing Countries contains several recommendations, based on a review of the evidence, including:  

  • Sexuality education can equip young people, in and out of school with the knowledge, skills and values to make healthy decisions. 
  • Strengthen girls’ social networks and support to refuse unwanted sexual attention. 
  • Health services delivered through youth-friendly health centers and integrated into a range of community services can give them a choice of family planning methods.
  • Support girls to stay in school at both primary and secondary levels

Save the Children is actively working to provide education and opportunities for young people to learn and plan early, before they face decisions.  In Northern Uganda, for example, Save the Children in partnership with the Institute for Reproductive Health, Georgetown University and Pathfinder International, implements the Gender Roles, Equality and Transformation (GREAT) Project.  Adolescents learn about age and situation-specific fertility awareness, gender, and sexual and reproductive health, including contraceptive use, through storytelling, games and activities.  A gender perspective helps girls and boys reflect on how they define themselves and support each other to change – to empower girls to speak up and boys to show more care in their relationships. View the Toolkit here. 

We cannot reduce newborn mortality without doing more to deliver contraception – especially to young people.  This is why family planning for all women including adolescent girls is an important component of Every Newborn.