Addressing Critical Knowledge Gaps in Newborn Health

Next, focus on the newborn

Next, focus on the newborn
Melinda Gates
November 21, 2012
Newborn News

Article originally published in The Economist

 Every September, statisticians at the United Nations make a terrible announcement: how many millions of children died the year before. The surprising truth is that this event makes me optimistic about the future. Because for at least 41 Septembers in a row, the number has gone down.

In September 2012 we learned that 700,000 fewer children died in 2011 than in 2010. That’s almost equivalent to the population of Amsterdam. In 2010 the figure was 200,000 lower than the year before, which is roughly the size of Bordeaux. The child-survival story is terrific any way you slice it.

Take a longer view: since 1970, the number of children dying has declined by more than half, even though the population has almost doubled. If the rate of death had stayed constant, more than 31m children would have died in 2011. Instead, fewer than 7m did.

Or look at it from the point of view of an individual country. In 1999 one in five Rwandan children died before turning five. The average Rwandan woman at the time gave birth to five children, so statistically speaking the experience of losing a child was typical for a Rwandan family. By 2005, though, the child-mortality rate had been cut in half. One in ten Rwandan children died. By 2011, it was one in 20. Over the same period, Rwandan mothers also made the decision to have smaller families, which means the experience of losing a child is even less typical. These patterns are similar in most African countries.

In 2013 the child-mortality figure will fall again. How far depends on how hard the world tries to deliver lifesaving innovations to the children who need them. If all children in developing countries got vaccinated, slept under bed nets and received vitamin a supplements, almost 1m more would survive.

There is one other vital variable. Will we finally learn how to save the lives of newborn babies?

Neonatal deaths—those that occur in the first 30 days of life—are not preventable in large numbers with vaccines, bed nets or the other interventions used to save older children. So the neonatal mortality figure has been very stubborn. The number of newborns who die in sub-Saharan Africa has actually gone up in recent years, even while overall child mortality has plummeted. Now, neonatal deaths make up more than 40% of all child deaths, and that proportion keeps rising.

I predict 2013 will be the year we start making serious progress on saving newborn lives. If I am wrong, it will be a great disappointment, because solutions are available now. To take just two examples, “Kangaroo Mother Care” and corticosteroids are inexpensive, simple innovations that haven’t taken hold—but that will save almost 700,000 newborns annually as soon as they do.

Kangaroo Mother Care involves encouraging mothers to hold their babies against their skin, which regulates body temperature, heart rate and breathing. The results are almost miraculous. Researchers have found that when a mother holds a cold baby, the body temperatures of both the mother and the baby go up. If I hadn’t seen the study, I would tell you it violates the second law of thermodynamics. Skin-to-skin contact is so beneficial that the medical establishment in developed countries is beginning to recommend it over incubators as the best way to keep babies warm.

Another life-saver, corticosteroids, are common anti-inflammatories that can be given to mothers in pre-term labour to develop the lungs of fetuses so they can breathe when they are born. Most hospitals have corticosteroids on hand for gastric ulcers, and many doctors don’t know of their obstetric uses. I heard a colleague say, “It’s not a last-mile problem, but a last-ten-feet problem.” Thousands of babies die during delivery for want of a drug that’s in the next room.

Making Kangaroo Mother Care, corticosteroids and other neonatal interventions a priority will prevent incalculable suffering. It will also boost development in some of the poorest places in the world.

I predict 2013 will be the year we start making serious progress on saving newborn lives.
The news about sub-Saharan Africa’s economic rise is well known. The region is growing at about 5% annually. The driving forces behind this growth are a decade-long commodity boom and sensible economic policies, but the continent’s long-term prospects depend on investments in the health and education of the people living there. Children surviving and staying healthy means more children in school and able to learn, which in turn means productive workers who can drive sustained economic growth across Africa. To build on Africa’s recent progress, then, we have to extend the revolution in child survival and start saving newborn lives

I look forward to September 2013, to the publication of the UNICEF child-mortality report. In the past, it has garnered a short blurb deep inside newspapers. In 2013 my goal is to see it on the front pages, where it belongs.