This blog was originally published in Impatient Optimists. Written by Gary Darmstadt.
When I started out as a pediatrician 25 years ago, the prevailing perception, it was a myth actually, about newborn health care was that it was highly technical, specialized, and too expensive and difficult to take on, on a global scale. And as Melinda writes in the foundation’s Annual Letter this year, “3 Myths that Block Progress for the Poor”, myths about saving the lives of children and newborns can be dangerous. At the time it was unclear what interventions to improve newborn health were feasible; and if feasible, what impact they would have on the lives and health of newborns in low resource settings. I remember traveling in rural Bangladesh at that time, trying to understand the situation, going from one health facility to another looking for newborns, and finding none. They were all at home, where they were born and where they stayed for any kind of health care. Clearly, the global health community needed to do something to focus more acutely on newborns, to save lives.
Why did this myth exist and, more importantly, how do we debunk it?
Newborns were viewed, at the time, as extremely fragile. This left many public health practitioners feeling intimidated by newborn care. Therefore most experts in global health focused on what were perceived as easier and more do-able solutions; those causes of child deaths that were better understood and for which we had interventions available at the time – for example, scaling up immunizations, and prevention and management of pneumonia and diarrhea.
In the last decade, however, the global health community has begun to turn its attention and focus on newborn survival, and bust the “newborn myths.” It was only fifteen years ago when Dr. Abhay Bang presented his landmark findings from Maharashtra, India, showing that a package of home-based newborn care reduced neonatal mortality by an astounding 62 percent .
An informal network of public health professionals began to recognize a need to address newborn health and started calling collectively for more attention and action. This led to a critical revolution in how newborn health was perceived: we learned from experience in research and programmatic settings that many simple, context relevant, feasible and cost effective solutions, including the ones below, exist. This evidence exploded the myths that addressing neonatal health requires expensive intensive care units staffed by specialists like neonatologists.
We now have the low-cost, simple interventions with proven efficacy in our hands that have the potential to avert the majority of newborn deaths. These interventions, delivered in integrated packages across regions and either through family-community care, outreach, or facility-based clinical care, address critical risk factors during pregnancy, childbirth, and the newborn period. We can prevent up to about 70 percent of newborn deaths worldwide by ensuring universal coverage with these solutions.
What are these proven solutions to reducing the number of newborns who die every year? They include:
- Kangaroo Mother Care (KMC), which can be provided for premature infants in various settings including health facilities and households. The very act of holding a newborn skin-to-skin facilitates mother-infant bonding and breastfeeding, keeps the baby warm, reduces the risk of serious infections and reduces mortality. If scaled up, this could translate globally into hundreds of thousands of lives saved each year, by simply helping mothers, fathers, and other family members adopt the practice of holding their babies close.
- Antenatal corticosteroids given to pregnant women with threatened preterm labor. Discovered and documented in the 1970s, it is widely used in high-income countries with an estimated 90 percent coverage of indicated cases of women in preterm labor. However, coverage in middle and low-income countries is only about 10 percent at best. If we could ensure wider pick-up of this particular intervention, in these settings, it could also save several hundred thousand lives around the world each year.
- Immediate and exclusive breastfeeding for six months is one of the most powerful and impactful public health interventions for reducing child deaths, including the vulnerable newborn period. Breastfeeding, like skin-to-skin care, may have “opportunity costs” in that it takes an investment of time that could be spent otherwise, but the practice itself costs nothing and the return on that investment in terms of newborn survival, and improved child health and well-being is phenomenal. Yet, exclusive breastfeeding has still not been widely adopted in developing countries, and globally it has only improved modestly.
We now have the opportunity to build on the extraordinary advances made in maternal and child health, and more recently in newborn health. Just as in child health, so much can be done that is simple. We have successfully busted the myth that it is inherently hard, and too difficult and expensive to do. We are armed with the knowledge to make significant improvements in the lives of newborns and families around the world. It’s time to get on with scaling up these interventions to save newborn lives around the world.