The birth of a child should be a time of wonder and celebration. But for millions of mothers and babies in developing countries, it is a dance with death. In commemoration of Mother’s Day, Save the Children is publishing its 14th annual State of the World’s Mothers report. Every year, nearly 3 million babies die within the first month of life, most from preventable causes. More than a third of these babies die on their first day of life – making the birth day the riskiest day for newborns and mothers almost everywhere. The data in this photo essay was taken from Save the Children’s State of the World’s Mothers Report: Surviving the First Day, May 2013.
Nearly two-thirds of all newborn deaths (2 million out of 3 million each year) occur in just 10 countries. Many of these countries have very large populations (such as China and Indonesia) and others have high percentages of newborns dying (Afghanistan, DR Congo, Ethiopia and Tanzania). Several have both large populations and high newborn mortality rates (Bangladesh, India, Nigeria and Pakistan). These are places where mothers are also at high risk of death during pregnancy and childbirth – 59 percent of maternal deaths occur in these same 10 countries.
Now we know that the three major causes of newborn mortality are preterm birth, severe infections and complications during childbirth. These three causes together account for more than 80 percent of all deaths among newborn babies. Prematurity is the single largest cause of newborn deaths worldwide. Preterm births, severe infections and complications during childbirth together account for more than 80 percent of all deaths among newborn babies.
But there is good news! We know that many low-cost low-tech products can help to save newborn lives. To demonstrate the cost-effectiveness of saving a newborn life, Save the Children conducted a Lives Saved Analysis (LiST) of four inexpensive, underutilized, lifesaving products. Universal coverage of these four products in high-mortality countries could save 1,077,000 babies’ lives.
The products are:
- resuscitation devices to help babies breathe;
- chlorhexidine to prevent umbilical cord infections;
- injectable antibiotics to treat newborn sepsis and pneumonia; and corticosteroid injections for women in preterm labor to prevent breathing problems in preterm babies.
These four products have been identified by global health experts as priority interventions to immediately and effectively address avoidable newborn deaths. Other newborn health interventions, such as kangaroo mother care and early and exclusive breastfeeding, would save many more babies.
Globally, preterm birth is the leading cause of newborn mortality and now the number two cause of child mortality. In Uganda, 14 out of every 100 babies are born preterm and complications of prematurity cause 38 percent of newborn deaths, translating to more than 16,000 babies each year. In October 2012, the government of Uganda announced a new commitment to do more to prevent preterm births and care for preterm babies. The government’s actions are aimed at increasing availability and accessibility of quality maternal and newborn care services at a national level. As part of this effort, Uganda has pledged to improve prenatal and childbirth care. High priority has been given to two interventions Uganda believes have significant potential to lower preterm mortality in a cost-effective manner: helping mothers to practice “kangaroo care” which keeps the baby warm and facilitates breastfeeding, and steroid injections for all women in preterm labor to help speed up the development of the baby’s lungs.
At a cost of about 50 cents to $1, two steroid shots can stop premature babies from going into respiratory distress when they are born. In high-income countries, steroids have been widely used for women in preterm labor since the 1990s and an estimated 95 percent of women in preterm labor before 34 weeks now receive steroid injections prior to delivery. By comparison, in low- and middle-income countries, only an estimated 5 percent of women receive these steroid injections.
Three years ago, Natnael probably would not have survived his first week of life. He was born healthy, but two days after he returned home from the birthing facility, he became feverish and restless. His breaths were very fast and he had difficulty breastfeeding. Natnael was suffering from sepsis, an infection that affects a baby’s entire body. In Ethiopia, sepsis is responsible for up to 19 percent of newborn deaths and kills approximately 15,500 babies each year. Natnael was fortunate to have a health extension worker named Belaynesh in his village. In 2010, Belaynesh had received training on how to diagnose and treat diseases like sepsis that kill many newborns. She discovered Natnael’s illness during a routine post-natal home visit and urged the parents to take their baby to the hospital right away for treatment. But the family would not go. The baby’s grandmother and several neighbors said Natnael’s illness was not serious and he would get better soon. Also, there was a long-held belief in the community that newborns cannot receive medicine until they are 2 months old. “That is why I refused to take my baby to the hospital for treatment,” said Doyole, the baby’s mother. Doyole couldn’t sleep that night, she was so worried for her son. “My baby was on the verge of dying,” she said. “I so desperately wanted him to get better.”
Belaynesh returned the next day and tried again to convince the family to take their baby to the hospital. Eventually they agreed to let her treat Natnael at home. “I immediately went to the health post to get the medicine and started giving the baby an antibiotic injection once a day,” said Belaynesh. “I also gave him amoxicillin syrup three times a day for seven days.” “My baby’s condition started improving on the first day after the treatment,” said Doyole. “He started sleeping well and breastfeeding, which were positive signs for us. We are so grateful to the health extension worker for treating our child and saving his life.” “Now I realize that the long-held belief in our community is untrue,” Doyole continued. “I have told people this and I will continue to spread the message to all members of the community so that our babies will get treatment when they need it and they won’t die from these diseases.”
In Nepal, 63 percent of births still take place at home, often in unhygienic conditions. Until recently, many families would follow traditional teachings and apply ash, oil, spice paste or other substances to the umbilical cords of newborn babies, which often led to infection and death. An inexpensive and easy-to-use ointment called chlorhexidine (CHX) can prevent these infections, and it is now being used throughout Nepal. After community-based trials in Nepal, Bangladesh and Pakistan found CHX cord cleansing reduces the risk of newborn death by up to 23 percent, Nepal decided to promote its use nationwide.
The first step was to educate health workers so they could educate families about this lifesaving product. All levels of health care providers were given training on how to introduce the product to mothers and how to apply it correctly. Female community health volunteers have been key to this effort, as they reach pregnant women in the most impoverished rural areas where the risks of death are highest. Health workers now routinely teach women and their families to use kawach – the Nepali word for CHX, which means protector or shield. A tube of kawach is given to women in their eighth month of pregnancy. They are told to use it immediately after cutting the cord, and not to use any other substances.
Sita is a one of 50,000 female community health volunteers in Nepal. She has been providing services to mothers and newborns in her community for 25 years, and she is a respected and sought-after source of knowledge. Sita recently helped a woman named Rihana to deliver her second baby. Immediately afterward, she applied chlorhexidine to the baby’s umbilical cord to prevent infection. Impressed with how well it worked, Rihanna says: “I now tell my friends to use chlorhexidine since the cord heals sooner.” Nepal’s success with CHX is a model for other countries to follow. The Nepal example is now informing efforts by Nigeria to make CHX widely available in the Sokoto region and accelerate training of community-based health volunteers to promote its use. Plans also are underway to begin manufacturing CHX locally in Sokoto in the future.
Syafrina, a healthy 25-year-old, was recently married and pregnant with her first child. She lived in a remote village in Aceh, Indonesia, but she was fortunate to have a dedicated and knowledgeable midwife named Desita nearby. During her pregnancy, Syafrina visited Desita for monthly check-ups, and everything seemed to be going well until the day she went into labor. “It was very painful,” said Syafrina. “I cannot describe it. I just wanted my baby to come out fast.”
Syafrina had planned to give birth at home, but Desita suspected something was wrong and urged Syafrina to go to the village health center where it would be easier to manage complications. Syafrina resisted this idea, but after six hours of increasing pain, she finally agreed to go. “It was a long and difficult birth,” said Desita. “The baby had the umbilical cord wrapped around her. It took two hours, but eventually I delivered the baby.” The baby was a blueish color and she didn’t cry. “I was panicked because I thought my baby might die,” said Syafrina. “But I had faith in Desita, so I tried to stay calm.”
Desita cleared the baby’s airways and tried to stimulate breathing by gently rubbing her body, but still she did not cry. So she resuscitated the baby using a tube. “Finally she cried!” said Desita. “We all felt so happy and relieved!” Baby Naisa was a beautiful little girl.
She weighed 7.7 pounds and was 19 inches long at birth. Soon after the birth, Desita showed Syafrina the correct position for breastfeeding. Naisa had problems latching at first, but Desita encouraged Syafrina to keep trying, and after about an hour she was breastfeeding successfully. Naisa is now almost 6 months old and has been exclusively breastfed since birth. She is starting to become more active and speaks in her own baby language
Desita visits Syafrina and Naisa at home regularly to check on their health, answer questions and give encouragement. “I am very grateful that I have Desita to help me,” said Syafrina. “We talk about everything. She taught me how to bathe my baby and how to breastfeed. Desita is an excellent midwife and she has also become a friend.”
What Can You Do?
The Global Newborn Action Plan will be launched later this year by governments and partners, including Save the Children, in support of the UN Secretary General’s Every Woman, Every Child strategy and A Promise Renewed. This plan – if made a reality – will provide a unique opportunity to improve the survival and health of newborns for the next generation – and ensure more happy birth days.
- Every mother and every newborn must have access to high-impact care that will save their lives.
- We need to create mother and baby-friendly health systems to deliver lifesaving interventions, especially at the time of birth.
- We need to address the underlying causes of newborn mortality, especially gender inequality and malnutrition.
Citizens everywhere should urge their governments – both recipient and donor governments – to invest in newborns and live up to the commitments made to achieve Millennium Development Goals 4 and 5. Mobilizing around the Global Newborn Action Plan is a practical way to do this. Join Save the Children’s global newborn and child survival campaign. Visit everyone.savethechildren.net to find the campaign in your country, make your voice heard, and join our movement.
Visit www.savethechildren.org/world-mothers or follow #SOWM on Twitter to learn how you can help.