{"id":39354,"date":"2019-10-22T09:07:29","date_gmt":"2019-10-22T13:07:29","guid":{"rendered":"https:\/\/www.healthynewbornnetwork.org\/?p=39354"},"modified":"2022-02-02T16:17:20","modified_gmt":"2022-02-02T21:17:20","slug":"call-to-action-conflict-of-interest-and-the-infant-formula-industry","status":"publish","type":"post","link":"https:\/\/www.healthynewbornnetwork.org\/blog\/call-to-action-conflict-of-interest-and-the-infant-formula-industry\/","title":{"rendered":"Call to action: Conflict of interest and the infant formula industry"},"content":{"rendered":"

This blog was originally published by the BMJ here<\/a>.<\/em><\/p>\n

\n

By Tanya Doherty, Lori Lake, Max Kroon, Chantell Witten, Natasha Rhoda, David Sanders<\/strong><\/em><\/p>\n

Breastfeeding<\/a> is one of the most cost-effective interventions for improving the health and survival of children, with important short and long-term benefits to families and society. [1] However, policies and interventions to support breastfeeding are undermined by powerful multi-national formula milk manufacturers who compete for a share of infant feeding.<\/p>\n

The Code of Marketing of Breastmilk Substitutes (BMS Code) including subsequent World Health Assembly resolutions, is an attempt to counter harmful marketing of breastmilk substitutes to the public and health professionals, but enforcement is weak and code non-compliant marketing continues despite BMS Code-related legislation. [2-4]<\/p>\n

In the field of child health and nutrition, the primary responsibility of health professionals is to safeguard optimal health and development, which includes protection and support of breastfeeding. The primary concern of companies who manufacture breastmilk substitutes is profit, and their marketing strategy often targets endorsement by health professionals. [5] The intersection of these two groups therefore leads to conflicts of interest. [6]<\/p>\n

In February 2019, a bold decision by the UK Royal College of Paediatrics and Child Health (RCPCH) to halt funding from manufacturers of breastmilk substitutes has once again highlighted a long-ignored conflict of interest and been followed by other decisions such as that of The BMJ<\/i> to no longer carry advertisements from BMS manufacturers. [7,8]<\/p>\n

But in our view, as academics and child health advocates, more needs to be done to raise awareness about conflict of interest and enforce the Code in research, service, training and policy spaces. We call for bold, proactive leadership to eliminate this conflict of interest, especially in low-and-middle income countries with the largest current growth in formula milk sales. [1] A look at the history of breastfeeding protection in South Africa highlights the importance of eliminating these competing interests.<\/p>\n

South Africa, an upper-middle income country with discrepantly high levels of young child mortality, has had a complex history in the promotion and support of breastfeeding. [9] In the early 2000s at the height of the HIV epidemic, the Department of Health recommended that women living with HIV (WLWH) should not breastfeed and instead provided six months of free formula milk. [10] With increasing evidence of a negative impact on the health of HIV-exposed infants,\u00a0suboptimal child mortality reduction and evidence that antiretroviral therapy (ART) prevents breastfeeding transmission, national policy evolved to promote breastfeeding by women supported on ART. [11-14]<\/p>\n

Since 2011, South Africa<\/a> has scaled up lifelong ART for women living with HIV and has discontinued free formula milk. In 2012, the Code of marketing of breastmilk substitutes was enacted as Regulation 991 (R991) with accompanying guidelines for industry and health care personnel. [15]\u00a0 Since 2015, the University of Cape Town (UCT) Department of Paediatrics and Child Health Advocacy Committee and the South African Civil Society for Women\u2019s, Adolescents\u2019 and Children\u2019s Health (SACSoWACH) have monitored and reported contraventions of R991 by BMS manufacturers. These have included offers to sponsor academic positions within universities, industry exhibition stands advertising specialised formula milks and sponsored breakfast symposia at paediatric, nutrition and allergy conferences and hosting of continuing medical education symposia for nurses and dieticians. These are not a few isolated cases, but rather part of a global phenomenon with a series of recent reports\u00a0documenting persistent, systematic violations by the BMS industry and a WHO report concluding that \u201cProtecting the health of children and their mothers from continued misleading marketing practices should be seen by countries as a public health priority and\u00a0 human rights obligation\u201d. [4]<\/p>\n

These examples illustrate the need to eliminate conflict of interest among health professionals and institutions focused on children\u2019s health.\u00a0 South Africa has fought a long, hard battle to protect, promote, and support breastfeeding. Policy decisions and programme implementation helped to increase the exclusive breastfeeding rate from 8% to 32% but it still falls far short of the Global Nutrition Target of 50% by 2025. [16] Moreover, the extensive use of formula milk (27% of infants aged 2-3 months) is particularly concerning when 66% of infants live in households below the upper-bound poverty line and 30% lack potable water on site, with consequent vulnerability to diarrhoea and pneumonia. [9, 17]<\/p>\n

Globally, 136 out of 194 countries have Code-related legislation, yet contravention and violations persist in the face of weak monitoring and enforcement mechanisms. [4] Internal review and disclosure, and proactive policies by institutions involved in child health policy, research, training and service to identify and counter breastmilk substitute-related conflict of interest is urgently required to send a clear message to industry. The recent bold decisions by the RCPCH\u00a0and The BMJ<\/i> will hopefully spark similar action in professional bodies and universities in low and middle income (LMIC) settings. [7,8] These institutions, who are important thought leaders, need to act independently and with integrity in the best interests of children.<\/p>\n

\n

References:<\/b><\/p>\n

    \n
  1. Rollins NC, Bhandari N, Hajeebhoy N, et al.<\/i> Why invest, and what it will take to improve breastfeeding practices? The Lancet<\/i> 2016;387(10017):491-504.<\/li>\n
  2. WHO. International Code of Marketing of Breast-milk Substitutes. Geneva, 1981<\/li>\n
  3. World Health Assembly. WHA69.9: Ending inappropriate promotion of foods for infants and young children. Geneva, 2016.<\/li>\n
  4. WHO. Marketing of breast-milk substitutes: national implementation of the international code, status report 2018. Geneva, 2018<\/li>\n
  5. McFadden A, Mason F, Baker J, et al.<\/i> Spotlight on infant formula: coordinated global action needed. The Lancet<\/i> 2016;387(10017):413-15.<\/li>\n
  6. Clark D. Avoiding Conflict of Interest in the in the field of Infant and Young Child Feeding: better late than never. World Nutrition<\/i> 2017;8(2)<\/li>\n
  7. Mayor S. Royal college stops taking funding from formula milk firms. BMJ<\/i> 2019;364:l743.<\/li>\n
  8. Godlee F, Cook S, Coombes R, et al.<\/i> Calling time on formula milk adverts. BMJ<\/i> 2019;364:l1200.<\/li>\n
  9. National Department of Health\/Statistics South Africa\/South African Medical Research Council and ICF. South Africa Demographic and Health Survey 2016. Pretoria, 2019<\/li>\n
  10. Doherty T, Sanders D, Goga A, et al.<\/i> Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa. Bulletin of the World Health Organization<\/i> 2011;89(1):62-7.<\/li>\n
  11. Doherty T, Chopra M, Jackson D, et al.<\/i> Effectiveness of the WHO\/UNICEF guidelines on infant feeding for HIV-positive women: results from a prospective cohort study in South Africa. AIDS<\/i> 2007;21(13):1791-7.<\/li>\n
  12. Coovadia HM, Rollins NC, Bland RM, et al.<\/i> Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet<\/i> 2007;369(9567):1107-16.<\/li>\n
  13. Arikawa S, Rollins N, Jourdain G, et al.<\/i> Contribution of Maternal Antiretroviral Therapy and Breastfeeding to 24-Month Survival in Human Immunodeficiency Virus-Exposed Uninfected Children: An Individual Pooled Analysis of African and Asian Studies. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America<\/i> 2018;66(11):1668-77.<\/li>\n
  14. South African National Department of Health. Circular minute number 3 of 2017\/18 HIV\/AIDS, TB, MNCWH: Amendment of the 2013 infant and young child feeding (IYCF) policy. In: Health, ed. Pretoria: South African Government, 2017.<\/li>\n
  15. South African National Department of Health. Guidelines to industry and health care personnel: The regulations relating to foodstuffs for infants and young children, R991 of 6th December 2012 (\u201cregulations\u201d). In: National Department of Health, ed. Pretoria, 2012.<\/li>\n
  16. WHO\/UNICEF. Global Nutrition Targets 2025: Breastfeeding Policy Brief (WHO\/NMH\/NHD\/14.7). Geneva, 2014<\/li>\n
  17. Sambu W. Analysis of the General Household Survey 2017. Cape Town: Children\u2019s Institute, University of Cape Town 2018.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    This blog was originally published by the BMJ here. By Tanya Doherty, Lori Lake, Max Kroon, Chantell Witten, Natasha Rhoda, David Sanders Breastfeeding is one of the most cost-effective interventions for improving the health and survival of children, with important short and long-term benefits to families and society. [1] However, policies and interventions to support … Continued<\/a><\/p>\n","protected":false},"author":7211,"featured_media":39355,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"acf":[],"yoast_head":"\nHealthy Newborn Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.healthynewbornnetwork.org\/blog\/call-to-action-conflict-of-interest-and-the-infant-formula-industry\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Call to action: Conflict of interest and the infant formula industry - Healthy Newborn Network\" \/>\n<meta property=\"og:description\" content=\"This blog was originally published by the BMJ here. 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With this programmes Save the Children has reached 3,071 children under 5 children and 1,002 pregnant women."},{"@type":"BreadcrumbList","@id":"https:\/\/www.healthynewbornnetwork.org\/blog\/call-to-action-conflict-of-interest-and-the-infant-formula-industry\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.healthynewbornnetwork.org\/"},{"@type":"ListItem","position":2,"name":"Call to action: Conflict of interest and the infant formula industry"}]},{"@type":"WebSite","@id":"https:\/\/www.healthynewbornnetwork.org\/#website","url":"https:\/\/www.healthynewbornnetwork.org\/","name":"Healthy Newborn Network","description":"Addressing critical knowledge gaps in newborn health.","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.healthynewbornnetwork.org\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/www.healthynewbornnetwork.org\/#\/schema\/person\/1d39aa815df3123275f62e3f3d9a417f","name":"HNN Team","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.healthynewbornnetwork.org\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/0762878efbad44b50487ac3aaf87e6ed?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/0762878efbad44b50487ac3aaf87e6ed?s=96&d=mm&r=g","caption":"HNN Team"},"url":"https:\/\/www.healthynewbornnetwork.org\/blog\/author\/hnn_admin\/"}]}},"featured_image":"<img width=\"768\" height=\"512\" src=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/CH184755-768x512.jpg\" class=\"attachment-medium_large size-medium_large\" alt=\"\" decoding=\"async\" srcset=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/CH184755-768x512.jpg 768w, https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/CH184755-300x200.jpg 300w, https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/CH184755-1024x683.jpg 1024w, https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/CH184755.jpg 1200w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/>","author_name":"HNN Team","author_image":"<img src=\"https:\/\/www.healthynewbornnetwork.org\/hnn-content\/themes\/hnn\/dist\/images\/member-default.jpg\" alt=\"\" class=\"avatar avatar-32 photo\" height=\"32\" width=\"32\"\/>","acf_custom_fields":{"publication_date":"20191003","authors":false,"additional_authors":"Tanya Doherty, Lori Lake, Max Kroon, Chantell Witten, Natasha Rhoda, David Sanders","partners":[],"issues":[{"ID":132,"post_author":"7211","post_date":"2015-10-21 15:20:24","post_date_gmt":"2015-10-21 15:20:24","post_content":"<p>[vc_row full_width=\"stretch_row\" css=\".vc_custom_1453403441710{margin-top: -60px !important;padding-top: 30px !important;padding-bottom: 30px !important;background-color: #ffffff !important;}\"][vc_column width=\"1\/2\"][vc_column_text]<\/p>\n<h2>Early and exclusive breastfeeding for the first six months of a child\u2019s life reduces child mortality and has health benefits that extend into adulthood. Breastfeeding benefits not only the child but the mother and family also, as it is free of cost and reduces the risk of infection in newborns, enhances neurodevelopment, and reduces the risk of acquiring certain non-communicable illnesses in adulthood. Breastmilk substitutes and animal milk not only lack essential immune-building components, they also expose the infant to an increased risk of infection and morbidity.<\/h2>\n<p>[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-red\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">44<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1690991173051{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage of infants under six months of age who are exclusively breastfed (2015-2020)<\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-yellow\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">800<\/span>k<\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1690991296488{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">number of infant deaths that can be <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6735804\/\">attributed to suboptimal breastfeeding practices<\/a><\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-blue\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">20<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1690991361409{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\"><span style=\"font-weight: 400;\">percentage reduction in risk of newborn death when <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5025980\/#:~:text=About%2020%25%20of%20all%20neonatal,the%20neonatal%20period%20%5B17%5D.\">breastfeeding is initiated within one hour of birth<\/a><\/span><\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner content_placement=\"middle\"][vc_column_inner][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_column_text]<\/p>\n<h6 style=\"text-align: center;\"><em>All data on this page represents the most recent data available, unless otherwise noted. Please visit our\u00a0<a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a>\u00a0page and download the Excel spreadsheet to explore the data further.<\/em><\/h6>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row full_width=\"stretch_row\" css=\".vc_custom_1452696349804{margin-top: 30px !important;margin-bottom: 30px !important;background-color: #f6f6f4 !important;}\"][vc_column][vc_text_separator title=\"More information\" color=\"custom\" accent_color=\"#cccccc\"][vc_row_inner equal_height=\"yes\"][vc_column_inner][vc_column_text]Human milk feeding and breastfeeding have immediate and long-term benefits for all babies, including the preterm and low birth weight. Feeding small and sick newborns is challenging because of immaturity or medical conditions that interfere with effective oral feeding. Moreover, small newborns are further affected by variation in the gut microbiome and increased risk for infections.<\/p>\n<p>They often need care in special or intensive care units, which commonly results in separation from their mothers, creating additional challenges to feeding. Care for small and sick newborns must include the promotion of safe and optimal use of human milk (with cup or nasogastric tube), and subsequent transition to breastfeeding, to achieve adequate gain weight and growth in these infants. Staff caring for these babies require specific knowledge and competencies, as well as sufficient supplies for feeding small and sick newborns.<\/p>\n<p>Studies have shown that Early Total Enteral Feeding (ETEF) is safe and decreases the incidence of infections, including necrotizing enterocolitis (NEC), enhances cognitive development, reduces days on parental nutrition, and helps shorten the time to achieve full feeds. Own mother\u2019s milk is the first choice for such babies. Delayed initiation of and infrequent breastmilk feeding can affect the establishment of milk supply and result in decreased milk supply and unnecessary use of breast milk substitutes. If the small baby cannot suckle at the breast, it is important to express, starting with the colostrum within an hour of birth to support the onset of lactation. Such mothers should continue to express every 2-3 hours for eight or more sessions during the day, including at night for ensuring no disruption of lactation and milk supply. To achieve low risk of contamination of expressed breast milk, it is very important to ensure hygienic milk collection, storage, and handling practices.<\/p>\n<p>When own mother\u2019s milk is not available, WHO and UNICEF promote the use of pasteurized donor human milk (PDHM) as the second option in preference to formulas. However, WHO has specified that, this \u201crecommendation (is) relevant for settings where safe and affordable milk-banking facilities are available or can be set up;\u201d The use of formulas as the next option requires counseling the mothers and families on their proper and clean preparation. The use of preterm formulas should only be recommended when the VLBW baby is not gaining weight on standard formula and if it can be afforded. For babies smaller than 1500gm, the WHO recommends adding vitamin D, calcium, phosphorus, and iron supplements.[\/vc_column_text][vc_column_text]<strong>Key resources<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/infant-and-young-child-feeding\">WHO Infant Feeding Recommendations<\/a><\/li>\n<li><a href=\"https:\/\/cdn.who.int\/media\/docs\/default-source\/nutritionlibrary\/breastfeeding\/unicef-who-capture-the-moment-eibf-2018.pdf?sfvrsn=587210cf_2\" target=\"_blank\" rel=\"noopener noreferrer\">Early Initiation of Breastfeeding to Promote Exclusive Breastfeeding<\/a><\/li>\n<li><a href=\"https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/question-and-answers-hub\/q-a-detail\/coronavirus-disease-covid-19-breastfeeding\">Coronavirus disease (COVID-19): Breastfeeding Q&A (WHO)<\/a> + <a href=\"https:\/\/www.who.int\/news-room\/commentaries\/detail\/breastfeeding-and-covid-19\">Scientific Brief\u00a0<\/a><\/li>\n<li>Lancet Breastfeeding Series (2016)<\/li>\n<li><a href=\"http:\/\/www.who.int\/maternal_child_adolescent\/topics\/child\/nutrition\/breastfeeding\/en\/\" target=\"_blank\" rel=\"noopener noreferrer\">WHO Resources on Breastfeeding<\/a><\/li>\n<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/breastfeeding-advocacy-toolkit\/\">Breastfeeding Advocacy Toolkit<\/a><\/li>\n<li>\n<p class=\"entry-title\"><a href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/who-recommendations-for-care-of-the-preterm-or-low-birth-weight-infant\/\">WHO recommendations for care of the preterm or low-birth-weight infant (2022)<\/a><\/p>\n<\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]<\/p>\n","post_title":"Breastfeeding and feeding of small and sick newborns","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"breastfeeding-and-feeding-of-small-and-sick-newborns","to_ping":"","pinged":"","post_modified":"2023-11-21 12:34:55","post_modified_gmt":"2023-11-21 17:34:55","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&p=132","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"}],"regions":[{"ID":247,"post_author":"7211","post_date":"2015-11-22 21:37:22","post_date_gmt":"2015-11-22 21:37:22","post_content":"","post_title":"Africa","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"africa","to_ping":"","pinged":"","post_modified":"2016-02-11 21:42:43","post_modified_gmt":"2016-02-11 21:42:43","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=region&p=247","menu_order":0,"post_type":"region","post_mime_type":"","comment_count":"0","filter":"raw"}],"countries":[{"ID":223,"post_author":"7211","post_date":"2015-10-21 22:04:20","post_date_gmt":"2015-10-21 22:04:20","post_content":"[vc_row][vc_column css=\".vc_custom_1453305596740{padding-top: 30px !important;padding-bottom: 30px !important;}\"][vc_text_separator title=\"Leading causes of neonatal deaths in South Africa (2020)\" el_class=\"transform:upperclass\"][vc_row_inner][vc_column_inner][vc_round_chart type=\"doughnut\" stroke_width=\"1\" stroke_color=\"custom\" values=\"%5B%7B%22title%22%3A%220%25%20Diarrhoea%22%2C%22value%22%3A%220%25%22%2C%22color%22%3A%22vista-blue%22%7D%2C%7B%22title%22%3A%220%25%20Tetanus%22%2C%22value%22%3A%220%25%22%2C%22color%22%3A%22mulled-wine%22%2C%22custom_color%22%3A%22%238d6dc4%22%7D%2C%7B%22title%22%3A%225%25%20Pneumonia%22%2C%22value%22%3A%225%25%22%2C%22color%22%3A%22peacoc%22%7D%2C%7B%22title%22%3A%2236%25%20Preterm%20birth%20complications%22%2C%22value%22%3A%2236%25%22%2C%22color%22%3A%22blue%22%7D%2C%7B%22title%22%3A%2220%25%20Intrapartum%20related%20events%22%2C%22value%22%3A%2220%25%22%2C%22color%22%3A%22turquoise%22%7D%2C%7B%22title%22%3A%2214%25%20Sepsis%20and%20other%20infectious%20conditions%20of%20the%20newborn%22%2C%22value%22%3A%2214%25%22%2C%22color%22%3A%22pink%22%7D%2C%7B%22title%22%3A%2210%25%20Congenital%20abnormalities%5Ct%22%2C%22value%22%3A%2210%25%22%2C%22color%22%3A%22violet%22%7D%2C%7B%22title%22%3A%2215%25%20Other%20conditions%22%2C%22value%22%3A%2215%25%22%2C%22color%22%3A%22chino%22%7D%5D\" custom_stroke_color=\"#f6f6f4\" css=\".vc_custom_1686335375365{padding-right: 30px !important;padding-left: 30px !important;background-position: center !important;background-repeat: no-repeat !important;background-size: contain !important;}\"][\/vc_column_inner][\/vc_row_inner][vc_column_text]\r\n<h6 style=\"text-align: left;\">Source: Estimates for causes of death 2000-2020 generated by the WHO and Maternal and Child Epidemiology Estimation Group (MCEE) 2023 and downloaded from <a href=\"http:\/\/data.unicef.org\/\" target=\"_blank\" rel=\"noopener noreferrer\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/data.unicef.org&source=gmail&ust=1551964625737000&usg=AFQjCNFsFTtu9FzS8H64YC88NPOzQVbPwQ\">http:\/\/data.unicef.org<\/a><\/h6>\r\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row full_width=\"stretch_row\" gap=\"5\" css=\".vc_custom_1453306441839{background-image: url(\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/country-stat-bkgr.jpg?id=389) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}\"][vc_column css=\".vc_custom_1453306493120{margin-top: 30px !important;margin-bottom: 30px !important;}\"][vc_text_separator title=\"key indicators\" el_class=\"transform:uppercase text-white\"][vc_row_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1552412356987{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">11<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Newborn mortality rate (deaths per 1,000 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1686335292465{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">2.2<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Annual reduction in newborn mortality rate 2000-2021 (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1650980934354{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">33<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Proportion of under-5 child deaths that are newborn (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1686335304276{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">16.2<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Stillbirth rate (deaths per 1,000 births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1686335350088{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">96.7<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Skilled birth attendance (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1578918718172{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">67<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Early initiation of breastfeeding (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1698697104922{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">13<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Preterm birth rate (births <37 weeks per 100 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1686335328630{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">127<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Maternal mortality ratio (deaths per 100,000 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_column_text css=\".vc_custom_1456677993474{margin-top: 20px !important;}\"]\r\n<h5 style=\"text-align: center;\"><span style=\"color: #ffffff;\">Visit our<\/span> <a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn numbers<\/a> <span style=\"color: #ffffff;\">page to explore the most recent data further<\/span><\/h5>\r\n[\/vc_column_text][\/vc_column][\/vc_row]","post_title":"South Africa","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"south-africa","to_ping":"","pinged":"","post_modified":"2023-10-30 16:17:00","post_modified_gmt":"2023-10-30 20:17:00","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=country&p=223","menu_order":0,"post_type":"country","post_mime_type":"","comment_count":"0","filter":"raw"}],"about_the_author":"","author_image":false},"_links":{"self":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/posts\/39354"}],"collection":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/users\/7211"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/comments?post=39354"}],"version-history":[{"count":0,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/posts\/39354\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media\/39355"}],"wp:attachment":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media?parent=39354"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/categories?post=39354"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/tags?post=39354"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}