PhD REVIEW Neonatal mortality: an invisible and marginalised trauma Mats Ma˚ lqvist* International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Sweden Neonatal mortality is a major health problem in low and middle income countries and the rate of improvement of newborn survival is slow. This article is a review of the PhD thesis by Mats Ma˚ lqvist, titled ‘Who can save the unseen Studies on neonatal mortality in Quang Ninh province, Vietnam’, from Uppsala University. The thesis aims to investigate structural barriers to newborn health improvements and determinants of neonatal death. The findings reveal a severe under-reporting of neonatal deaths in the official health statistics in Quang Ninh province in northern Vietnam. The neonatal mortality rate (NMR) found was four times higher than what was reported to the Ministry of Health. This underestimation of the problem inhibits adequate interventions and efforts to improve the survival of newborns and highlights the invisibility of this vulnerable group. The findings of the thesis also point at an inequity in survival chances based on ethnicity of the mother. Newborns of ethnic minority mothers were at a twofold risk of dying within the first 4 weeks of life compared to their peers belonging to the hegemonic group of Kinh (OR 2.08, 95% CI: 1.39 3.10). This increased risk was independent of maternal education and household economic status. Neonatal mortality was also associated with home deliveries, non-attendance to antenatal care and distance to the health care facilities. However, ethnic minority mothers still had an increased risk of experiencing a neonatal death even if they attended antenatal care, delivered at, or lived close to a health facility. This example of ethnic inequity highlights the importance to target those most in need. Keywords: neonatal mortality; inequity; ethnic minorities; care seeking; delivery care utilisation; under-reporting; Vietnam This article has been commented on by Zulfiqar A Bhutta. Please follow this link http:// www.globalhealthaction.net/index.php/gha/article/view/6360 to read his Commentary. Received: 15 October 2010; Revised: 20 December 2010; Accepted: 20 December 2010; Published: 16 March 2011 N4 early weeks four of million life newborns each year die and during world-wide the first neonatal mortality makes up 40% of the total child mortality (1, 2). With an annual number of births in the world reaching 130 million, this means that the overall neonatal mortality rate is about 30/1,000. This is a level that has gone basically unchanged for the past 50 years, despite minor improvements (3). However, recently there has been an increasing focus on the neonatal period among researchers and policy makers calling for action (4, 5), as well as some evidence of an accelerating improvement during the past few years (6). One reason for the stagnant development in neonatal survival might be found in global inequity. While Sweden and the rest of the industrialised sector maintain a neonatal mortality rate of 2 3/1,000, it is not uncommon that this rate reaches over 60/1,000 in the poorer segments of the world (6). Ninety-nine (99%) of all children who die during the first 4 weeks of life are doing so in the poorer parts of the world, especially in sub- Saharan Africa and South Asia (7). In order for interventions that improve the chances for neonatal survival to be put into practice, demand and supply need to meet: there should be enough resources and knowledge among care providers, as well as adequate care-seeking behaviours, and a readiness and willingness to utilise the existing health system among families. To have skilled attendance at birth might avert a large proportion of all intrapartum-related neonatal deaths if good coverage is reached (8, 9). A person with knowledge Global Health Action 2011. # 2011 M. Ma˚ lqvist. This is an Open Access article distributed under the terms of the Creative Commons Attribution- Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Global Health Action 2011, 4: 5724 - DOI: 10.3402/gha.v4i0.5724 (page number not for citation purpose) 1