Newborn survival: changing the trajectory over the next decade

The first month of a baby’s life is surrounded by emotion and new experiences. The mother and father are learning how to be parents, interpreting and responding to the myriad of different cries, sounds and movements. Parents everywhere are concerned that their new baby is warm, safe and feeds well. The first month is one of soaring hopes and possibilities. Yet that month, and especially the birth and first few days after, carries the highest risk of death for mothers and newborns and the highest risk of long-term disability, for example after preterm birth, labour complications, infections or severe jaundice. Moreover, under-nutrition during the 1000-day period from conception through age 2 years has life-long consequences, including increased risk for infectious diseases, intellectual impairment, reduced economic productivity, and increased risk for adult-onset cardiovascular diseases and diabetes. During the last decade the world has changed in many ways with urbanization, rapid uptake of communication technologies such as cell phones and changing lifestyles and health outcomes. In some countries, newborns face a more certain future than 10 years ago, yet in other countries very little has changed. Worldwide, 3.1 million newborns still die each year, and most of these deaths are preventable (Lawn et al. 2012). This series presents a comprehensive analysis of the changes in newborn care and survival over the last decade at global level, as well as five detailed country assessments undertaken by over 60 experts from governments and multiple organizations, in order to better understand the process of taking solutions to scale and how to accelerate progress towards reductions in mortality and morbidity. Recognition of the importance of newborn survival globally and nationally was stimulated by the Millennium Development Goals (MDGs), notably MDG 4 for child survival, to reduce under-five mortality by two-thirds from 1990 to 2015, and closely linked with MDG 5, to reduce maternal mortality by three-quarters (Lawn et al. 2005). Between 2000 and 2010, progress towards both MDGs 4 and 5 has accelerated, with an annual rate of reduction of 2.9% mortality for children 1–59 months, and 2.3% for maternal mortality (Lawn et al. 2012). Having specific targets and the focus of national governments and donors have been critical factors in this increased progress since 2000. Even if the targets for child and maternal mortality are not met at global level, many countries will come closer than they otherwise would have. However, progress in reducing newborn deaths has lagged behind post-neonatal under-five mortality at only 1.7% per year from 1990 to 2000, and despite some improvement is still only 2.1% per year for 2000–2010 (Lawn et al. 2012). This is 40% slower progress than for older children and 30% slower than for maternal mortality. Because of the more rapid decline in post-neonatal and child survival, Figure 1 Fatoumata Sogoba holds her 9 hour-old baby boy, Moussa. She is a 15 year-old mother, married at 14. She has never attended school and lives in with her husband, a 27 year-old trader, in Bougouni, Mali. Michael Bisceglie/Save the Children. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine The Author 2012; all rights reserved. Health Policy and Planning 2012;27:iii1–iii5 doi:10.1093/heapol/czs054