Hidden Deaths of the World's Newborn Babies

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Hidden deaths of the world’s newborn babies

A: The time taken varies hugely but Joy Lawn is an African-born paediatrician and perinatal there are examples of sudden change epidemiologist with British citizenship. She is based especially when governments prioritize in South Africa as Senior Research and Policy Advisor a problem, there is a do-able solution with the Saving Newborn Lives programme of Save the and United Nations agencies and do- Children-USA. She completed her medical degree in nors pull in the same direction. For ex- 1990 in the United Kingdom and has worked in several ample, neonatal tetanus still killed over African countries providing newborn care services and 200 000 babies a year in 2000 despite training. She shifted to public health working at the a very do-able solution, an injection WHO WHO Collaborating Centre in Reproductive Health at during pregnancy costing only US$ Joy Lawn the Centers for Disease Control and Prevention, Atlanta, 0.20. With new funds and coordinated United States of America (1998–2001), and then at the Institute of Child Health, efforts, many more women have been reached, even in the poorest districts. in the United Kingdom (2001–2004). She co-led the Neonatal Group in the Child The world is moving towards elimina- Health Epidemiology Reference Group (CHERG), which developed the firstestimate tion of neonatal tetanus after missing of annual global neonatal deaths, published in the Lancet neonatal series and the the goal in 2000 when commitment World health report 2005. and funds were lacking. In 2005, very few countries included newborn care in their Integrated Management Improving newborn survival rates takes more than money, says Joy Lawn. But how for Childhood Illness (IMCI) pro- do you get disparate partners, countries and donors working together effectively? grammes, but now more than half of the MDG Countdown Priority countries have changed their policy to add Q: You and your colleagues produced the ing proportion of under-five deaths in newborn case management. But policy Lancet neonatal series in 2005 helping to the neonatal period (globally now at change alone does not save lives – and put 4 million annual newborn deaths on almost 40%) raised a flag. At the same nor do process changes such as new the global agenda. Why were these deaths time several publications highlighted drugs or new training programmes. previously invisible? the huge numbers of deaths, but also These changes have to reach high A: Despite the huge numbers, newborn the solutions that could save babies’ population coverage. deaths were and to some extent still are lives. We have growing evidence of invisible at many levels. This starts in how many lives can be saved at the Q: Have the child and maternal health- the homes of the poor where most of community level (through breastfeed- related mortality MDGs become a stick these deaths occur and goes right up to ing, warmth, cleanliness) and with with which to beat African countries that the corridors of power. More than two- simple, low-tech care in facilities. are not on track to meet the 2015 targets? Newborn survival has moved up the thirds of these 4 million newborns die A: To Africans it shows the world’s global agenda partly because of better in sub-Saharan Africa and south Asia, ongoing perception of Africa as one communication – between maternal often in the first days of life, without a and child health programmes, coun- entity – these countries are not all the name let alone a birth certificate. There tries and donors, and various groups of same. There are some that are on track have been initiatives such as the Safe health professionals. Partnerships such for several if not all the MDGs, for Motherhood Initiative, which was most as the Healthy Newborn Partnership, example Mauritius. In the last few years concerned for the mother, while the now merged in the [WHO-hosted] we have seen several African countries child survival campaign was primarily Partnership for Maternal Newborn report reductions in child mortality for the older child. The newborn has & Child Health, provide a forum for of 25–30%, for example Madagascar, fallen between the cracks. However, if consensus building and enable joint Malawi, Mozambique and the United all partners worked together effectively, action instead of duplication. Policy Republic of Tanzania. Africa starts with if roles were clear and services were inte- and programme change are more likely an unfair disadvantage. If you have grated, this would not be the case. if there is one clear message rather than 11% of the world’s population but you a cacophony of calls to action. In the carry the burden of 50% of child and Q: Neonatal mortality was a neglected past three years, there has been a global maternal deaths, probably 95% of the issue until 2005. How has this changed shift to integrated maternal, new- HIV, more than 95% of the malaria, and how do you respond to criticism of born and child health and this holds combined with the poorest countries, some of the initiatives? potential to speed up progress for all then you have to run faster. The respon- A: When the Millennium Develop- the health MDGs, and especially for sibility for the MDGs is a collective ment Goals (MDGs) were launched in newborn survival. one. The Group of Eight (G8) countries 2000 almost no global attention was has committed to 0.7% of gross domes- paid to newborns. As countries and Q: How long does it usually take for tic product for development aid and partners began to track MDG progress global policy changes to permeate to action there are health targets attached which for child survival the high and increas- at community level? very few donor countries meet.

250 Bulletin of the World Health Organization | April 2008, 86 (4) News

Q: Under-five child mortality must be down to providing services you need ready overloaded. You also need to in- reduced by two thirds by 2015 to meet communities to be on board. There vest in the vehicle, and this is starting MDG 4. Was this target unrealistic are countries in Africa where people to happen. There is a paradigm shift at when it was set? live close to health facilities but they the GAVI Alliance [formerly known as A: It wasn’t a deliberately unrealistic give birth at home. There has to be a the Global Alliance for Vaccines and goal although, in retrospect, it was feeling of trust and respect and an un- Immunisation] which has funnelled highly aspirational. From 1960 to 1990 derstanding of the benefits available, as billions into immunization. They now there was wonderful progress in child well as removing practical barriers such have a health system strengthening survival. The goal was based on the as catastrophic costs for emergency fund that is starting to invest consider- trend observed up until then, but no caesarean sections. able amount of money. Ethiopia was one could have predicted the massive the first country to benefit from this. increase of HIV, particularly in south- Q: This month South Africa is hosting New initiatives such as the Interna- ern Africa. In addition, during the the second Countdown to 2015. What do tional Health Partnership hold hope 1990s many African countries also suf- you expect to come out of this conference? for such progress. The message to the fered through structural readjustment A: The Countdown tracks progress [on upcoming G8 summit in Japan is that plans that reduced health funding and the MDGs] in 68 priority countries, maternal newborn and child mortal- at the same time donor funding was with a focus on the population cover- ity are the litmus test of a functioning reduced especially for regular maternal age of a set of selected interventions health system. A consistent focus to and child health programmes, even for – those most likely to save the lives of strengthen health systems will reduce immunization. women, babies and children. There those deaths. is great news for immunization and Q: Setting targets is a favoured public malaria coverage. Investment in these Q: One aspect of the debate on global health communications strategy. But programmes has gone up and the warming is population control. Shouldn’t doesn’t it result in failure if targets are results are there. But we need invest- the focus be more on birth control than not met? ment to go up more for maternal and saving lives? A: If you don’t set targets nothing newborn interventions and also for the A: Use of modern contraceptives is happens. If it wasn’t for a very strong care of sick children. one of the most cost-effective ways to MDG framework there would be a lot reduce the numbers of maternal and more dissonance among donors and Q: Overseas donor aid for vertical child deaths. But the birth rate is also there would be a lot less political will programmes such as immunization, connected to education and gender to bring change in many governments. malarial bednets and HIV increased equality. Bangladesh, for example, has Many African governments are very dramatically over the past two years – for had a big drop in maternal mortality committed to the MDGs. example 200% for malaria bednets. Is and under-five mortality despite hav- extra money the only answer to child and ing a low number of skilled attendants. Q: What is necessary to bring about the maternal mortality? This may be explained by increased integration of the policies and services and A: It’s not just about more money, it is maternal literacy and a big rise in the develop an understanding at community also about where the money goes and use of contraceptives. ■ level that people have a right to good care? how this affects the health system. You A: Policy must be owned by national can’t drop extra antenatal interventions governments, but when it comes on antenatal care if the system is al-