How to ensure newborn survival in resource-limited settings

Maheshwori Devi Bishwokarma with her daughter Manisha. Bishwokarma struggled over three days to give birth to her daughter. Nepal has one of the highest maternal mortality rates in the world. Photo by: Gates Foundation / CC BY-NC-ND

My oldest child is now 11 years old. But it seems like just yesterday we were preparing for her arrival, thumbing through baby books for hours in search of the perfect name. My daughter’s first name chose itself; she was named after my Tongan Peace Corps sister. Her middle name presented more of a challenge, as we wanted something both beautiful and meaningful. After much deliberation, we opted for Beatrice, "bringer of joy." A year later, we went through much the same process when I became pregnant with my son.

Sadly, there are many places in the world where parents dare not select their babies' names in advance. It's not that these parents love their children any less than we do — it is because they know there is a good chance their babies will die. I will never forget my visit to a referral hospital in Africa several years ago. The “delivery room” was a 6-by-12-foot alcove with two metal tables and a peeling tile floor. There was no running water, no stethoscope or simple suction equipment, and no blankets or towels to dry and warm newborns. Metal bins were set within easy reach, as it was common for the bodies of stillborn infants — who had yet to utter a single cry — to be placed inside and left for dead.

It is sobering for me to contrast this with my own experience. My son was born 10 days after his due date, delivered by stat C-section when the fetal monitor showed drops in his heart rate. Less than 10 minutes later, I heard the beautiful sound of my baby’s first cry. My recollection of that night is otherwise hazy, as my blood pressure plummeted to 60/30 during surgery. My son has asked me several times what would have happened if he had been born in a place where they didn't have hospitals. I have replied, quite honestly, that both of us would probably have died.

The reality is that, unlike those of us fortunate enough to have ready access to skilled medical care, millions of women throughout the world still do die during childbirth, and go through their pregnancies knowing that their babies may also die before, during or shortly after birth. In many parts of the world, even those babies who are lucky enough to survive infancy have no guarantee of long-term survival.

Every mother deserves to deliver her baby safely, and to experience the immeasurable joy of hearing that first cry. Every baby deserves to have a skilled birth attendant, someone trained to help them take their first breath, who can keep them out of that metal bin. And every child deserves to receive the basic care required to ensure his or her survival.

Sustainable improvements in global newborn, infant and child health are greatly needed, but require constant innovation, widespread collaboration, steadfast leadership, and dedicated funding. Innovation can take many forms: from the introduction of a new vaccine or improvements in supply chain to major changes in technology. Those that help meet basic needs, are simple in practice and accessible to many will have the greatest impact.

Helping Babies Breathe, an intervention focused on newborn survival in resource-limited settings, is a perfect example. HBB was developed by the American Academy of Pediatrics, in consultation with the World Health Organization and in collaboration with the U.S. Agency for International Development, Save the Children, NICHD, Laerdal Global Health, Johnson & Johnson, and a number of other organizations. A highly committed public-private partnership has been the key to implementing the HBB program, now taught in over 70 countries.

HBB trains birth attendants in developing countries in the essential skills of basic newborn resuscitation. Our goal is to have at least one skilled attendant at the birth of every baby, armed with the simple, inexpensive equipment needed to help each baby breathe within the first minute after birth. A recent study in Tanzania has shown that HBB training of birth attendants there reduced newborn deaths by nearly half, by teaching simple steps to help babies breathe in the first moments of life.

The remarkable success of HBB prompted the AAP and its partners to address other preventable causes of newborn death. Essential Care for Every Baby was rolled out last month, and covers care for newborns in the first few days of life, emphasizing effective feeding, warmth, and infection control. The AAP is now working on the third module in the “Helping Babies Survive” series. Essential Care for Small Babies focuses on low-tech interventions health workers can use to help babies survive in under-resourced settings.

There are many reasons why HBB and similar programs continue to succeed — the focus on simple high-impact practices that are easily taught and easily learned, rigorous research and piloting, and sustained funding for implementation. The driving force behind HBB — and the real key to its success — however, comes from the people, the organizations and the alliances that have formed in response to the many unmet needs of the world’s children. HBB is an example of a new and robust model of collaboration involving a diverse array of partners — health care providers, professional associations, government agencies, NGOs and corporate philanthropists, who share a commitment to saving children’s lives.

It is crucial that we find ways to increase support for essential newborn and child survival programs like HBB, and to foster effective multisector partnerships, so that more health care workers can be taught to evaluate newborns, to stimulate the breathing of infants who would otherwise be left for dead, and to support the overall survival of infants and children everywhere. As this goal is achieved, more and more babies will survive and thrive, and end up — not in those metal bins — but home with their families, where the joy of choosing their names can begin.

Want to learn more? Check out the Healthy Means campaign site and tweet us using #HealthyMeans.

Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.

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About the author

  • Linda arnold

    Linda Arnold

    Linda Arnold is an associate professor of pediatrics in the section of emergency medicine at the Yale School of Medicine, and a Public Voices Fellow in the Yale Op-Ed project. She is chair of the American Academy of Pediatrics’ Section on International Child Health, a member of the Academy's Global Immunization Advocacy Project Advisory Committee, and represents the AAP on both the Shot at Life global immunization initiative, and the Survive and Thrive Global Development Alliance.