Gladis Atyang and her newborn baby Maraga at Changara dispensary, Busia County, Kenya. Photo by: Allan Gichigi / Save the Children

Between 1990 and 2018, the annual newborn mortality dropped from 4.4 million to 2.5 million. While we celebrate the remarkable progress in newborn health and survival, we are cognizant of an unfinished agenda and new emerging priorities. Latest estimates for newborn mortality highlight an increasing proportion within the under-5 group, accounting for 47% of deaths. No low- or middle-income country has yet achieved national effective coverage of major life-saving interventions for newborns.

In order to continue improving newborn health, we call for action to expand gains made in essential newborn care and resuscitation and to address the remaining issues in providing care to last mile populations.

Our future newborn health agenda at Save the Children includes reaching the most marginalized groups beyond the rural poor: small and sick newborns and those in humanitarian emergencies and urban slums. There has been an upward movement in global policy, but implementation to scale, learning and adaptation, as well as documentation of best practices in different contexts remain before us. 

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As Save the Children’s Saving Newborn Lives initiative celebrates 20 years of progress, we reflect on the successes, lessons learned, and the global good that has been generated.

Beginning in 2000 with a visionary and generous investment by the Bill & Melinda Gates Foundation, SNL embarked on a journey with partners that has elevated newborn health and survival as a public health mandate, putting the “N” in MNCH, or maternal, newborn, and child health, policies, and programs.

This is an unprecedented shared legacy, but it is only the start of our journey to reach globally endorsed targets to reduce newborn mortality and stillbirth rates in all countries, rich and poor. Moreover, progress and partnership mean that the movement is well poised for a laser-like focus on the unfinished newborn health agenda, as well as to advance the future priority agenda of the newborn health community.

SNL — in close collaboration with global and country stakeholders and partners — has advanced the critical evidence base for “what” works to save newborn lives in LMICs and “how” to implement interventions within existing health systems to achieve impact.

This is what we have learned:

1. Advocacy and leadership are critical

SNL began with a priority agenda — determined through consultation with implementing and academic partners — and mounted vast advocacy efforts based on a situation analysis conducted globally and at the country level.

Country-focused “State of the World Newborn” reports were used to advocate with ministries of health and partners. This helped spur on numerous policy and strategy changes to safeguard the health of newborns. At the global level, the release of the Every Newborn Action Plan resulted in high-level awareness and commitment to ending preventable newborn mortality and stillbirths.

2. Data driven intervention design matters 

The measurement of, and evidence on, implementation should be generated with the end — and with scalability — in mind. We ensure that data is at the center of all of our implementation efforts so that we are providing support where it's needed most and in a way that's likely to be the most effective in both the short and long-term.

We believe that data should continue to guide the identification of gaps in newborn health programming and continue to monitor implementation performance and direct the need for program adjustments to achieve effective coverage with life-saving newborn interventions.

3. A national strategy and coordinating structure is needed 

Inclusion of the newborn health agenda in national strategies helps guarantee long-term sustainability of interventions and the continuation of progress. It is important for governments to have a national strategy and accompanying operational plan.

They should then insist that all implementing partners and donors design their projects in alignment with the national strategy. Along with that, a national coordinating body must monitor the roll out of the strategy and recommend adjustments to keep it on track, help address challenges, and ensure the resources needed for sustainability.

The facts:

• Newborn deaths account for nearly half of all children who die under the age of 5.

• Every year, 2.5 million newborns die in the first month of their life.

• Every year, 2.6 million newborns are stillborn.

• Every year, 1 million babies die on their first day of life.

80% of newborn deaths are due to prematurity, childbirth complications, and infections.

• In low-income countries, almost half of births occur without a skilled birth attendant.

• An average of 18 in every 1,000 newborns die in their first month of life.

• Newborn mortality has decreased from 4.4 million to 2.5 million between 1990 and 2018.

4. Long-term funding is critical 

It takes a deliberate effort — including the provision of targeted technical support and funds — for countries to adopt and adapt new proven newborn health interventions. Interventions that do not have metrics incorporated into the national health management information systems, or global metrics, receive less attention.

Getting the relevant indicators into global or national monitoring and evaluation systems is imperative. For SNL, this took years, and it was possible only because of long-term funding and support. Donors should be aware of the time it takes to get new indicators into global or national systems, and be committed to provide the funds for the duration it takes to get this done.

5. Partnerships matter

Over the last two decades, Save the Children has worked in 34 countries, creating close partnerships with governments, United Nations agencies, nongovernmental organizations, stakeholders, and health professionals through extensive newborn and perinatal research, advocacy, and program implementation.

By creating these partnerships and relationships, we have fostered dialogues at the national and global levels about our shared goals in newborn health policy and programming. SNL engaged with governments to identify programming gaps and worked together to close them. We also work with governments to ensure their continued support for the activities after SNL programming.  

6. The need for research

The dissemination of research and program learning by SNL has enabled great strides in developing innovative approaches, as well as informing and strengthening interventions.

Some examples of this progress include the management of possible serious bacterial infections at first-level health facilities when referral is not feasible. Another example is the use of chlorhexidine antiseptic applied to a freshly cut umbilical cord to prevent newborn sepsis resulting from harmful bacteria colonizing the cord after birth. Additionally, the development and validation of newborn health indicators through SNL-led multipartnered technical working groups was critical.

The deadline to meet the Sustainable Development Goals and neonatal mortality rate targets is fast approaching and COVID-19 has meant the arrival of yet more challenges to overcome in the continuation of essential maternal and newborn health services.

To ensure continued progress so that no newborn, woman, or child faces preventable death, the global health community must catalyze its efforts. This will mean uniting as a sector to prioritize agendas relating to the most vulnerable in our midst.

Countries that have the highest burden of newborn deaths and stillbirths must also prioritize initiatives within their budgets, policies, and programs, ensuring that quality interventions for small and sick newborns are universally accessible, affordable, and scalable.

As SNL comes to a close, we call on maternal and newborn health partners, countries, and the global health community to take action to address the unfinished maternal, newborn, and child health agenda.

To find out more, join us for the upcoming Saving Newborn Health Legacy e-Talks.

Several Save the Children’s Maternal and Newborn Health team members contributed to this article.

About the authors

  • Stephen Wall

    Dr. Stephen Wall is a pediatrician, neonatologist, and public health expert. For the past 15 years, he has been senior technical advisor to Save the Children's Saving Newborn Lives Initiative, becoming director in 2018. He is currently senior director of newborn health at Save the Children where he has overseen global and country-based efforts to improve newborn survival through research and innovation, implementation research, and advocacy for policy change and program development. Prior to joining Save the Children, Wall served as a neonatologist and perinatal epidemiologist at the University of Chicago Pritzker School of Medicine and at Northwestern University Medical School. He received his medical education at the University of North Carolina at Chapel Hill, followed by pediatrics and neonatology training at University of California-San Francisco, and neonatology fellowship training at Harvard.
  • Joseph de Graft-Johnson

    Dr. Joseph de Graft-Johnson is a public health physician and has worked as a medical doctor and in international public health for over 30 years in Africa, the Caribbean, and Asia. de Graft-Johnson received his medical degree from School of Medical Sciences, Kumasi, Ghana and his public health degrees, MPH and DrPH, from the University of North Carolina at Chapel Hill. He worked with the Ghana Ministry of Health and Family Health International before joining Save the Children as a health program manager in Malawi in 1997 and has held various positions since. The most recent being the senior director of the maternal and reproductive health team. He has spent over 20 years contributing to the advancement of newborn health programming in low- and middle-income countries.
  • Neena Khadka Basnet

    Dr. Neena Khadka Basnet is a pediatrician with over 30 years of experience in clinical and public health practices. She began her career with the government of Nepal and worked with the Ministry of Health for 15 years before joining Save the Children in 2001 as the program manager for the Saving Newborn Lives Program-I. She subsequently led Save the Children Nepal's health portfolio as its health team leader and has held the roles of program director, program implementation director, and lead of the community health service delivery team for the USAID bilateral program in Nepal. Khadka-Basnet joined the Save the Children USA team in 2013 and since then has supported the newborn heath portfolio for USAID's Maternal and Child Survival Program and is presently on the MOMENTUM country and global leadership program.