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.
Saving Newborn Lives Legacy e-Talks
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.
• 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.
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.