In a review published in The Lancet as part of its Every Newborn Series, Dr Elizabeth Mason, at the World Health Organization, Switzerland, and co-authors, identify priorities for action on improving maternal and newborn health, ahead of the World Health Assembly debate (scheduled for 22 May) on the Every Newborn Action Plan , which provides an evidence-based roadmap towards care for every woman, and a healthy start for every newborn baby.
Speeding up progress on child survival requires more focus on a healthy start, say the authors. "The day of birth is the most dangerous for mothers and their babies, and we must start challenging the fatalism around newborn deaths and stillbirths, most of which are actually preventable," says Dr Mason.
If newborn deaths continue to fall at current rates, international targets to reduce mortality in children will not be met, say the authors, and more than a century will pass before a child born in Africa has the same chance of survival as one born in a high-income country such as the UK or US. However, concerted action to address the key issues currently affecting newborn health identified in the Series, and expanded on in the Every Newborn Action Plan, could lead to substantial improvements in just a few decades.
The Every Newborn Action Plan is based on the latest evidence and country experiences. It is a framework to end preventable newborn deaths and stillbirths by 2030. The Action Plan will also advance standards for quality of care, measurement of births and deaths, and health service coverage with accountability for results.
The study suggests that as rates of death in newborn babies decline, global and national emphasis will need to move beyond survival, and towards improved health and development. However, this will not be possible unless the case for reducing newborn deaths reaches political voices on the global stage, as has been the case for HIV and malaria. Moreover, although dramatic reductions in the rate of newborn deaths are achievable, the lack of policies targeting care for small and sick babies will need to be addressed.
The review also underlines the importance of parent advocacy, and ensuring that every stillbirth or newborn death is registered. "The voices of those who bear the burden of stillbirth and newborn deaths - the parents - are rarely heard. This silence perpetuates the idea that newborn deaths and stillbirths are inevitable," says Dr Mason. "The problem is compounded by huge gaps in the registration of newborn births and deaths. In the 21st century, no child should be born and die without a single piece of paper left behind to mark their life. Likewise, no maternal death should go uncounted.
Improvement of civic and vital registration systems is a fundamental step in improvement of the capacity of countries to plan and monitor health investments and to respect the right of all citizens to be counted."
According to Dr Mason, "This Series and the Every Newborn Action Plan call for specific changes to ensure that Every Newborn is country-led action. These changes include an intensification of political attention and leadership on eliminating preventable deaths of mothers and their babies; promoting the voices of parents; targeted investment that is harmonised with other health funding; and greatly improved implementation and evaluation of care for mothers and their children. Although this plan has a newborn title, its main message is to urge greater collective action to support women and babies together at the time of birth and consistently throughout the days and months after childbirth, so that the time of birth becomes the celebration that it should be.