Investments in quality care at birth could save the lives of 3 million babies and women each year who die needlessly around the world, according to a new global action plan launched at the Partners' Forum in Johannesburg. The Every Newborn action plan (ENAP), which was approved by Ministers of Health from all over the world at the May 2014 World Health Assembly, brings together the latest evidence on effective interventions for a clear roadmap to end preventable stillbirths and newborn deaths.
ENAP gives two specific targets for all countries to achieve by 2035: 1) Reduce neonatal mortality rates to 10 or fewer newborn deaths per 1,000 live births and 2) Reduce stillbirth rates to 10 or fewer stillbirths per 1,000 total births. Every Newborn also lays out an interim post-2015 goal, calling for a reduction to 12 or fewer newborn deaths and stillbirths by 2030.
While maternal and child mortality rates have improved dramatically over the last two decades, newborns have missed out on this attention. Each year globally, 2.9 million newborns (first four weeks) die and there are an additional 2.6 million stillbirths (last three months of pregnancy). Newborn deaths now account for 44 percent of all under-5 deaths worldwide. The day of birth is the time of greatest risk of death and disability for babies and their mothers - contributing to around half of the world's 289,000 maternal deaths.
Accompanying the launch of the ENAP is a package of approximately 40 financing, policy and service delivery commitments showcasing multi-stakeholder interest and recognition of the need to invest in newborn health. These commitments represent a significant contribution to the Every Woman Every Child movement (EWEC) and underscore the sustained determination by the global community to ensure accelerated progress towards the Millennium Development Goals (MDGs), and women's and children's health in particular.
"The strong accountability mechanism under the Every Woman Every Child umbrella will ensure that resources and results are tracked when it comes to commitments to newborns," states United Nations Secretary-General Ban Ki-moon in the action plan's foreword. "Let us do all we can to ensure a healthy start for all mothers and newborns. This will open the way for progress across the development agenda and around the world."
"The 5.5 million newborn deaths and stillbirths occurring every year make up the single largest group of deaths in the unfinished agenda of the Millennium Development Goals for women's and children's health," said Professor Joy Lawn of the London School of Hygiene & Tropical Medicine and senior health advisor to Save the Children, lead author of The Lancet Every Newborn Series. "Yet they are also our greatest opportunity for major impact in a short time frame. The Every Newborn action plan clearly lays out what needs to be done differently, and which efforts and investments have the greatest impact, with a triple return on saving women and newborns and also preventing stillbirths."
Most newborn deaths result from three preventable and treatable conditions, including prematurity, complications around birth and severe infections. Over 71 percent of newborn deaths could be avoided without intensive care, mainly though quality care around birth and care of small and sick newborns. An additional investment of only $1.15 per person per year in 75 high burden countries would prevent 3 million deaths of women and babies. This care requires skilled health workers, especially midwives, and essential commodities, such as steroid injections costing less than a dollar per treatment, or resuscitation devices costing under $5 (for bag and mask resuscitator).
Critical attention is especially needed for the 29 slowest progressing countries - most of which are in sub-Saharan Africa. If current trends continue, it will be more than 110 years before an African baby has the same chances of survival as a baby born in North America or Europe. Progress in Africa has been three times slower than what has been achieved in high-income countries, even before the advent of intensive care or the new simpler interventions, such as Kangaroo Mother Care or steroid injections for preterm labour.
"The Every Newborn Action Plan is explicit acknowledgement that even the smallest and newest babies have a right to live and that we are going to do our utmost to see that they do," said Dr. Mickey Chopra, Chief of Health, UNICEF, and Co-Chair of the Countdown to 2015. "While more children are living past their fifth birthday than ever before, now we need deliberate, focused attention for newborns, who have been voiceless and uncounted for too long. It is both the right thing to do and the smart thing to do."
Led by WHO and UNICEF, the process to develop the Every Newborn action plan lasted nearly two years and involved more than 80 organizations, multiple multi-stakeholder consultations and a web-based consultation drawing over 300 comments. The plan takes into account all inputs as well as findings from The Lancet Every Newborn Series published in May 2014. Discussed at the 67th World Health Assembly, 194 Member States endorsed the document and committed to put recommended actions into practice. The WHO Director General has been requested to monitor progress towards the achievement of the global goal and targets and report periodically to the World Health Assembly until 2030. The ENAP is founded on overarching principles of country leadership, human rights, integration, equity, accountability and innovation.
"This plan calls for key actions that link the care of the mother and the child at the critical time of birth within a continuum that starts before pregnancy and continues into postnatal care. We know these interventions cannot be separated and, therefore, we call on all partners to implement this plan as quickly as possible," said Dr. Flavia Bustreo, Assistant Director-General for Family, Women's and Community Health at the World Health Organization. "By doing so, we can accelerate action towards the MDGs and move closer to our collective goal - ending preventable maternal and child deaths within a generation."
The nearly 40 commitments being announced at the Partners' Forum from a range of organizations within government, the private sector, philanthropy, civil society, professional associations and academia take action to support key aspects of ENAP. With innovation and private-public partnerships playing an increasing, key role in advancing women's and children's health, the contribution of 17 private sector companies, including Johnson & Johnson, GSK, and Laerdal Global Health, and other donors such as Islamic Development Bank, will be pivotal for accelerating interventions and helping to save the lives of newborns and their mothers. The package of commitments represents one of the most significant contributions to the Every Woman Every Child movement since its 2010 launch.
Graça Machel, co-chair of The Partnership for Maternal, Newborn & Child Health, endorsed the vision of the Every Newborn action plan in her opening comments at the Partners' Forum. "This plan demonstrates that together we can achieve the vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential."