|© UNICEF/HQ02-0570/ Pirozzi|
|A newborn sleeps in a health centre in Accra, Ghana.|
Goal MDG 4:
To reduce the infant mortality rate by two thirds by 2015.
Thirty-eight percent (38%) of the estimated 10.1 million children under 5 deaths each year occur in the first four weeks of life, the neonatal period. This means that a newborn baby has a 30 fold increased risk of dying during the first month of life than in the following 11 months. Ninety-nine percent (99%) of all newborn deaths occur in developing countries and within these countries, the poorest fare far worse than the richest. This is a powerful statement about inequity and access to quality care.
Child mortality in most countries has been decreasing in past decades, however, both neonatal and maternal mortality have largely remained the same.
With close to 50% of all newborn deaths occurring within 24 hours of delivery, and up to 75% in the first week post partum, strategies must center on a continuum of care approach. This approach includes improving access to antenatal care during pregnancy, improved management of normal delivery by skilled attendants, access to emergency obstetric and neonatal care (EmONC) when needed, and timely post natal care for both mothers and newborns. In addition to strengthening linkages between the different levels of care in health facilities, the continuum of care also refers to strengthening linkages between the community and health facilities.
It is a myth to assume that high cost neonatal care hospital units are the only way to treat sick newborns, this is a myth. There is now evidence proving that a large proportion of newborn death and disease can be reduced by implementing simple, low-cost interventions during delivery and in the vulnerable days and week post-partum, both in the facility and at home. These essential interventions include drying the newborn and keeping the baby warm, initiating breastfeeding as soon as possible after delivery and supporting the mother to breastfeed exclusively, giving special care to low-birth weight infants, and diagnosing and treating newborn problems like asphyxia and sepsis.
The majority of essential interventions are home care practices that families can provide themselves or use the help of a community health worker (CHW) who could be present at delivery to care for the newborn and/or visit within the first 24 hours and again 1-2 additional times during the first week. This is crucial as more than 50% of newborn deaths occur at home, and the long term goal of training sufficient numbers of skilled attendants to be present at all births will not be a reality in many countries for years to come. Experts estimate that providing these essential interventions at scale (over 90% coverage) in the community and in health facilities can reduce the neonatal mortality rate by 70%.
UNICEF, working with governments and partners, can assist in developing home-based maternal and newborn care programmes based on successful models of CHWs, and/or community women’s groups, while strengthening health facilities and the referral linkages between communities and hospitals providing emergency care.
UNICEF also addresses newborn health within other UNICEF programme areas, such as immunization, nutrition, prevention of mother-to-child transmission of HIV/AIDS (PMTCT) and prevention and cure of malaria.
Global partnerships and initiatives
UNICEF is a key member of the Partnership for Maternal Newborn and Child Health (PMNCH), and continues to work closely with the United Nations Population Fund (UNFPA), WHO, Columbia University’s Averting Maternal Deaths and Disabilities (AMDD) and Save the Children/Saving Newborn Lives. To support newborn care initiatives at country level, UNICEF and Save the Children have written a Joint Programme Guidance Note on the Newborn.
The ‘two-thirds rule’
More than 7 million infants die each year between birth to two months.
Almost two-thirds of infant deaths occur in the first month of life.
Among those who die in the first month of life, about two-thirds die in the first week of life.
Among those who die within the first week, two-thirds die in the first 24 hours of life.
External links open a new window and take you to a non-UNICEF web site.