Upholding the rights of newborns
Each newborn that dies, each stillbirth that occurs and each woman who dies during pregnancy or childbirth is an unbearable and unnecessary loss, which should be a matter of great concern for society, the government, for everyone. Even today there are communities that do not give a name to newborns until they are at least six weeks old. The newborn deaths and stillbirths remain uncounted. Each such death indicates that the health system has yet to reach all communities with quality services, especially the marginalised and most vulnerable population.
In WHO Southeast Asia Region, an estimated 0.9 million newborns died in 2015. This is about 30% of the global newborn deaths from a region that accounts for 25% of the world's population.
High newborn mortality is unacceptable, especially since most of these deaths can be prevented by cost-effective interventions. More so, as countries in the region are capable of achieving ambitious public health feats, evident from the region's polio-free certification in 2014, and the elimination of maternal-newborn tetanus by India and the elimination of malaria by Maldives last year.
Countries in the region have been making efforts to address newborn, child and maternal health issues. In the last 15 years, under the Millennium Development Goals, there has been a more than 60% reduction in deaths of children up to the age of five years and of mothers during pregnancy and childbirth.
However, despite this significant reduction, the WHO Southeast Asia Region missed the Millennium Development Goal of reducing child deaths by two-thirds, as the decline in newborn deaths was slower in comparison to the reduction in deaths among children up to five years of age.
In the region, Bangladesh, India, Indonesia, Myanmar and Nepal account for the highest number of newborn deaths. India accounted for an estimated 700,000 newborn deaths in 2015, which is about 75% of newborn deaths in the whole region. There were 74,000 estimated newborn deaths each in Indonesia and Bangladesh; 24,000 in Myanmar and 12,000 in Nepal in 2015. There is a significant disparity in the risk of newborn deaths within the countries on account of social and economic factors. The risk is higher in poor communities, in rural and geographically difficult areas, and in children born to women who are not educated or are less than 20 years of age.
The main reasons for newborn deaths are complications in premature babies delivered before 37 weeks of pregnancy; inability of babies to breathe soon after delivery; and infections in newborns. There are well-known effective interventions to address these issues and about two-thirds of newborn deaths can be prevented by scaling-up such interventions. About 50% of newborn deaths can be reduced by taking good care of the mother during pregnancy and childbirth.
This requires that a pregnant woman can access timely health care by a trained healthcare provider who is supported with adequate equipment and supplies, and that transport is ensured for referral in case of an emergency. Governments need to ensure that well-equipped health facilities and skilled birth attendants such as midwives, nurses and physicians are available, especially in under-served areas.
Globally, there is a renewed focus and commitment now on maternal and newborn health. The Global Strategy for Women's, Children's and Adolescents' Health, 2016-2030 provides a roadmap to end all preventable deaths of newborns, children and women, and improve the health of adolescents. It has identified targets that align with the Sustainable Development Goals that includes the commitment to reduce newborn mortality rate to 12 or less per 1,000 live births and reduce maternal mortality to 70 or less per 100,000 births by 2030.
WHO has been prioritising ending preventable maternal, newborn and child deaths in the Southeast Asia Region. It is supporting countries to prioritise universal coverage of essential interventions and to ensure high-quality care around the time of childbirth and the first days of life because of the dangerous implications during this period for women, their unborn babies and newborns. Evidence suggests that this strategy will accelerate a reduction in newborn mortality and at the same time help reduce stillbirths and maternal mortality.
Accelerating interventions to improve maternal and newborn health would require governments to ensure sufficient, sustainable and equity-focused financing; adequate and skilled human resources; and essential commodities and equipment for maternal and newborn health.
Strong health systems are needed to deliver high-quality service, including when humanitarian emergencies arise as well as in fragile settings since mothers and newborns are among the most vulnerable populations. Strong partnerships are needed with communities to reach the unreached women and newborns; and with other related sectors, civil society and the private sector to meet the new goals of reducing newborn mortality by 2030.
Pulling together their collective strengths and distinct capacities, six partner agencies -- WHO, Unicef, UNFPA, the World Bank, UNAIDS and UN WOMEN -- have jointly pledged coordinated support to countries for ending maternal, newborn and child mortality with a focus to accelerate reduction in newborn mortality.
Though countries are making efforts, clearly more needs to be done. It is now time to collectively and aggressively move forward to end preventable deaths of mothers and newborns. Survival and good health are the rights of every mother and her baby.
Dr Poonam Khetrapal Singh, Regional Director of WHO Southeast Asia.