Saving a million people per year on the most dangerous day of their life for less than $10 each

More than one million babies die on their birth day every year and four inexpensive products can help to save most of them. A baby’s first day the riskiest day of his or her life — in the USA and other countries, according to the 14th annual State of the World’s Mothers report (88 pages). Every year nearly 3 million babies die in the first month and mostly from preventable causes.

Four products costing between 13 cents and $6 each can save newborns — many on the first day of life.

The products are:
• steroid injections for women in preterm labor (to reduce deaths due to premature babies’ breathing problems);

• resuscitation devices (to save babies who do not breathe at birth);

• chlorhexidine cord cleansing (to prevent umbilical cord infections); and

• injectable antibiotics (to treat newborn sepsis and pneumonia).

Other low-cost interventions such as kangaroo mother care and early and exclusive breastfeeding would save many more babies. Such interventions, as part of strengthened health care systems, not only can dramatically reduce maternal and newborn deaths, but also can prevent a lifetime of negative health consequences such as long-term disabilities, intellectual impairment and increased vulnerability to illness. Poor health is not only costly for individuals and their families, it can also impede a nation’s efforts toward economic growth.

Every year, 40 million women give birth at home without the help of a skilled birth attendant.

Every day, 800 women die during pregnancy or childbirth and 8,000 newborn babies die during their first month of life.

Newborn deaths account for 43 percent of all deaths among children under age 5.

3 million newborn babies die every year – mostly due to easily preventable or treatable causes such as infections, complications at birth and complications of prematurity.

60 percent of infant deaths occur in the first month of life. Among those, nearly three-fourths (2 million per year) die in their first week. And more than a third (1 million per year) die on their day of birth.

Nearly all newborn and maternal deaths (98 and 99 percent, respectively) occur in developing countries where pregnant women and newborn babies lack access to basic health care services – before, during and after birth.

The United States has the highest first-day death rate in the industrialized world. An estimated 11,300 newborn babies die each year in the United States.

Recommendations
1) Address the underlying causes of newborn mortality, especially gender inequality.

When mothers are strong and stable – physically, financially and socially – their children are more likely to survive and thrive. Educated girls tend to marry later and begin childbearing later in life, when their bodies are more fully developed. They are also more likely to make healthy choices for themselves and their babies. Well-nourished girls also grow up to be healthier mothers who are less at risk for many health problems, including preterm birth.

2) Invest in health workers – especially those working on the front lines – to reach the most vulnerable mothers and babies.

The world faces a shortage of 5 million health workers of all types and there is an acute shortage of frontline health workers, including 350,000 with midwifery skills. New frontline health workers need to be recruited and trained, and those who are already practicing need opportunities to update and improve their skills. These health workers must be part of functioning health systems, and deployed to serve communities where they are most needed.

3) Invest in low-cost, low-tech solutions which health workers can use to save lives during pregnancy, at birth and immediately after birth.

Most newborn deaths could be prevented by ensuring access to lifesaving products and approaches, including: treatment of infections in pregnant women; access to low-tech equipment that can help babies breathe; clean cord care using chlorhexidine; prompt treatment of newborn infections; and basic education for mothers about the importance of proper hygiene, warmth and breastfeeding for newborns. Increasing the use of these services and these practices can prevent up to 3 out of 4 newborn deaths.

4) Strengthen health systems and address demand-related barriers to access and use of health services.

5) Increase commitments and funding to save the lives of mothers and newborns.

In order to meet internationally agreed-upon development goals to reduce child and maternal deaths, lifesaving services must be increased for women and newborns. In most countries the majority of health financing comes from domestic sources. In many cases, countries need to increase their public investment in health – especially investments in maternal, newborn and child health – and take steps to ensure that direct payments for health care are not a barrier to survival. Developing countries should develop their own funded road maps to identify and implement solutions that work best within their existing health systems to end preventable maternal and newborn deaths. A range of stakeholders, including donor countries, developing countries, international agencies, nongovernmental organizations (NGOs) and the private sector all have separate roles to play in helping improve and expand effective health care coverage so even the poorest mothers and their newborns have access to quality care. NGOs, in particular, can help monitor progress and make sure stakeholders are held accountable

Low-Cost Solutions During Pregnancy, Childbirth and the First Weeks of Life

Low-cost, evidence-based interventions in the hands of trained birth attendants could reduce newborn deaths by up to 75 percent if provided universally. If taken to scale, these interventions together could save as many as 2 million of the 3 million newborns who die each year.

The cost of these solutions is not high. One recent study estimated that 90 percent coverage of essential newborn health interventions could be achieved at an additional cost of less than $1 per capita in the 75 countries where most children die. About 30 percent of the cost is for newborn-specific interventions, while the majority is for interventions that would also benefit mothers and older children

Prenatal Care

The cost to deliver prenatal care to 90 percent of pregnant women in Africa is estimated at only an additional 20 cents per capita.

Tetanus toxoid vaccination

– Immunizing women of reproductive age with the tetanus toxoid vaccine protects both mothers and newborns. Tetanus toxoid is one of the safest, most effective and least expensive vaccines available. It can prevent tetanus infection in mothers during childbirth, and it passes immunity on to the fetus. Tetanus kills about 58,000 newborns and a significant number of mothers each year. These deaths can be prevented by ensuring that every pregnant woman receives two doses of tetanus toxoid during pregnancy, or that all women of childbearing age receive three shots over a two-year period. Two doses of tetanus toxoid cost only about 40 cents.

• Treatment of maternal infections – Infections during pregnancy are a major cause of complications such as miscarriage, premature rupture of the amniotic sac, preterm birth and congenital infection and anomalies. Prevention of infection should be part of prenatal care. Testing and treatment for sexually transmitted infections such as syphilis and gonorrhea are simple and inexpensive, with significant payoffs for newborns.

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