Comment
The world we want for every newborn child for implementation, and champion change. For this to happen, communities need to be empowered to demand better care for mothers and newborn babies and hold governments accountable for their deaths. There is still a woeful acceptance of newborn deaths as inevitable in some cultural settings in high-burden countries; practices such as delaying the naming of a newborn baby continue. The grief of those affected by such deaths—women, parents, families, and communities—is hardly ever heard by policy makers or politicians. It is time for this to change. A huge amount of energy and debate is currently being expended on the sustainable development goals (SDGs). Although newborn babies benefited from the Millennium Development Goals (MDG), they were not explicitly mentioned in them. There is a risk they will be left out of the SDGs too.2 The Series sets out national and global goals for newborn babies, which must be incorporated into the post-MDG framework, with corresponding accountability mechanisms. By 2035, every country should have ten or fewer neonatal deaths per 1000 livebirths and ten or fewer stillbirths per 1000 births.2 These goals have been guided by countries themselves as well as science, and are ambitious yet achievable. Reaching these goals will require a doubling or more of current rates of reduction in high-burden countries. Without it, the concept of grand convergence will take not 20 years but a century to become a reality in Africa.2,6
www.thelancet.com Published online May 20, 2014 http://dx.doi.org/10.1016/S0140-6736(14)60837-0
Published Online May 20, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60837-0 See Online/Series http://dx.doi.org/10.1016/ S0140-6736(14)60458-X, http://dx.doi.org/10.1016/ S0140-6736(14)60496-7, http://dx.doi.org/10.1016/ S0140-6736(14)60792-3, http://dx.doi.org/10.1016/ S0140-6736(14)60582-1, and http://dx.doi.org/10.1016/ S0140-6736(14)60750-9
Corbis
That our newest and youngest citizens have a better chance of survival today than they did 20 years ago is a huge achievement. Worldwide, neonatal mortality has decreased by 2% each year between 1990 and 2012, from 33 to 21 deaths per 1000 livebirths.1,2 This success is due to several factors, one of which is surely the existence of an extremely dedicated group of scientists who have not only generated the evidence to save newborn lives but have also led the advocacy campaign for change. Although the world has certainly improved for newborn babies, progress has been considerably slower than for mothers and children. As a result, neonates are an increasing proportion (44%) of deaths in children younger than 5 years.1 This share is rising in every region and almost all countries. Every year, 2·9 million newborn babies die from largely preventable causes, and 2·6 million more are stillborn.2 These remain appallingly high numbers. The Lancet Every Newborn Series aims to accelerate action for newborn babies; it updates and extends the evidence from our first Series in 2005 and sets out the best strategy for future efforts to save newborn lives and improve neonatal health. We owe a huge amount of gratitude to Joy Lawn and Zulfiqar Bhutta in particular: they have led the development, discussions, and drafting of the five papers in the Series. Interventions across the continuum of care (preconception, antenatal, intrapartum, postnatal) and in the community are essential for women, mothers, and newborn babies. However, this Series advocates a specific focus: facility-based care around the time of birth. This is the time when most deaths occur—more than 40% of maternal deaths and newborn deaths and stillbirths—and when most lives can be saved, and long-term disabilities averted, through higher coverage of effective interventions.2,3 This strategy requires responsive health systems that are equipped with lifesaving commodities and staffed with health workers who can deliver high-quality and timely skilled care, including emergency obstetric care and interventions for small and ill newborn babies.3,4 Unfortunately, knowing what needs to be done does not mean it gets done as we have learned from our 2005 Series.5 Extraordinary political leadership is required to act on the evidence, allocate sufficient funds
1
Comment
Governments need support and guidance to achieve these targets. WHO and UNICEF have begun to show vital leadership for neonates with the development of the Every Newborn Action Plan from country consultations and evidence from this Series, which will launch later this year.7,8 Other UN agencies such as the UN Population Fund also have reason to elevate this visibility of newborn babies in their programming. The Series shows that countries with the highest fertility rates have had the slowest declines in neonatal mortality rates.2 Increasing access to family planning services would contribute to a halving of births and therefore deaths. Deferring age at first birth to after 18 years, promotion of optimum spacing between births, and improvement of pre-pregnancy nutritional status also benefits girls, women, and newborn babies.3 What world do we want for every mother and every newborn baby? We want one in which they are given the best chance to not only survive but also thrive. The requirements for such a world are laid out in this Series and accompanying action plan. Who will commit to providing it?
1
2
3
4
5
6 7
8
You D, Bastian P, Wu J, Wardlaw T. Levels and trends in child mortality. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. Report 2013. New York: UNICEF, WHO, The World Bank, and United Nations, 2013. Lawn JE, Blencowe H, Oza S, et al, for The Lancet Every Newborn Study Group. Progress, priorities, and potential beyond survival. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S01406736(14)60496-7. Bhutta ZA, Das JK, Bahl R, et al, for The Lancet Newborn Interventions Review Group and The Lancet Every Newborn Study Group. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 2014; published online May 20. http:// dx.doi.org/10.1016/S0140-6736(14)60792-3. Dickson KE, Simen-Kapeu A, Kinney MV, et al, for The Lancet Every Newborn Study Group. Health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S0140-6736(14)60582-1. Darmstadt GL, Kinney MV, Chopra M, et al, for The Lancet Every Newborn Study Group. Who has been caring for the baby? Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S0140-6736(14)60458-X. Jamison DT, Summers LH, Alleyne G, et al. Global health 2035: a world converging within a generation. Lancet 2013; 382: 1898–955. Mason E, McDougall L, Lawn JE, et al, for The Lancet Every Newborn Study Group, on behalf of the Every Newborn Steering Committee. From evidence to action to deliver a healthy start for the next generation. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S01406736(14)60750-9. WHO. Every newborn: an action plan to end preventable deaths. May 2, 2014. http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_21-en.pdf?ua=1 (accessed May 11, 2014).
Udani Samarasekera, Richard Horton The Lancet, London NW1 7BY, UK
2
www.thelancet.com Published online May 20, 2014 http://dx.doi.org/10.1016/S0140-6736(14)60837-0
The world we want for every newborn child for implementation, and champion change. For this to happen, communities need to be empowered to demand better care for mothers and newborn babies and hold governments accountable for their deaths. There is still a woeful acceptance of newborn deaths as inevitable in some cultural settings in high-burden countries; practices such as delaying the naming of a newborn baby continue. The grief of those affected by such deaths—women, parents, families, and communities—is hardly ever heard by policy makers or politicians. It is time for this to change. A huge amount of energy and debate is currently being expended on the sustainable development goals (SDGs). Although newborn babies benefited from the Millennium Development Goals (MDG), they were not explicitly mentioned in them. There is a risk they will be left out of the SDGs too.2 The Series sets out national and global goals for newborn babies, which must be incorporated into the post-MDG framework, with corresponding accountability mechanisms. By 2035, every country should have ten or fewer neonatal deaths per 1000 livebirths and ten or fewer stillbirths per 1000 births.2 These goals have been guided by countries themselves as well as science, and are ambitious yet achievable. Reaching these goals will require a doubling or more of current rates of reduction in high-burden countries. Without it, the concept of grand convergence will take not 20 years but a century to become a reality in Africa.2,6
www.thelancet.com Published online May 20, 2014 http://dx.doi.org/10.1016/S0140-6736(14)60837-0
Published Online May 20, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60837-0 See Online/Series http://dx.doi.org/10.1016/ S0140-6736(14)60458-X, http://dx.doi.org/10.1016/ S0140-6736(14)60496-7, http://dx.doi.org/10.1016/ S0140-6736(14)60792-3, http://dx.doi.org/10.1016/ S0140-6736(14)60582-1, and http://dx.doi.org/10.1016/ S0140-6736(14)60750-9
Corbis
That our newest and youngest citizens have a better chance of survival today than they did 20 years ago is a huge achievement. Worldwide, neonatal mortality has decreased by 2% each year between 1990 and 2012, from 33 to 21 deaths per 1000 livebirths.1,2 This success is due to several factors, one of which is surely the existence of an extremely dedicated group of scientists who have not only generated the evidence to save newborn lives but have also led the advocacy campaign for change. Although the world has certainly improved for newborn babies, progress has been considerably slower than for mothers and children. As a result, neonates are an increasing proportion (44%) of deaths in children younger than 5 years.1 This share is rising in every region and almost all countries. Every year, 2·9 million newborn babies die from largely preventable causes, and 2·6 million more are stillborn.2 These remain appallingly high numbers. The Lancet Every Newborn Series aims to accelerate action for newborn babies; it updates and extends the evidence from our first Series in 2005 and sets out the best strategy for future efforts to save newborn lives and improve neonatal health. We owe a huge amount of gratitude to Joy Lawn and Zulfiqar Bhutta in particular: they have led the development, discussions, and drafting of the five papers in the Series. Interventions across the continuum of care (preconception, antenatal, intrapartum, postnatal) and in the community are essential for women, mothers, and newborn babies. However, this Series advocates a specific focus: facility-based care around the time of birth. This is the time when most deaths occur—more than 40% of maternal deaths and newborn deaths and stillbirths—and when most lives can be saved, and long-term disabilities averted, through higher coverage of effective interventions.2,3 This strategy requires responsive health systems that are equipped with lifesaving commodities and staffed with health workers who can deliver high-quality and timely skilled care, including emergency obstetric care and interventions for small and ill newborn babies.3,4 Unfortunately, knowing what needs to be done does not mean it gets done as we have learned from our 2005 Series.5 Extraordinary political leadership is required to act on the evidence, allocate sufficient funds
1
Comment
Governments need support and guidance to achieve these targets. WHO and UNICEF have begun to show vital leadership for neonates with the development of the Every Newborn Action Plan from country consultations and evidence from this Series, which will launch later this year.7,8 Other UN agencies such as the UN Population Fund also have reason to elevate this visibility of newborn babies in their programming. The Series shows that countries with the highest fertility rates have had the slowest declines in neonatal mortality rates.2 Increasing access to family planning services would contribute to a halving of births and therefore deaths. Deferring age at first birth to after 18 years, promotion of optimum spacing between births, and improvement of pre-pregnancy nutritional status also benefits girls, women, and newborn babies.3 What world do we want for every mother and every newborn baby? We want one in which they are given the best chance to not only survive but also thrive. The requirements for such a world are laid out in this Series and accompanying action plan. Who will commit to providing it?
1
2
3
4
5
6 7
8
You D, Bastian P, Wu J, Wardlaw T. Levels and trends in child mortality. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. Report 2013. New York: UNICEF, WHO, The World Bank, and United Nations, 2013. Lawn JE, Blencowe H, Oza S, et al, for The Lancet Every Newborn Study Group. Progress, priorities, and potential beyond survival. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S01406736(14)60496-7. Bhutta ZA, Das JK, Bahl R, et al, for The Lancet Newborn Interventions Review Group and The Lancet Every Newborn Study Group. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 2014; published online May 20. http:// dx.doi.org/10.1016/S0140-6736(14)60792-3. Dickson KE, Simen-Kapeu A, Kinney MV, et al, for The Lancet Every Newborn Study Group. Health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S0140-6736(14)60582-1. Darmstadt GL, Kinney MV, Chopra M, et al, for The Lancet Every Newborn Study Group. Who has been caring for the baby? Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S0140-6736(14)60458-X. Jamison DT, Summers LH, Alleyne G, et al. Global health 2035: a world converging within a generation. Lancet 2013; 382: 1898–955. Mason E, McDougall L, Lawn JE, et al, for The Lancet Every Newborn Study Group, on behalf of the Every Newborn Steering Committee. From evidence to action to deliver a healthy start for the next generation. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S01406736(14)60750-9. WHO. Every newborn: an action plan to end preventable deaths. May 2, 2014. http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_21-en.pdf?ua=1 (accessed May 11, 2014).
Udani Samarasekera, Richard Horton The Lancet, London NW1 7BY, UK
2
www.thelancet.com Published online May 20, 2014 http://dx.doi.org/10.1016/S0140-6736(14)60837-0
