Measuring coverage of essential maternal and newborn care interventions: An unfinished agenda

Over the past few decades, the agenda for newborn health has shifted remarkably, taking newborns from being nearly invisible in the global health agenda of 1990s to being central in discussions today. Despite this change, the decline in neonatal mortality from 1990 to 2016 has been slower than that of post–neonatal under–five mortality: 49% compared with 62% globally [1]. Newborn deaths represent 46% of all under–five deaths–of the 5.6 million under–5 deaths in 2016, nearly 2.7 million deaths occurred in the neonatal period, with a large proportion dying within the first week following birth [1,2]. Preterm birth complications (35%), intrapartum–related events (24%) and sepsis (15%) – most of which are preventable–have been identified as leading causes of neonatal deaths [3]. Although maternal mortality was estimated by the UN inter–agency group to have declined by 44% between 1990 and 2015, the reduction was far below the 75% MDG target. Approximately 303 000 women die each year from complications of pregnancy and childbirth, with 99% of deaths in low– and middle–income countries, making maternal mortality one of the indicators with the largest disparity between rich and poor countries [4]. With the majority of maternal and newborn deaths occurring around the time of birth, quality and equitable maternal and newborn care are essential to improve survival. Several global partnerships and initiatives such as the United Nations Every Woman Every Child movement (EWEC) and Every Newborn Action Plan (ENAP) have called for more focused attention on newborn health in order to end preventable newborn and child deaths [5,6]. The 2030 agenda of Sustainable Development Goals (SDG) and accompanying Global Strategy for Women’s Children’s and Adolescents’ Health (2016–2030) include a specific target for all countries to reduce neonatal mortality to at least as low as 12 per 1000 live births, further reinforcing and strengthening commitment to neonatal survival [7].