Newborn health: a revolution in waiting.

By a host of metrics, women and their children have been getting healthier in recent years. Between 1990 and 2013, the annual number of maternal deaths dropped from 523 000 to 289 000. The child mortality story is just as impressive. Since 1990, deaths in children younger than 5 years have declined by 47%. Given the critical role that women and children have in securing a healthy, prosperous, and stable future for everyone, this is encouraging news. But the progress for women and children also highlights the fact that mortality rates for newborn babies have remained stubbornly high. Each year, 2·9 million newborn babies worldwide die within their fi rst month of life, and more than 1 million die on their fi rst day of life. Newborn babies now comprise 44% of under-5 deaths, and as child mortality continues to decline, the proportion of newborn deaths continues to climb. An analysis in 2011 by the Institute for Health Metrics and Evaluation showed that as many children die during the fi rst week of life as during the period from age 1 to 4 years. While the statistics about newborn babies are dire, they point to opportunity for improvement. Many newborn deaths could have been prevented with existing interventions. These babies are not dying because we lack the knowledge to save them; they are dying for a lack of attention and investment. The Lancet Every Newborn Series aims to stimulate attention and investment and place newborn health more prominently on the global agenda, alongside reproductive, maternal, and child health. The Series is both a call to action and a clear-cut case that a dramatic decrease in neonatal mortality is achievable with currently available interventions. Data from a systematic analysis of interventions across the continuum of care show that by 2025 it will be possible to save the lives of almost 2 million newborn babies each year and avert 71% of neonatal deaths. When it comes to saving the lives of newborn babies, the evidence base shows that a few inexpensive, proven interventions can go a long way. Examples of key interventions for newborn babies include immediate drying and stimulation at birth; immediate and exclusive breastfeeding; chlorhexidine umbilical cord care; and kangaroo mother care, which involves skinto-skin contact between a mother and baby to promote breastfeeding and regulate the baby’s temperature, heart rate, and breathing. Despite the eff ectiveness of such interventions, many have failed to take hold. One reason that coverage of these interventions remains so low is that more than 50% of women in low-income countries give birth at home without a skilled attendant present. However, since the early 1990s, more women in almost every country around the world are choosing to deliver their babies in health facilities. Provided they are properly staff ed and equipped, health facilities can provide high quality care during the crucial moments surrounding labour and delivery. Encouraging women to seek that care, and continuing to emphasise the quality of care in facilities, is critical to advancing maternal and newborn health. When women either cannot or choose not to go to a health facility for delivery, there are still ways to improve outcomes for newborn babies. When complications arise during labour and delivery or when a baby is born small or sick, a trained health worker can mean the diff erence between life and death. Countries such as Ethiopia and Nepal have shown that building and maintaining a sizeable force of health workers with the skills to care for distressed newborn babies can drive signifi cant gains in newborn health. Although this Lancet Series focuses on newborn babies, it also underlines the importance of placing newborn babies within the larger continuum of care by linking their wellbeing to reproductive, maternal, and child health. For Published Online May 20, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60810-2