Reducing global neonatal mortality is possible.

BACKGROUND The global neonatal mortality of 28/1,000 live births is unacceptably high. Furthermore, the huge difference in mortality between high- and low-income countries and regions is presently one of the most burning human rights issues. The decline in neonatal mortality has been slow and is a main reason the Millennium Development Goal 4 does not seem to have been reached. OBJECTIVES Several countries have shown it is possible to reduce neonatal mortality quickly and dramatically without much cost. METHODS It is important to learn from the successful countries and focus on the 3-4 major causes of neonatal death: asphyxia, infection, low birth weight/prematurity and congenital malformations. RESULTS A reasonable short-term goal is to reduce global neonatal mortality to 15/1,000 which can be achieved without introduction of high technology medicine. A further reduction of mortality to 5/1,000 should be the next global goal. Reaching this would reduce the present 3.8 million annual deaths by 3 million. In order to do this, regionalization of health care should be implemented. Maternal health should be the focus, with free antenatal care and centralized deliveries with health personnel attending the birth. Education of girls is perhaps the best way to prevent perinatal and neonatal deaths. Ten simple recommendations are given to reduce neonatal mortality. One of these is that each newborn baby in the world should have free access to essential drugs. CONCLUSIONS It is possible to reduce newborn mortality in all countries and regions. Most important to achieve these goals is, however, political will.