Lives Interrupted

Newborns need a prominent place on the government’s health agenda in India where, unfortunately, the day of birth is the most dangerous day when nearly half of maternal and newborn deaths and still births occur

In the year 2015, an estimated 16,000 children died every day across the globe; most of these deaths were from preventable diseases and circumstances. A total of 5.9 million children under five years of age died in 2015 and 75% of these deaths occurred within the first year of life.
Within the first year of life, nearly 61% of the deaths occurred in the first week of life. This is an appalling tragedy that demands an accelerated response. Therefore it is time that the global strategies give more importance to newborns. In India also the picture is similar with an under five mortality rate of 49/1000 live births and the infant and neonatal morality rate being 40/1000 live births and 28/1000 live births respectively (SRS 2013).
The day of birth is the most dangerous day when nearly half of maternal and newborn deaths and still births occur. It is also the day babies face the greatest risk of disability. Protecting newborns means ensuring proper care for their mothers before, during and after pregnancy. The majority of these deaths are preventable, caused by complications related to prematurity, birth, and severe infections.
Preterm and small babies are in much greater peril, including the long-term risk of stunting and developing non-communicable diseases like diabetes and hypertension as adults. The every newborn action plan takes forward the Global Strategy for Women and Children’s Health. By focusing on the quality of care at birth, millions of lives can be saved and accelerate progress towards the Sustainable Development Goals (SDGs).
The governments, civil society, donors, the private sector and other partners can take action to address preventable newborn deaths and ensure that the rights of women and children are fully recognized. The robust accountability mechanism under the Every Woman Every Child umbrella will ensure that resources and results are tracked when it comes to commitments to newborns.
Millions of babies and women could be saved each year through investing in quality care around the time of birth and special care for sick and small newborns. Cost-effective solutions are now available to protect women and children. Newborn health and still births are part of the “un¬nished agenda” of the Millennium Development Goals for women’s and children’s health.
With newborn deaths still accounting for 44% of under-5 deaths globally, newborn mortality and still births require greater visibility in the emerging post-2015 sustainable development agenda if the overall under-5 mortality is to be reduced.More than 80% of all newborn deaths result from three preventable and treatable conditions – complications due to prematurity, intrapartum-related deaths (including birth asphyxia) and neonatal infections.
Cost-effective, proven interventions exist to prevent and treat eachleadingcause. Improving quality of care around the time of birth will save most lives, but this requires educated and equipped health workers, including those with midwifery skills, and availability of essential commodities. Women’s and children’s health is an investment, particularly with specific attention to care at birth. High coverage of care around the time of birth and care of small and sick newborns would save nearly 3 million lives (women, newborns, and stillbirths) each year.
This would have a triple impact on investments – saving women and newborns and preventing stillbirths. The every newborn action plan sets out a clear vision of how to improve newborn health and prevent still births by 2035. The plan builds on the United Nations Secretary General’s Global Strategy for Women’s and Children’s Health and the Every Woman Every Child movement by supporting government leadership and providing guidance on how to strengthen newborn health components in existing health sector plans and strategies, especially those that relate to reproductive, maternal and child health.
Every Newborn calls upon all stakeholders to take speci¬fic actions to improve access to, and quality of, health care for women and newborns within the continuum of care. The guiding principles are based on Country leadership, Human rights, Integration, Equity, Accountability and Innovation.
The following are the strategic objectives:
1. Strengthen and invest in care during labour, birth and the fi¬rst day and week of life.
2. Improve the quality of maternal and newborn care.
3. Reach every woman and newborn to reduce inequities.
4. Harness the power of parents, families, and communities.
5. Count every newborn through measurement, programme-tracking, and accountability.
The packages of care with the greatest impact on ending preventable neonatal deaths and still births include care during labour, around birth and the first week of life; and care for the small and sick newborn.
Since these packages would save the most newborn lives as well as prevent maternal deaths and still births, these are the focus of the Every Newborn action plan.Interventions in the package of “care during labour, around birth and in the first week after birth” include skilled care at birth, basic and comprehensive obstetric care, management of preterm births (including the use of antenatal corticosteroids), and essential newborn care (hygienic care, thermal control, support for breastfeeding and, if required, newborn resuscitation.These packages could prevent more than 1.9 million maternal and newborn deaths and stillbirths by 2025 with universal access.
The package of “care of small and sick newborns” comprises interventions to deal with complications arising from preterm birth and/or small for gestational age, and neonatal infections (sepsis, meningitis, pneumonia and those causing diarrhoea). Appropriate management of small and sick newborns includes extra thermal care and support for feeding for small or preterm babies, including kangaroo mother care, antibiotic treatment for infections and full supportive facility care. The last encapsulates additional feeding support (including cup and nasogastric tube feeding and intravenous fluids), infection prevention and management, safe oxygen therapy, case management of jaundice and possibly surfactant and respiratory support.
Postnatal care provides the delivery platform for the care of the normal newborn, including the promotion of healthy practices and detection of problems requiring additional care. It is provided in a different time window, often by different providers in different places. Care of the normal newborn includes early initiation of (exclusive) breast feeding, prevention of hypothermia, clean postnatal care practices and appropriate cord care.
Close observation for 24 hours and at least three additional postnatal contacts (on day 3, between days 7 and 14, and at six weeks after birth) is recommended for all mothers and newborns to establish good care-giving practices and detect any life-threatening conditions. Other interventions across the continuum of care are also vital for the survival and health of women and their babies. For example, antenatal care provides an opportunity for integrated service delivery for pregnant women, including obstetric services, but also covers infections, such as preventing, detecting and treating malaria and syphilis in pregnancy, caring for women with tuberculosis and HIV infection, preventing mother-to-child transmission of HIV and reducing harmful lifestyle practices such as smoking and alcohol use.
Some 81% of women receive antenatal care at least once during pregnancy, but only 55% receive the recommended minimum of four visits or more, and the quality of care is often suboptimal. Care before and between pregnancies affects the survival and health of women and their babies. Family planning is a vital contributor through delaying, spacing and limiting births, all of which can reduce newborn mortality and boost the health of mothers, their babies and their other children.
Access to family planning and the right to control if, when and how frequently to become pregnant empower women and girls and improves babies’ health and survival. Investments in family planning will contribute significantly to an overall reduction in newborn deaths and prevent still births and disability.
Hence it is time for the policymakers to ponder over the recommendations and design the interventions accordingly to reduce mortality in the neonatal period.

(Contributed by Dr Suneela Garg, Director Professor and Head, Department of Community Medicine, Maulana Azad Medical College, New Delhi, Dr Arvind Garg, Senior Child Specialist, Apollo Hospital, Noida, Dr Archana R, Senior Resident, Department of Community Medicine, Maulana Azad Medical College, New Delhi)