In the past two decades, the world has seen a dramatic reduction in childhood deaths. Compared to 1990, in 2012 (the latest year for which we have complete data), 47% fewer kids died before the age of 5. Globally, more women survive pregnancy and childbirth, and more children survive their early years than at any point in history.
This is a great accomplishment, but there's an equally big problem—newborn babies account for 43% of all deaths of children under age 5. Most of the progress we've made in improving health for children and mothers simply has not made it to newborns. Here are five research-backed ways to help newborns survive.
1. Encourage Breastfeeding
Breastfeeding is a powerful, simple, and proven way to help newborns survive. UNICEF provides some statistics (emphasis added):
Children who are exclusively breastfed for the first six months of life are 14 times more likely to survive than non-breastfed children.
Studies show that initiating breastfeeding immediately after birth can reduce the risk of newborn death by up to 20 per cent, by boosting the child’s immune system.
But what's so special about breastfeeding? In the first few hours and days after a baby is born, the mother produces colostrum, a special form of milk that is a powerful immune system booster for the baby. When mothers begin breastfeeding immediately after birth, this boost is passed along to the newborn. The best health outcomes come when breastfeeding is both immediate and exclusive for the first six months of the newborn's life.
So what can we do to encourage breastfeeding? According to a study published last year in The Lancet, "Counselling, education and support can increase exclusive breastfeeding rates among children less than six months old by up to 90 per cent." Put simply, explaining the benefits of breastfeeding and supporting mothers through the process can make the difference.
2. Make Direct Skin-to-Skin Contact
Direct skin-to-skin contact between baby and mother (or father) after birth can have a dramatic positive effect on the newborn's longterm health. Part of the benefit is that the newborn is exposed to the same bacteria as the parent, helping to establish a healthy immune system. But there are other benefits too—skin-to-skin contact can help improve a newborn's temperature, respiration, and heart rate. (Skin-to-skin contact with the baby also has benefits for the mother and father as well, including reductions in parental stress and depression.)
All babies can benefit from direct contact with their mothers' skin, but it's especially important with low-birthweight or preterm babies. A method dubbed "Kangaroo Mother Care" encourages mothers of these high-risk babies to frequently and exclusively breastfeed, while maintaining plenty of skin-to-skin contact. According to the International Breastfeeding Center, a baby given skin-to-skin contact:
• Is more likely to latch on
• Is more likely to latch on well
• Maintains his body temperature normal better even than in an incubator
• Maintains his heart rate, respiratory rate and blood pressure normal
• Has higher blood sugar
• Is less likely to cry
• Is more likely to breastfeed exclusively and breastfeed longer
• Will indicate to his mother when he is ready to feed
Costs nothing, can be done with no equipment at all, and helps everybody involved? Sounds like a winner to me.
3. Clean the Umbilical Cord
When the umbilical cord is cut after a baby is born, that cut can be an entry point for infections. The common "dry" method of cutting the cord can leave the baby's belly button exposed to infection. Using a dash of the antiseptic chlorhexidine on the cut provides extra protection for the baby, and in many parts of the world, means the difference between life and death. Here are some statistics from medical studies bearing this out (emphasis added):
Nepal: 24% reduction in newborn mortality when community health workers applied chlorhexidine to the cord during home visits. This intervention can be successfully incorporated into maternal and newborn care programs using [the] existing cadre of female community health volunteers. (The Lancet, March 2006)
Pakistan: When chlorhexidine was recommended and provided by traditional birth attendants to families, risk of newborn infection dropped by 42%, and neonatal mortality reduced by nearly 40%. (The Lancet, March 2012)
Meta-Analysis: Application of any CHX [chlorhexidine] to the umbilical cord of the newborn led to a 23% reduction in all-cause neonatal mortality in the intervention group compared to control.... (BMC Public Health, September 2013)
The simple conclusion here? An inexpensive disinfectant, applied once, saves newborns' lives.
4. Use Antenatal Corticosteroids (ACS) for Preterm Babies
Babies born prematurely face greater risks than full-term babies—and more than 1 in 10 babies worldwide are born preterm. According to Healthy Newborn Network, "over 1 million children die each year due to complications of preterm birth." But we have medicine that can dramatically improve the odds.
The Healthy Newborn Network breaks it down (emphasis added):
Antenatal corticosteroids (ACS) are a class of drugs which can reduce the risk of preterm death by more than 50% in facilities where ventilation support technologies are not available, and by roughly 30% even where advanced Neonatal Intensive Care Units (NICUs) are available.
These drugs are among the best documented, most effective, safest, and least expensive interventions we have to reduce preterm deaths. Antenatal steroids are now identified by the UN-led Commission on Life-Saving Commodities for Women and Children as an essential medicine that should be available everywhere.
The use of ACS is also supported by The National Institutes of Health as well as The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice.
5. Choose When to Become Pregnant
When births are spaced out by three or more years, the later siblings have a much better shot at life (though their odds of being on the same high school sports teams as their older brothers and sisters are pretty much nil). According to the Healthy Newborn Network, "Children born less than two years after a sibling are two times more likely to die within the first year of life than those born 3 or more years later." The reason for this is simple: birth spacing allows the mother to devote her energy to breastfeeding and caring directly for one baby at a time in the crucial first and second years of life. Birth spacing benefits the mother, the existing child (or children) and the new baby.
Another factor here is mothers bearing children while the mothers are too young. Again quoting the HNN (emphasis added): "More than 1 million babies born to adolescent girls [each year] die before their first birthday. In developing countries, if a mother is under 18, her baby's chance of dying in the first year of life is 60% higher than that of a baby born to a mother older than 19." What's more, reducing adolescent pregnancies keeps more girls in school; this raises their earnings over a lifetime, benefiting not just them, but their families and communities down the line.
According to The London Summit on Family Planning:
By 2020, if 120 million more women who want contraceptives could get them, there would be:
• More than 100 million fewer unintended pregnancies
• 200,000 fewer women and girls dying in pregnancy and childbirth
• Over 50 million fewer abortions
• Nearly 3 million fewer babies dying in their first year of life
Giving women the means to space their pregnancies would decrease deaths of children under age 5 by 25%. That's a goal worth fighting for.
The Every Newborn Action Plan
On May 19, the Every Newborn Action Plan will be presented to the World Health Organization. This is the start of the first-ever global initiative to improve newborn health and save lives. If this issue speaks to you, the Every Newborn toolkit is well worth a read.