EDEL RODRIGUEZ /
Union-Tribune illustration
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It is life's most basic relationship: a mother and her newborn. Yet, as we celebrate Mother's Day in the United States, how many of us fully understand the needless tragedy that so many mothers face every day around the world – the loss of their babies due to preventable causes or the lack of basic health care?
As you read this, 5,000 mothers who give birth today in poor countries will see their babies die within the next 24 hours. That's more babies on average than are delivered successfully in all the hospitals in San Diego County each month. Most maternity wards in the U.S. are scenes of joy. But in too many poor countries around the world, what should be the happiest day of a woman's life – giving birth to a baby – has become a dance with death.
The latest numbers, as reported this week in Save the Children's annual State of the World's Mothers report, are staggering. Each year an estimated 2 million newborns die within their first 24 hours of life and an additional 2 million die before they are a month old. That's 4 million newborns dying each year in the first month of life, most from causes that can be treated or prevented. While mortality rates for children under 5 worldwide have declined significantly in recent decades, little progress has been made in reducing death rates for newborns.
To put this in perspective, 4 million babies are born every year in the United States, but only 16,000 do not survive their first month – a newborn mortality rate that is 10 times lower than in many developing countries. (The newborn mortality rate in the United States, however, is still behind many other industrialized countries such as Norway and Japan.)
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Every minute, a woman meets her death during pregnancy and childbirth.
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Newborn deaths account for 40 percent of all deaths among children under the age of 5.
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4 million newborns die every year, mostly due to preventable causes.
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The primary causes of newborn deaths, while rare in the United States, are commonplace in the developing world: pregnancy-related complications such as low birth weight or premature delivery; injuries or asphyxia during labor; and infections such as tetanus or pneumonia. Another big factor: 60 million women in the developing world give birth at home each year with no skilled care.
Babies born to poor mothers in rural areas face perhaps the greatest challenges to survival. An analysis of 50 developing countries found that babies born to the poorest mothers were almost 30 percent more likely to die than babies born to the richest mothers. The same analysis found that newborns in rural areas were 21 percent more likely to die than those in urban areas.
It doesn't have to be this way. As many as 3 million newborns – and tens of thousands of their mothers – could be saved each year through simple, low-cost interventions such as immunizing women against tetanus, providing a skilled attendant at birth, treating newborn infections promptly, encouraging immediate breast-feeding after birth and making more information available about family planning.
Besides improving basic health services, simple changes in traditional cultural practices performed at childbirth also can make a big difference. In poor regions of Bolivia, for example, umbilical cords are often cut with a sharp stone or piece of clay pot because people believe using a knife or blade will cause the baby to grow up to be a thief. Save the Children has worked to educate Bolivian families to sterilize stones by boiling them, and to sterilize a special piece of ceremonial clay pot that is made during pregnancy and broken at the time of birth. Both approaches respect tradition and prevent infection.
In Africa and South Asia, premature babies often die because newborns are normally scrubbed with cold water and soap and left on a cold floor to dry. We are working to teach mothers to gently wipe babies clean, wait three days before the first bath, keep babies cuddled next to the skin and consistently breastfeed. These practices – called “skin to skin” or “kangaroo mother care” – have helped reduce death rates for premature infants by 50 percent in parts of India. In Ethiopia, we have seen similar positive results among preterm, low birth-weight babies.
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An analysis of 50 developing countries found that babies born to mothers in the poorest fifth of a population were almost 30% more likely to die compared to those in the richest fifth
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The U.S. is tied for second to last place in lowest infant mortality rate with Hungary, Malta, Poland and Slovakia (5 deaths per 1,000 live births.)
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The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the UK, but its newborn mortality rate is higher than in any of these countries.
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25% of newborn deaths are in the first day (2 million deaths per year) and 75% of newborn deaths are in the first week (3 million deaths per year.)
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African American babies are twice as likely to be born with a low birth rate, to be born preterm, and to die at birth.
SOURCE: Save the Children organization's State of the World's Mothers report 2006
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Overall, 10 countries account for more than two-thirds of all the 4 million newborn deaths worldwide every year. India leads the list with more than 1 million newborn deaths per year, and China is next with 416,000. But India and China have huge populations, and their rates of newborn deaths is not the world's highest.
The region with the highest rate of newborn death is sub-Saharan Africa, where in some countries one in every five mothers has lost at least one baby in childbirth – a terrible rate of grief. So many newborns die in sub-Saharan Africa that babies are often not named until they are a week to 40 days old.
So where is the good news about child survival in the developing world? Our new report shows a number of countries including Vietnam, Nicaragua, Philippines and Tajikistan doing well in keeping newborn death rates relatively low even though they are low-income countries. In Vietnam, girls are encouraged to stay in school so they begin having babies later, when their bodies are more mature. More than half of Vietnamese women use modern contraception, which has been shown to save lives by helping mothers to space births at healthy intervals. Nearly all pregnant women get prenatal care, including tetanus vaccinations. Most have a skilled attendant at delivery who knows to keep the baby warm and to urge the mother to breastfeed exclusively starting within an hour after delivery.
In contrast, consider Angola. It has a low per-capita annual income similar to Vietnam's – the equivalent of about $500 a year in U.S. currency, about $2,400 a year in “purchasing power parity.” Yet Angola's newborn mortality rate is more than four times higher and its maternal mortality rate is nearly 39 times higher. One in seven Angolan women dies in pregnancy or child birth compared with one in 270 Vietnamese women. To a large extent, Angola's grim statistics are a legacy of more than a quarter-century of civil war. Pregnant women often go without basic prenatal care and do demanding physical work right up until childbirth. More than half of all births occur with no medical staff present.
So what can be done to save lives? In the developing world, communities are pulling together to help themselves. For example, in Mali, one of the poorest countries in Africa, grandmothers, who are highly respected and influential in family matters, have been enlisted to educate new mothers on the merits of breast-feeding. As a result, in many Mali communities, the number of mothers who provide their babies only breast milk during the first three days after birth has increased dramatically, to the benefit of these babies.
Now is the time for governments, the private sector and humanitarian organizations to take joint responsibility to reduce the needless deaths of mothers and babies worldwide. Low-cost, low-tech solutions – combined with political will and financial commitment – could save the vast majority of these lives.
One encouraging sign: there is growing support in Congress for new legislation that would authorize increased resources to reduce maternal, infant and child mortality. The measure would also call on the U.S. government to implement a strategy to promote the health and well-being of mothers and children around the world. The House already is considering the legislation, and this week Sens. Gordon Smith of Oregon and Christopher Dodd of Connecticut introduced similar legislation in the Senate.
For millions of mothers worldwide, helping them ensure the survival of their babies would be the greatest Mother's Day gift of all.
MacCormack is president and CEO of Save the Children, an independent global humanitarian organization, based in Westport, Conn. Tinker is head of the agency's Saving Newborn Lives initiative, which is supported by the Bill & Melinda Gates Foundation.
