Newborn death and illness

Updated September 2011

Millennium Development Goal (MDG) 4

The fourth Millennium Development Goal (MDG 4) aims to reduce the 1990 mortality rate among under-five children by two thirds. Child mortality is also closely linked to MDG 5- to improve maternal health. Since more than one third of all child deaths occur within the first month of life, providing skilled care to mothers during pregnancy, as well as during and after birth, greatly contributes to child survival. Millennium Development Goals adopted by the United Nations in 2000 aim to decrease child deaths worldwide by 2015.

Key facts

  • Every year nearly 41% of all under-five child deaths are among newborn infants, babies in their first 28 days of life or the neonatal period.
  • Three quarters of all newborn deaths occur in the first week of life.
  • In developing countries nearly half of all mothers and newborns do not receive skilled care during and immediately after birth.
  • Up to two thirds of newborn deaths can be prevented if known, effective health measures are provided at birth and during the first week of life.
  • Of the 8.2 million under-five child deaths per year, about 3.3 million occur during the neonatal period —in the first four weeks of life.
  • The majority - almost 3 million of these - die within one week and almost 2 million on their first day of life.
  • An additional 3.3 million are stillborn.
  • A child’s risk of death in the first four weeks of life is nearly 15 times greater than any other time before his or her first birthday.
  • Virtually all (99%) newborn deaths occur in low- and middle-income countries. It is especially in Africa and South Asia that the least progress in reducing neonatal deaths has been made.
  • Almost 3 million of all the babies who die each year can be saved with low-tech, low-cost care.

The challenge: Making it through the first day

Until recently, there has been little effort to tackle the specific health problems of newborn babies. Most of their deaths are unrecorded and remain invisible. A lack of continuity between maternal and child health programmes has meant that care of the newborn has fallen through the cracks between care of the mother and care of the older child.

The survival and health of newborn babies is a critical part of the push towards lower child mortality in Millennium Development Goal 4, because a large portion of under-five deaths actually occur during the first month of life. Because many of these deaths are related to care at the time of birth, newborn health goes hand in hand with the health of mothers, Millennium Development Goal 5.

According to figures from August 2011, newborn deaths, that is deaths in the first four weeks of life (neonatal period), today account for 41% of all child deaths before the age of five. That share grew from 37% over the last decade, and is likely to increase further. The first week of life is the riskiest week for newborns, and yet countries are only just starting postnatal care programmes to reach mothers and babies at this critical time.

Newborn deaths dropped from 4.6 million in 1990 to 3.3 million in 2009, but fell only slightly during the last decade. More investment into health care for women and children since 2000 when the United Nations Millennium Development Goals (MDGs) were set resulted in more rapid progress for the survival of mothers (2.3% per year) and under-five children (2.1% per year) than for newborns (1.7% per year).

Causes of newborn death

The three major causes of neonatal deaths worldwide are infections (36%, which includes sepsis/pneumonia, tetanus and diarrhoea), pre-term (28%), and birth asphyxia (23%). There is some variation between countries depending on their care configurations.

Why has care for newborns fallen between the cracks?

  • Lack of continuum of care from maternal to child: a lack of continuity between maternal and child health programmes has meant that care of the newborn has fallen through the cracks. More than half the neonatal deaths occur after a home birth and without any health care.
  • In many countries there is no record of neonatal deaths: until recently, there has been little effort to tackle the specific health problems of newborn babies. Most of their deaths are unrecorded.
  • Neonatal mortality and gender: reduced care-seeking for girl babies compared with boy babies has been reported, especially in South Asia.

What can be done?

  • Effective care can reduce almost 3 of the 4 million deaths of babies under-one month: the package of essential care includes antenatal care for the mother, obstetric care and birth attendant's ability to resuscitate newborns at birth. Most of the infection-related deaths could be avoided by treating maternal infections during pregnancy, ensuring a clean birth, care of the umbilical cord and immediate, exclusive breast-feeding. For infections, antibiotics is life-saving and needs to be available locally. Low birth weight babies need to maintain body temperature through skin-to-skin contact with the mother. Several of the above interventions would also help save the lives of mothers and prevent stillbirths.
  • Empowering families and communities to close the gap of postnatal care: healthy home practices and empowering families to recognize problems and access care will quickly save many lives. In high mortality settings with low access to care, some interventions may need to be provided closer to home.
  • The gap for care of mothers and babies in the first few days of life is important even where women do deliver in facilities. New approaches are required to reach a large majority of these families.
  • Political commitment and social visibility. Communities and decision makers need to be informed that neonatal deaths are a huge portion of child deaths, and need therefore to receive adequate attention. Improved registration and increasing the availability and use of relevant information in programmes and to decision makers is essential if health care for newborn babies and their mothers is to be given adequate attention. Stillbirths should also be counted.

COUNTDOWN TO 2015 – Tracking Progress in Maternal, Newborn and Child Survival

The Countdown to 2015 Initiative collects and analyses data from 68 countries that account for at least 95 % of maternal and child deaths, working to create an account of progress towards the achievement of MDGs 4 and 5. The Countdown Initiative has released Reports in 2005, 2008 and 2010 and produces country profiles that present coverage data for a range of key health services including:

  • Contraceptive use
  • Antenatal care
  • Skilled attendance at delivery
  • Postnatal care
  • Child health
  • Financial investments in MNCH
  • Equity of access, health systems and policy

Sources: 2005 World Health Report: Make Every Mother and Child Count (WHO) and The Lancet’s Newborn Survival Series (2005) and UNICEF (2008)