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The newborn deaths that went unnoticed
If further progress is to be made in reducing child mortality, increased efforts are needed to bring about a substantial reduction in deaths among newborns. The first global estimates of neonatal mortality, dating from 1983 ( 53 ), were derived using historical data and are generally considered to give only a rough indication of the magnitude of the problem. More rigorous estimates became available for 1995 and for 2000. These are based on national demographic surveys as well as on statistical models. The new estimates show that the burden of newborn mortality is considerably higher than many people realize.
Each year, about four million newborns die before they are four weeks old: 98% of these deaths occur in developing countries. Newborn deaths now contribute to about 40% of all deaths in children under five years of age globally, and more than half of infant mortality ( 54 , 55 ). Rates are highest in sub-Saharan Africa and Asia. Two thirds of newborn deaths occur in the WHO Regions of Africa (28%) and South-East Asia (36%) ( 56 ). The gap between rich and poor countries is widening: neonatal mortality is now 6.5 times lower in the high-income countries than in other countries. The lifetime risk for a woman to lose a newborn baby is now 1 in 5 in Africa, compared with 1 in 125 in more developed countries ( 57 ).
The above figures do not include the 3.3 million stillbirths per year. Data on stillbirths are even more scarce than those on newborn deaths. This is not surprising, as only 14% of births in the world are registered. Both live births and deaths of newborns go underreported; fetal deaths are even more likely to go unreported, particularly early fetal deaths.
While the burden of neonatal deaths and stillbirths is very substantial, it is in many ways only part of the problem, as the same conditions that contribute to it also cause severe and often lifelong disability. For example, over a million children who survive birth asphyxia each year develop problems such as cerebral palsy, learning difficulties and other disabilities ( 58 ). For every newborn baby who dies, at least another 20 suffer birth injury, infection, complications of preterm birth and other neonatal conditions. Their families are usually unprepared for such tragedies and are profoundly affected.
The health and survival of newborn children is closely linked to that of their mothers. First, because healthier mothers have healthier babies; second, because where a mother gets no or inadequate care during pregnancy, childbirth and the postpartum period, this is usually also the case for her newborn baby. Figure 1.2 shows that both mothers and newborns have a better chance of survival if they have skilled help at birth.
53 Maternal and child health: regional estimates of perinatal mortality. Weekly Epidemiological Record, 1989, 24:184-186.
54 Perinatal mortality. A listing of available information. Geneva, World Health Organization, 1996 (WHO/FRH/MSM/96.7).
55 State of the world’s newborns: a report from Saving Newborn Lives. Washington, DC, Save the Children Fund, 2004:1-28.
56 Hyder AA, Wali SA, McGuckin J. The burden of disease from neonatal mortality: a review of South Asia and Sub-Saharan Africa. BJOG: an international journal of obstetrics and gynaecology, 2003, 110:894-901.
57 Tinker A, Ransom E. Healthy mothers and healthy newborns: the vital link. Washington, DC, Save the Children/Population Reference Bureau, 2002 (Policy Perspectives on Newborn Health).
58 Best practices: detecting and treating newborn asphyxia. Baltimore, MD, JHPIEGO, 2004.
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