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UNICEF Report: enormous progress in child survival but greater focus on newborns urgently needed
© Wardlaw et al.; licensee BioMed Central. 2014
Received: 24 November 2014
Accepted: 26 November 2014
Published: 6 December 2014
The world has made enormous progress in improving child survival since 1990, reducing the under-five mortality rate by nearly half from 90 to 46 deaths per 1,000 live births in 2013. Currently, the global under-five mortality rate is falling faster than at any other time over the past two decades. Yet, progress is insufficient to meet the Millennium Development Goal 4 (MDG 4) which calls for reducing the under-five mortality rate by two-thirds between 1990 and 2015. If current trends continue in all countries, the world will not meet the target until 2026, 11 years behind schedule. To accelerate progress in child survival, focusing on the newborn is critical since the share of all under-five deaths occurring in the neonatal period (the first 28 days of life) is increasing. Globally, 44 per cent of the 6.3 million under-five deaths occurred in the neonatal period in 2013. Many of these deaths are easily preventable with simple, cost-effective interventions administered before, during and immediately after birth. However, UNICEF’s analysis reveals a remarkably high degree of variability in the utilization and quality of services provided to pregnant women and their babies. Furthermore, quality care is grossly lacking even for babies and mothers in contact with the health system. The latest levels and trends in child mortality as well as the coverage and quality of key maternal and newborn care from pregnancy through childbirth and the postnatal period are the subject of the new UNICEF report Committing to Child Survival: A Promise Renewed Progress Report 2014 released recently in September.
The dramatic decline in preventable child deaths over the past quarter of a century is one of the most significant achievements in human history. In 1990, 12.7 million children under age five died. This number fell to 6.3 million in 2013, a reduction of about 50 per cent. This means that in 2013, every single day, 17,000 fewer children died than in 1990 – thanks to more effective and affordable treatments, innovative ways of delivering critical interventions to the poor and excluded, and sustained political commitment. The global progress in reducing newborn deaths is almost as striking. Between 1990 and 2013, the number of newborn babies who died within the first 28 days of life declined from 4.7 million to 2.8 million.
Despite these gains, child survival remains an urgent concern. About 17,000 children under age five died every day in 2013. Progress has been insufficient, and the target of the Millennium Development Goal 4 (MDG 4) which calls for reducing the under-five mortality rate by two-thirds between 1990 and 2015 is likely to be missed. If current trends continue in all countries, the world will not meet the target until 2026, 11 years behind schedule. At the country level, only 12 of the 60 countries with high under-five mortality rates (at least 40 deaths per 1,000 live births in 2013) are on track to achieve MDG 4 if current trends continue.
To further accelerate progress in child survival, focusing on the newborn is critical. Globally, the neonatal mortality rate fell from 33 deaths per 1,000 live birth in 1990 to 20 in 2013. However, the decline has been slower than the decline in the post-neonatal (1-59 months) mortality rate. As a result, neonatal deaths currently represent a larger share of the total under-five deaths than in 1990. In 2013, about 44 per cent of all under-five deaths occur in the first 28 days of life, increasing from 37 per cent in 1990. Every region of the world is experiencing an increase in the proportion of under-five deaths occurring in the neonatal period. In four regions, South Asia, East Asia and the Pacific, Latin America and the Caribbean, and the Middle East and North Africa – half or more of all under-five deaths are now concentrated in the first 28 days of life.
The report highlights wide disparities in global newborn survival. In West and Central Africa, for example, the risk of a baby dying within the first 28 days of life is almost 10 times higher than the risk facing a baby born in a high-income country. With 47 neonatal deaths per 1,000 live births, Angola is the riskiest place for a newborn, while Iceland and Luxembourg have only 1 neonatal death per 1,000 live births.
Encouragingly, substantial progress in some countries demonstrates that combining political commitment, sound strategies and adequate resource makes it possible to rapidly reduce neonatal mortality, regardless of national income. Although neonatal deaths are often more difficult to prevent, 80 countries have reduced the neonatal mortality rate by at least half since 1990, and 27 of those have reduced it by two-thirds or more since 1990. The largest relative gains in neonatal survival have been in nine European countries and one Asian country. The good news is that many low- and lower middle-income countries have also experienced considerable declines in the neonatal mortality rates. The 10 countries with the largest absolute declines in neonatal mortality are all low- and lower middle-income countries in Africa or Asia. The decline in these 10 countries saved the lives of 3.4 million newborns.
Quality care for pregnant women and newborns is lacking, even for babies and mothers who have contact with the health system. A 10-countries analysis suggests that less than 10 per cent of mothers who saw a skilled health provider during pregnancy received a set of eight key interventions . Similarly in these countries less than 10 per cent of all babies who were delivered by a skilled health professional went on to receive seven needed interventions including early initiation of breastfeeding and postnatal care.
The report calls for accelerating progress on newborn and child survival and states that more countries need to turn their pledges into practical action by sharpening national strategies for reproductive, maternal, newborn and child health, setting costed targets and monitoring progress. With millions of women and children still at risk of dying of preventable causes, maternal, newborn and child survival must remain at the heart of the post-2015 global development agenda. The world cannot abandon its promise to women and children.
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