New UNICEF report points out that 2.8 million babies die each year during first 28 days of life

Child survival rates have increased dramatically since 1990, during which time the absolute number of under-five deaths has been slashed in half from 12.7 million to 6.3 million, according to a report released today by UNICEF.

The 2014 Committing to Child Survival: A Promise Renewed progress report, indicates that the first 28 days of a newborn’s life are the most vulnerable with almost 2.8 million babies dying each year during this period. One million of them don’t even live to see their second day of life. Many of these deaths could be easily prevented with simple, cost-effective interventions before, during and immediately after birth.

Analysis points to failures in the health system during the critical time around delivery as a significant contributing factor to these unnecessary deaths. It also shows that there is considerable variation – from country to country and between rich and poor – in the take-up and quality of health services available to pregnant women and their babies.

East Asia and the Pacific is the best performing region in the world, with a 67 per cent decline in in under-5 mortality since 1990, and a 60 per cent decline in neonatal mortality. However, the level and breadth of success is by no means uniform, particularly at the sub-national-level where disparities within countries are evident. The major killers remain pneumonia and diarrhoea, along with more pronounced numbers in the first month after birth.

In the Philippines, for example, ending preventable deaths remains an important priority. According to the latest figures, there were approximately 71,000 deaths of under 5-year-olds in 2013, down from 119,000 in 1990. Similarly, there was a reduction in newborn deaths, from 23 in 1,000 births in 1990, to 14 in 1,000 births in 2013. However, newborn mortality has fallen more slowly – babies under 28-days-old now account for approximately 46 per cent of all under-5 deaths.

Key findings in this study include:

• Around half of all women do not receive the recommended minimum of four antenatal care visits during their pregnancy.

• Complications during labour and delivery are responsible for around one quarter of all neonatal deaths worldwide. In 2012, 1 in 3 babies (approximately 44 million) entered the world without adequate medical support.

• Evidence shows that initiating breastfeeding within one hour of birth reduces the risk of neonatal death by 44 per cent, yet less than half of all newborns worldwide receive the benefits of immediate breastfeeding.

• Quality of care is grossly lacking even for mothers and babies who have contact with the health system. A UNICEF analysis of 10 high mortality countries indicates that less than 10 percent of babies delivered by a skilled birth attendant went on to receive the seven required post-natal interventions, including early initiation of breastfeeding. Similarly, less than 10 per cent of mothers who saw a health worker during pregnancy received a core set of eight prenatal interventions.

• Those countries with some of the highest number of neonatal deaths also have a low coverage of postnatal care for mothers.

• Babies born to mothers under the age of 20 and over the age of 40 have higher mortality rates.

Additionally, the report shows that the education level and age of the mother has a significant bearing on the chances of her baby’s survival. Neonatal mortality rates among mothers with no education are nearly twice as high for those with secondary schooling and above.

“The data clearly demonstrate that an infant’s chances of survival increase dramatically when their mother has sustained access to quality health care during pregnancy and delivery,” said Geeta Rao Gupta, UNICEF Deputy Executive Director. “We need to make sure that these services, where they exist, are fully utilised and that every contact between a mother and her health worker really counts. Special efforts must also be made to ensure that the most vulnerable are reached.”

Inequality, particularly in health care access, remains high in the least developed countries: women from the richest households are almost three times as likely as those from the poorest to deliver their baby with a skilled birth attendant. Despite this, the report suggests that the equity gap in under-5 child mortality is steadily reducing. In every region, except sub-Saharan Africa, the proportion of under-five mortality among the poorest sections of society is declining faster than in the richest. More significantly, worldwide, the poor are registering greater absolute gains in child survival than their wealthier compatriots.

“It is deeply heartening that the equity gap in child survival is continuing to narrow,” said Rao Gupta. “We need to harness this momentum and use it to drive forward programmes that focus resources on the poorest and marginalised households; a strategy which has the potential to save the largest number of children’s lives.”