Over a million babies a year die on first day of life

"More than a million babies around the world die on the day of their birth yearly," is the sobering news in The Guardian after a report by the charity Save the Children argued that further action is required to combat child mortality. 

The report shows that 2.9 million babies died within 28 days of being born in 2012, with 1 million of these babies dying within 24 hours. The causes of these deaths include premature birth, complications during birth such as abnormal presentation (for example, when a baby presents feet or buttocks first rather than head first), and infections such as meningitis. In addition, in the same year there were 1.2 million stillbirths during labour.

The report focuses on the combined total of the 2.2 million newborn deaths on the first day of life and stillbirths during labour. Arguably, most of these 2.2 million deaths were preventable.

The report found that there is huge regional variation in newborn deaths. Generally, the poorest countries have the highest mortality rates for newborns. There are dramatic inequalities in death rates for newborn babies within poor countries, with the poorest communities and other marginalised groups generally experiencing considerably higher rates of newborn mortality.

The report has identified essential services that should be provided to prevent newborn deaths, and calls upon world leaders, philanthropists and the private sector to implement a Newborn Promise to end all preventable newborn deaths. 

Who produced the report?

The report was produced by the charity Save the Children, which works for the rights of children in more than 120 countries.

What are the risk factors for newborn death?

The main causes of death for newborn babies are problems arising from premature birth, complications during labour and delivery, and infections acquired by the baby during or after birth.

The major causes of stillbirth include childbirth complications, maternal infections and hypertension (high blood pressure).

How can newborn deaths be prevented?

The key way to stop newborn deaths is to ensure that essential care is provided during labour, delivery and immediately after, when the risks are greatest.

Save the Children's report has identified eight essential services that midwives and other skilled health workers should provide during labour, birth and immediately after to reduce newborn mortality and prevent stillbirth during labour. These include:

• skilled care at birth and emergency obstetric care, including assisted vaginal delivery and caesarean section if needed, and ensuring timely care for women and babies with complications
• management of preterm birth, including antenatal corticosteroids for mothers with threatened preterm labour to reduce breathing difficulties and other problems in preterm babies
• basic newborn care with a focus on cleanliness, including cord care, warmth and support for immediate breastfeeding, recognition of danger signs and care seeking
• neonatal resuscitation for babies who do not breathe spontaneously at birth
• promoting the practice of "kangaroo" mother care – skin-to-skin contact and breastfeeding has been shown to improve outcomes for babies, especially for premature and small babies
• treatment of severe newborn infections with a focus on early identification and the use of antibiotics
• inpatient supportive care for sick and small newborns, such as a focus on intravenous fluids or feeding support and safe oxygen use
• prevention of mother-to-child transmission of HIV during pregnancy, labour and the immediate newborn period – with the use of the right medication it is possible to reduce the risk of HIV being passed to the baby to less than 1 in 100; this is especially important in sub-Saharan Africa, where rates of HIV are high

What is the Newborn Promise?

Save the Children is calling on world leaders, philanthropists and the private sector to commit to a Newborn Promise to end all preventable newborn deaths. They want:

• governments and partners to issue a declaration to end all preventable newborn mortality
• governments and partners to ensure that by 2025 every birth is attended by trained and equipped health workers who can deliver essential newborn health interventions
• governments to increase expenditure on health to at least the World Health Organization minimum of US$60 per capita (per person, per year) to pay for the training, equipping and support of health workers
• governments to remove user fees for all maternal, newborn and child health services, including emergency obstetric care, providing the same level of free care that the NHS offers to mothers

The charity also wants the private sector, including pharmaceutical companies, to help address unmet needs by developing innovative solutions, as well as increasing the availability of new and existing products for maternal, newborn and child health for the poorest.

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