1. World Health Organization
19 April 2017
Every Newborn Action Plan
Midwives for a better tomorrow
Fran McConville, RCM IDM , Edinburgh May 5th 2015

2. From evidence to action
Every Newborn Series
5 papers, 6 comments 55 authors from 18+ countries 60+ partner organizations Published May 2014
Main funders: Bill & Melinda Gates Foundation, USAID, Children’s Investment Fund Foundation
Every Newborn Action Plan
Based on the evidence from the Series
Co-led by UNICEF & WHO
World Health Assembly 2014 resolution
Over 300 experts consulted
60+ partner organization
Launched 30th June 2014
40+ commitments to EWEC

3. Causes of under five deaths 44% are from neonatal causes
3 main killers to address:
Preterm birth
Birth complications
Neonatal infections
Two-thirds of neonatal deaths
are preventable
Data source: Cause of death - WHO. Global Health Observatory Child deaths - UN Inter-agency Group for Child Mortality Estimates. Levels and Trends in Child Mortality. Report 2013; Stillbirths - Lawn et al The Lancet stillbirth series (9775) p1448 – 1463 3

4. When are mothers and newborns dying? Source: Lancet newborn series

5. What is the coverage of PNC services? Source Countdown 2013 Update

6. We have the knowledge and tools to reduce the main causes of death
Preterm birth
Preterm labor management including antenatal corticosteroids*
Care including Kangaroo mother care, essential newborn care
Birth complications (and intrapartum stillbirths)
Prevention with essential obstetric care *
Essential newborn care, and resuscitation*
Neonatal infections
Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate*
Case management of neonatal sepsis * 1 2 3
* Prioritised by the UN Commission on Life Saving Commodities for Women and Children
Over two-thirds of newborn deaths preventable – actionable now without intensive care

7. There are proven interventions within RMNCH continuum of care
Source: Adapted from The Lancet Every Newborn Series

8. Care around birth gives a triple return on investments by reducing maternal and newborn deaths and stillbirths
The lives of more than 3 million babies and women could be saved each year with high coverage of quality care around birth and care for small and sick babies
Source: Special analysis detailed in The Lancet Every Newborn Series - forthcoming

9. What do we need to do differently for newborns
What do we need to do differently for newborns? ENAP 5 Strategic Objectives - midwifery!
Strengthen and invest in care during labour, birth and the first day and week of life
Improve the quality of maternal and newborn care:
Reach every woman and every newborn; reduce inequities
Harness the power of parents, families and communities
Count every newborn – measurement, tracking and accountability
The Every Newborn Action Plan proposes five strategic objectives.
Strategic objective 1: Strengthen and invest in care during labour, childbirth, and the first day and week of life. More than one-third of stillbirths (1.2 million), 75% of newborn deaths (2 million) and 72% of maternal deaths ( ) occur within this period. Many deaths and complications can be prevented by ensuring provision of high-quality, essential care for every pregnant woman and every baby around the time of labour, childbirth and in the first 24 hours and week after birth.
Strategic objective 2: Improve the quality of maternal and newborn care. Substantial gaps in the quality of care exist across the continuum of care for women and children’s health. In many settings women and newborns do not receive the care that they need even when they have a contact with the health system whether before, during or after pregnancy. The key to success is introducing high-quality care with high-impact, cost-effective interventions for mother and baby together – in most cases, by the same health providers at the same time.
Strategic objective 3: Reach every woman and every newborn to reduce inequities. Access to high-quality health care that people need without suffering financial hardship when paying for them is a human right. There is increasingly robust evidence of approaches for ending preventable newborn deaths that effectively accelerate the coverage of essential interventions, through innovations that include task sharing, improved access to life-saving commodities, health insurance and financing mechanisms, and use of information technology and social and knowledge networks.
Strategic objective 4: Harness the power of parents, families and communities. Education and information are crucial for empowering parents, families and their communities to demand quality care. Evidence has shown the power of engaged community leaders, women’s groups, and community workers in turning the tide for better health outcomes for newborns. Participatory learning and action in poor rural communities is a core intervention that requires investment and expansion.
Strategic objective 5: Count every newborn - measurement, programme tracking and accountability. Measurement enables managers to improve performance and adapt actions as needed. Assessing outcomes and financial flows with standardized indicators improves accountability. There is an urgent need to improve the metrics globally and nationally, especially for birth outcomes and quality of care. Every newborn needs to be registered and newborn deaths need to be counted. Counting every maternal death and stillbirth is of equal importance.

10. The critical role of nursing and midwifery for maternal and newborn care
Invest in education of midwives to international standards – they provide the essential interventions to save women's and children's lives
Invest in health facilities – so they are well equipped and organized to enable staff to provide quality care
Collect more and better data on births, deaths and numbers of midwives – information is critical to have the right staff, in the right place, at the right time

11. The critical role of nursing and midwifery personnel for maternal and newborn care
4. Legislation and regulation – is essential to protect women and newborns, as well as nurses and midwives 5. Fight gender discrimination – essential for women to be empowered to seek quality care, and for nurses and midwives to work under acceptable conditions 6- midwifery will free up doctors and other medical staff and is the pathway towards universal humanized care for women and newborns

12. World Health Organization
19 April 2017

13. Number and timing of postnatal contacts
World Health Organization
Number and timing of postnatal contacts
19 April, 2017
What is recommended?
For facility births: postnatal care for at least 24 hours.
For is at home births: first postnatal contact as early as possible within 24 hours.
At least 3 additional postnatal contacts for all mothers and newborns, on day 3 (48-72 hours) and between day 7-14 after birth, and 6 weeks after birth.
Special circumstances: stay in facility probably needs to be longer after Caesarean sections, for single mothers, first time mothers, adolescent mothers, complicated deliveries, small /preterm infants.
What has changed? Harmonization between post-partum and postnatal care

14. Every Newborn Action Plan goal:
NEW GLOBAL TARGETS : Ending preventable newborn mortality (EPMN) and stillbirths
Every Newborn Action Plan goal:
National NMR of 10 or less in 2035
National NMR of 12 or less in 2030
Global average NMR of 9 by 2030
The action plan sets out a vision, and proposes a goal and targets for neonatal mortality reduction by 2035, with intermediate mortality targets for 2020 and This slide shows the current trajectory for under-five and neonatal mortality, along with the targets for under-five mortality reduction as proposed by A Promise Renewed and matching targets for newborn mortality reduction as proposed by the Every Newborn action plan.
Global target of ending preventable newborn deaths: All countries have less than 10 neonatal deaths/1000 live births by 2035, with a resultant global neonatal mortality rate of 7 deaths/1000 live births, with interim global targets as shown below. This target is consistent with and supports that in Committing to child survival: A Promise Renewed for ending preventable child deaths and with proposed targets for ending preventable maternal deaths. To achieve a global neonatal mortality rate of 7 deaths/1000 live births, all countries will have to reduce neonatal mortality by at least two-thirds from a baseline in 2012, which may be considered a continuation of Millennium Development Goal 4 applied to the unfinished agenda for the reduction in the number of newborn deaths.

15. Ending preventable maternal mortality is within reach!
Global MMR of less than 70 per live births by 2030

16. NEW! Strategies toward ending preventable maternal mortality (EPMM)
Stakeholder and Member States consultation was conducted in August 2014
First references to the evidence in Lancet Special Series on Midwifery

17. NEW ! alignment of ENAP + EPMM
Engage in data-driven country analysis to effectively address all causes of death, morbidities, disability and foster country leadership
Strengthen and invest in care during pregnancy, labour, birth and the first day and week of life, ensuring full integration of maternal and newborn care
Focus on improving quality of care
Strengthen health systems — health work force, commodities, innovation
Reach every women and every newborn and address inequities in the context of a human rights approach
Harness power of parents, families and communities and engage with civil society
Count every woman, newborn and stillbirth: strengthen measurement capacity and improve data quality to drive improvement and accountability

18. Global Strategy for Women’s, Children’s and Adolescents’ Health
FIRST DRAFT HIGHLIGHTS
MAY 2015

19. Draft Outline: post 2015 Global Strategy
EVERY WOMAN, CHILD AND ADOLESCENT EVERYWHERE: A HISTORIC JOURNEY AND OPPORTUNITY
BIG RETURNS TO INVESTING IN WOMEN’S, CHILDREN’S AND ADOLESCENTS’ HEALTH
WHAT IS NEEDED: DEFINING GOALS, OVERCOMING CHALLENGES
HOW TO ACHIEVE THE GOALS: 7 TRANSFORMATIVE ACTIONS
WE ALL HAVE A ROLE TO PLAY

20. Next steps to finalize the new Global Strategy 2015
5th May: First draft for EWEC public consultation
6-7th May: EWEC South Africa consultation meeting
14th May: Greentree high-level retreat with UNSG
18th May: World Health Assembly high-level session
5th June: EWEC consultation concludes
12th June: PMNCH synthesis report
18th July: Addis meeting, Strategy and Coordination Group
Sign-off and send to UNSG for endorsement
Translation and publication of the Strategy
September: UN General Assembly launch alongside the SDGs

21. State of World’s Midwifery Report event, Geneva, 23rd February 2015
THANK YOU !
“We need more midwives, we need more midwives, we need more midwives!!!”
State of World’s Midwifery Report event, Geneva, 23rd February 2015