Saving Newborn Lives: The Global Perspective Anne Tinker Director Saving Newborn Lives Initiative Save the Children Federation Washington, DC, USA World Bank, October 29, 2003

 40% of the world’s deaths of children under age 5 occur in the first month of life  4 million newborns die each year, and 4 million more are stillborn  Nearly 99% of the deaths occur in the developing world, most at home without skilled care  Poor newborn health can lead to learning disabilities, stunted growth, and early onset of chronic diseases  To meet the MDG on child mortality reduction, neonatal mortality must be reduced by at least one half Why Focus on Newborns?

Relative Risk of Death per Month Deaths per 1000 live births Average number of deaths per month in each period of a child’s life Newborn period 31 deaths per month Post-neonatal period (1-11 months) 2 deaths per month Children (12-59 months) 1 death per month The risk of dying is 15 times higher in the first month of life than in subsequent months of infancy From: State of the Worlds Newborns 2001, State of the World’s Children 2001, WHO Publications

Causes of Newborn Deaths  Pregnancy-related complications (e.g., complications of prematurity, congenital anomalies) 34%  Delivery-related complications (e.g., asphyxia, birth injury) 29%  Infectious diseases (e.g., neonatal tetanus, pneumonia, sepsis, meningitis, diarrhea) 32% WHO, 2001

Newborn Deaths are Preventable 70% of newborn deaths can be prevented by simple, cost-effective interventions during  Pregnancy  Delivery  Newborn period for as little as $1-3 per person per year.

Health Priorities for Newborns  Strong links with maternal health  Clean delivery and cord care  Warming and drying  Immediate, exclusive breastfeeding  Recognition and management of the sick newborn: asphyxia, infection  Special care for the LBW infant

What is SNL? A global initiative, led by Save the Children and supported by the Gates Foundation, to improve newborn health and survival in the developing world

SNL’s strategy for improving newborn health and survival Strengthen and expand proven, cost-effective interventions Discover and diffuse new and better technologies and approaches Increase understanding and commitment at global and country level Build partnerships and mobilize resources to achieve scale and impact Strengthen global and country level capacity to lead and support improved and sustained newborn health programming

Where we work National programs fully operational in Pakistan, Bangladesh, Nepal, Malawi, Mali, and Bolivia New programs being launched in India, Vietnam, Ethiopia, Myanmar, Indonesia, and Guatemala

Tools Development Situation Analysis Newborn care training package Formative research guide List of core indicators

What can the World Bank do? Strengthen newborn health services in health sector lending Include newborn mortality reduction as an indicator of progress towards meeting the health MDGs Establish partnerships, such as providing supplies and equipment while SNL or others provide technical assistance and community support

SNL Research Priorities I. Improve household and community behaviors II. Improve ENC delivery III. Prevent and improve management of LBW IV. Prevent and improve management of infection V. Improve knowledge of causes of neonatal mortality VI. Prevent and improve management of birth asphyxia

Research on key questions relating to newborn health and survival How to improve newborn care practices and services in resource poor settings: community- based trials in India, Nepal and Malawi and Bangladesh How to improve management of the sick newborn: research in prevention and management of birth asphyxia and infection How to manage the low birth weight baby: lessons learned about kangaroo mother care and remaining research questions