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

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

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 http://www.who.int/gho/child_health/en/index.html); 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 2011. 377 (9775) p1448 – 1463 3

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

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

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

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

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

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 (206 250) 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.

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

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

World Health Organization 19 April 2017

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

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 2025. 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.

Ending preventable maternal mortality is within reach! Global MMR of less than 70 per 100.000 live births by 2030

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

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

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

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

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

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