A newborn baby dying within the first month of life is a tragedy. With more than a million newborn deaths per year in South Asia, many mothers face the mental, physical and social trauma of losing their new baby. Since almost 70 percent of neonatal mortality is avoidable, even without intensive care facilities, improvements are certainly possible. As death rates in older children are falling faster than neonatal death rates, governments in South Asia need to focus on this area in order to reach Millennium Development Goal 4 (reduce child mortality by two thirds between 1990 and 2015).
There are more than a million neonatal deaths per year in South Asia. Progress in reducing neonatal mortality (death in the first 28 days of life) has been slower than progress in reducing underfive and infant mortality: in South Asia as a whole, newborn deaths now account for more than half of all child mortality. Tackling neonatal mortality is therefore increasingly important. There are marked disparities in neonatal mortality between countries. Figures range from six deaths per 1,000 live births in Sri Lanka and the Maldives to 42 per 1,000 in Pakistan. In Pakistan a baby dies about every three minutes; in Nepal three babies die approximately every two hours.
Although there are many causes of neonatal mortality, the main ones are premature birth, low birth weight, problems during delivery and infections. Globally, lower socioeconomic groups are more likely to have higher rates of neonatal mortality. Neonatal death is more common where health care for mothers is inadequate – mothers need high-quality health care throughout pregnancy, during labour and after giving birth.
Both UNICEF and the World Health Organization (WHO) advise that a skilled birth attendant should provide care during delivery, as this is an important way to reduce neonatal mortality. Yet there are vast disparities in the access to and use of skilled birth attendants in South Asia – only 32 percent of births in Bangladesh occur in the presence of skilled health staff, whereas in Sri Lanka there is skilled health staffat almost every birth. There is a lack of data on both numbers and quality of skilled birth attendants.
National averages can conceal wide differences associated with geography and social factors within a country. In Bangladesh, for instance, women in urban areas are better served than their rural peers: 54 percent of births in urban areas are attended by a medically trained provider compared to only 25 percent in rural areas. Affluence and good education also make a difference: about two thirds of the wealthiest women, and those who have completed secondary or higher education, have a medically trained provider at birth. In Nepal, 32 percent of rural births are attended by a skilled provider compared to 73 percent in urban areas.
The reasons for higher death rates in very young babies are complex, but some of the solutions are well understood and urgently needed. They include having sufficient numbers and training of skilled birth attendants, high quality delivery facilities, and regular follow-up during pregnancy and after birth. There needs to be a special focus on the quality of care of newborn babies and on key interventions, for example the critical importance of breastfeeding.
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