[This entry has been published in Spanish in Planeta Futuro-El País]
Even today, 16,000 children around the world die every day before reaching their fifth birthday
It seems logical to those of us who live in the Western world to say that children born in 2017 or in the past few years will be teenagers or adults in 2030, the final year of the current development agenda. By contrast, in many other settings such a prediction would be much less certain, since the likelihood of survival of many children is threatened every day by precarious health conditions. Newborn children are particularly at risk and are a population still affected by a very high mortality rate and burden of disease associated with avoidable causes. Even today, 16,000 children around the world die every day before reaching their fifth birthday.
“The high rates of preventable death and poor health and well-being of newborns and children under the age of five are indicators of the uneven coverage of life-saving interventions and, more broadly, of inadequate social and economic development.” These are the opening lines of the “Child Health Challenges” section of the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030)—the roadmap for the health of mothers, children and adolescents over the next 15 years. Although neonatal and child health is a key focus in global development efforts—and despite significant progress over the last decade—we are still a long way from being able to guarantee good conditions of health and well-being for the many children in developing regions who are not fortunate enough to belong to the most affluent populations.
Of the nearly 6 million neonatal deaths in 2015, 1 million occurred on the first day of life, and nearly 2 million within the first week
The neonatal period—the first 28 days of life—is the riskiest stage in the life of a child, especially the first hours and days of life. Of the nearly 6 million neonatal deaths in 2015, 1 million occurred on the first day of life, and nearly 2 million within the first week. Between 2000 and 2015, the worldwide neonatal mortality rate fell from 31 to 19 per 1,000 live births. Despite this progress, neonatal mortality has not declined at the same rate as deaths between the ages of 1 month and 5 years; consequently, neonatal deaths now account for a higher percentage of all child deaths (45%).
African children are born into the most deadly stage of life; their first month in the world is the most dangerous of their lives
Along with Southeast Asia, sub-Saharan Africa is one of the regions that is farthest from achieving the global target. The average neonatal mortality rate in sub-Saharan Africa is 28.6 per 1,000 live births, which in 2015 represented over a million deaths among newborns in the region. In some countries, such as Sierra Leone and Nigeria, the neonatal mortality rate is even higher, with over 34 deaths per 1,000 live births. Therefore, it is not unreasonable to say that African children are born into the most deadly stage of life; their first month in the world is the most dangerous of their lives.
To improve these disheartening statistics, the Sustainable Development Goals (SDGs) have established the target of ending preventable deaths of newborns and reducing neonatal mortality to at least as low as 12 per 1,000 live births in all countries by 2030. Another SDG target is to reduce child mortality—deaths among children under 5 years of age—to at least as low as 25 per 1,000 live births. Going from 19 to 12 neonatal deaths per 1,000 live births might not seem like a big leap, but the task is more difficult than it seems because the national rate in most developing countries is (much) higher than the global average. These goals will not be reached until national health systems are strengthened and can provide the care before, during and after childbirth that will significantly improve the quality of neonatal health and ensure higher survival rates.
There is a close relationship between the health of the fetus and that of the newborn, and the health of the mother
There is also a close relationship between the health of the fetus and that of the newborn, and the health of the mother. When good quality specialised care is not available, childbirth is associated with a spike in both maternal and neonatal death. Timely access to quality medical services before, during and after childbirth is essential to the survival of both mother and child. Moreover, the impact of maternal deaths on children’s living conditions is well documented. Children who lose their mother are more likely to die during the first year of life, have poorer health and well-being, and suffer from impaired cognitive and emotional development. They are also less likely to attend school and in many cases are poorer than non-orphans.
Photo: Andalu Vila San Juan
To make matters worse, not all women and adolescents have the same access to maternal and reproductive health services, especially in sub-Saharan Africa, where certain groups are especially vulnerable. The poorest women, women living in remote rural areas, and women with a low level of education are less likely to have access to these crucial services that can give their children better chances of survival and well-being.
To mark the Day of the African Child, ISGlobal’s Maternal, Child and Reproductive Health Initiative has published a monograph on inequality in access to maternal and reproductive health care services, an issue closely linked to newborn health, in 29 countries in sub-Saharan Africa. The report quantifies the inequalities and the main determinants of inequality in each country.
The implementation of the 2030 agenda will require political will and the mobilisation of additional resources, not only to sustain but also to accelerate progress
We in the academic and research community can contribute by generating new data and knowledge on the levels and causes of these inequalities to monitor trends and inform new strategies. Information is an essential prequisite for progress, but information alone is not enough. Equity is a basic principle of the SDGs, and this implies providing excluded groups with access to basic care. The implementation of the 2030 agenda will also require political will and the mobilisation of additional resources, not only to sustain but also to accelerate progress. These factors can play a crucial role in achieving development goals in sub-Saharan Africa—but more importantly, they can help save millions of lives.
Digital report 'Maternal and Reproductive Health: An Epidemic of Inequality'