New evidence shows that addressing neonatal mortality requires continuity of care: a major series of articles in The Lancet highlights the need for skilled attendance at birth and low-cost interventions to promote the wellbeing of the newborn.


The international medical journal, The Lancet, published in March this year a 'landmark' series of articles on neonatal survival. The editor, Richard Horton, wrote, introducing the series, "A major gap in information and action remains about deaths in the first 4 weeks of life. ... Neonatal deaths, estimated at nearly 4 million annually, now account for 36% of deaths worldwide in children aged under 5 years. Millenium Development Goal 4 (MDG-4), regarding child survival, stipulates a reduction of two-thirds in deaths in children aged under 5 years, from 95 per 1000 in 1990 to 31 per 1000 in 2015.... A substantial reduction in neonatal deaths will be required to meet MDG-4. Reduction of neonatal deaths should become a major public-health priority.

'Most neonatal deaths are unseen and undocumented. In rich countries childbirth is accompanied by a fanfare, but in many poorer countries childbirth is accompanied by apprehension for the mother and baby who may remain hidden at home with limited access to care. Often the baby is unnamed until one or even six weeks has passed, reflecting a cultural acceptance of high mortality. Unfortunately, neonatal deaths also have low visibility on the global agenda.

'... Interventions to reduce neonatal deaths belong in two health-system programmes: maternal-health programmes covering pregnancy, childbirth, and early neonatal care; and child-health programmes, which move on through infancy into childhood. Addressing neonatal mortality requires a continuity between these elements of care, which is lacking in many settings. The greatest gap in care often falls during the critical first week of life when most neonatal and maternal deaths occur, often at home and with no contact with the...

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