Global deaths of newborn babies remain alarmingly high, particularly among the world’s poorest countries. A new UNICEF report newborn mortality says that every year 2.6 million babies die before turning one month old. One million of them take their first and last breaths on the day they are born.

Although, the number of deaths among children under the age of five in the last quarter century has been halved, the world has not made similar progress in ending deaths among children less than one month old.  Millions of these young lives could be saved every year if every mother and every baby had access to affordable, quality health care, good nutrition and clean water. The report addresses the challenges of keeping every child alive, and calls for strong cooperation among governments, businesses, health-care providers, communities and families to give every newborn a fair chance to survive, and to collectively work towards the achievement of universal health coverage, and a world where no newborn dies of a preventable cause.

According to the report, babies born in Japan, Iceland and Singapore have the best chance of survival, while newborns in Pakistan, the Central African Republic and Afghanistan face the worst odds. Globally, in low-income countries, the average newborn mortality rate is 27 deaths per 1,000 births. In high-income countries, that rate is 3 deaths per 1,000. Newborns from the riskiest places to give birth are up to 50 times more likely to die than those from the safest places.

The countries with the lowest newborn mortality rates, after Japan, are mostly well-off countries with strong education and health care systems: Iceland (a one in 1,000 chance of death), Singapore (one in 909), Finland (one in 833), Estonia and Slovenia (both one in 769), Cyprus (one in 714) and Belarus, Luxembourg, Norway and South Korea (all with risks of one in 667). The United States ─ generally affluent, but with considerable income inequality and wide variations in access to health care ─ was only the 41st safest country for newborns.

UNICEF also notes that eight of the 10 most dangerous places to be born are in sub-Saharan Africa, where pregnant women are much less likely to receive assistance during delivery due to poverty, conflict and weak institutions. If every country brought its newborn mortality rate down to the high-income average by 2030, 16 million lives could be saved.

More than 80 per cent of newborn deaths are due to prematurity, complications during birth or infections such as pneumonia and sepsis. These deaths can be prevented with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition. However, a shortage of well-trained health workers and midwives means that thousands don’t receive the life-saving support they need to survive. For example, while in Norway there are 218 doctors, nurses and midwives to serve 10,000 people, that ratio is 1 per 10,000 in Somalia.

Pakistan fares poorly in the UNICEF report. It declares Pakistan as the riskiest country for newborns, saying that out of every 1,000 babies born in Pakistan, 46 die before the end of their first month. Pregnant women are much less likely to receive assistance during delivery in Pakistan, where 14 skilled health professionals are available for every 10,000 people.

The report points out that the percentage of mothers who give birth in a health facility in Pakistan increased from 21 percent to 48 percent between 2001 and 2013. It also noted the proportion of women giving birth with a skilled attendant during the same period more than doubled from 23 percent to 55 percent. In UNICEF’s opinion, despite these remarkable increases, largely the result of rapid urbanization and the proliferation of private sector providers not subject to satisfactory oversight, Pakistan’s very high newborn mortality rate fell by less than one quarter, from 60 in 2000 to 46 in 2016.

Civil rights organizations have long called for increasing the health budget in Pakistan, which spends less than one percent of its GDP on health services, as opposed to the World Health Organization benchmark of at least six percent of the GDP to ensure basic and life saving services. After Pakistan, the Central African Republic and war-shattered Afghanistan are the next most dangerous countries for newborns. Poverty, conflict and weak institutions in these countries are cited as primary reasons for the alarming number of newborn deaths.

UNICEF is now launching Every Child ALIVE, a global campaign to demand and deliver solutions on behalf of the world’s newborns. Through the campaign, UNICEF is issuing an urgent appeal to governments, health care providers, donors, the private sector, families and businesses to keep every child alive by:

• Recruiting, training, retaining and managing sufficient numbers of doctors, nurses and midwives with expertise in maternal and newborn care.
• Guaranteeing clean, functional health facilities equipped with water, soap and electricity, within the reach of every mother and baby.
• Making it a priority to provide every mother and baby with the life-saving drugs and equipment needed for a healthy start in life.
• Empowering adolescent girls, mothers and families to demand and receive quality care.

UNICEF is confident that the world can save the vast majority of its newborn babies with affordable, quality health care solutions for every mother and every newborn. To quote the UNICEF chief: “Just a few small steps from all of us can help ensure the first small steps of each of these young lives”.