Version Jan 2013

Version Jan 2013

44 percent of all under five deaths (2.9 million) are

newborns, and another 2.6 million babies are stillborn, yet huge potential for rapid change

with high impact, avoidable, feasible interventions

Country demand for guidance and action to accelerate

progress towards MDGs 4 and 5, universal health coverage, and

towards ending preventable deaths among women and

children

For greater effectiveness we must accelerate and harmonize

global response and link to existing initiatives for

reproductive, maternal, child and adolescent health care.

Why Every Newborn?

Photo credit: Save the Children

Source: Adapted from Lawn J,E. et al. 2012. Newborn survival: a multi-country analysis of a decade of change. Health Policy and Planning. 27(Suppl. 3): iii6-ii28. Data sources: UNICEF 2012 www.childinfo.org , UN MMR estimates 2012* Maternal mortality ratio annual rate reduction 190-2010

We’ve made significant progress toward MDGs 4 & 5, but newborn survival is lagging behind

Average annual rate reduction 1990-2012

Maternal mortality ratio* 4.2%

Children aged 1- 59 months 3.4%

Neonatal mortality (newborn, first 4 weeks after birth)

2.1%

Stillbirths (last 3 months of pregnancy)

1.0%(1995-2009)

At least 40% slower for newborn survival and

slower still for stillbirths

3

We know the causes of newborn deaths

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

4

3 main killers to address: 1. Preterm birth 2. Birth complications 3. Neonatal infections

Pneumonia5%

Prematurity14%

Birth asphysia and birth trauma

10%

Neonatal sepsis5%

Congenital anomolies4%

Neonatal tetanus1%

Other conditions3%Diarrhoea

1%

Diarrhoea9%

Measles2%

Malaria7%HIV/AIDS

2%

Injuries4%

Non-communicable diseases

8%

Other conditions13%

Pneumonia13%

Neonatal44%

Two-thirds of neonatal deaths

are preventable

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 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

* 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

3

Fam

ily/c

omm

unity

Out

reac

h/ou

t pa

tient

Clin

ical

antenatal care postnatal care

early postnatal home visits for

mother and newborn

cleaner, safer birth

adolescent health at

home and school

child health care

obstetric and childbirth care including essential newborn care

emergency newborn care

reproductive health care

reproductive health care

intersectoral Improved living and working conditions including housing, water and sanitation, and nutrition Education and empowerment

emergency child care

ongoing care for the child at home

pregnancy home visits

There are proven interventions within RMNCH continuum of care

ChildhoodNewborn/postnatalBirthPregnancyPre-pregnancy Birth

Time around birth is critical window of opportunity to prevent and manage complications

Reproductive health care

Treatment for pregnancy

complications

Pre-conception

care

Care during pregnancy

• Labour monitoring; childbirth care• Not breathing at birth: Resuscitation• Obstruction/Fetal distress: caesarean section,

vacuum• Preterm labour: corticosteroids, antibiotics for

PPROM

Labour and childbirth care

• Birth: drying, skin-to-skin; first week: early and exclusive breastfeeding, warmth, cord care, hygiene

• Suspected sepsis: Early antibiotic treatment• Preterm/LBW: Kangaroo Mother Care,

breastfeeding support, immediate treatment of suspected infection

Essential newborn care

Care during labour, childbirth and the days following birth

Source: Pattinson R, Kerber K, Buchmann E, et al, for The Lancet’s Stillbirths Series steering committee. Stillbirths: how can health systems deliver for mothers and babies? Lancet 2011; published online April 14. DOI:10.1016/S0140-6736(10)62306-9.

If intervention in pregnancy and at birth reached all families by 2015: 1.4 million newborn

deaths averted (43%)

1.1 million stillbirths prevented (45%)

201,000 maternal deaths averted (54%)

Care at birth gives a triple return on investments by also reducing stillbirths and maternal deaths

0

500000

1000000

1500000

2000000

2500000

Stillbirths Maternal deaths Neonatal deaths

Deat

hs a

vert

ed

NEW NEONATAL MORTALITY TARGETUnless we greatly accelerate newborn survival efforts, goal to end

preventable child deaths by 2035 unreachable

19901992

19941996

19982000

20022004

20062008

20102012

20142016

20182020

20222024

20262028

20302032

20340

10

20

30

40

50

60

70

80

90

100

Mor

talit

y ra

te (p

er 1

,000

live

birt

hs)

2000-2012AAR = 2.7%

Proposed NMR target: National NMR of 10 or lessGlobal NMR of 7

2000-2012 AAR = 3.8%Global U5MR

Global NMR

APR target: National U5MR of 20 or lessGlobal U5MR of 15

Business asusual: U5MR

AAR = 4.3%

Business asusual: NMR

Scenario 2035 global NMR 2035 neonatal deaths

If current trends are unchanged 13 1.8 million

Every country to NMR of 10 per 1000 7 0.9 million

Similar to 2/3 reduction in NMR as if a continuation of MDG4

0

5

10

15

20

25

Glo

bal a

vera

ge sti

llbirt

h ra

te

(per

1,0

00 to

tal b

irths

) 2000-2009ARR = 1.3%

ARR = 3.5%

Scenario 2035 global SBR 2035 stillbirths

If current trends are unchanged 15.9 2.2 millionEvery country reaches SBR of 10 per 1000 8.0 1.1 million

Also similar to ≥2/3 reduction in SBR for every country

Business asusual: SBR Proposed SBR target:

National SBR of 10 or lessGlobal SBR of 8

NEW target for stillbirths and a maternal mortality target is in process

We can bend the curve: proof of impact at scale even in low income countries

MDG 4 MDG 5 Neonatal mortality rateAv annual change 2000-2010

Rwanda Progressing 6.2%

Bangladesh 4.0%

Nepal 3.6%

Malawi Progressing 3.5%

Source: Newborn survival decade of change analysis: Health Policy and Planning. 27(Suppl. 3) papers 3 to 7

Over the last decade, 77 countries reduced NMR by >25%, including at least 13 low income countries:

Bangladesh, Bolivia, Eritrea, Guatemala, Indonesia, Nepal, Madagascar, Malawi, Morocco, Senegal, Rwanda, Tanzania, Vietnam

A global roadmap for change…

A movement for greater action and accountability…

A platform for harmonized action by all partners…

Sets out a clear vision with mortality target, strategic directions, and innovative actions within the continuum of care

Supported by new evidence to be published in The Lancet in May 2014

The Every Newborn Action Plan: building a movement

Photo credit: Save the Children

Every Newborn’s strategic framework

Every Newborn’s guiding principles

Country leadershipGood governance, community

participation, partner alignment

IntegrationIntegrated service delivery, continuum

of care, programme coordination

EquityUniversal coverage, closing the equity

gap

InnovationInterventions, delivery approaches,

technologies

Every Newborn’s strategic objectives

Strengthen and invest in care during labour, child 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

Family Planning 2020

A Promise Renewed

Country leadership & Implementation

Global action plans: Every Newborn, scaling up nutrition, global action plan for pneumonia & diarrhea, vaccines,

WASH for all, and others

Visit www.everywomaneverychild.org

Key catalytic initiatives in support of Every Woman Every Child

Commission on Information and Accountability and independent Expert Review Group

Every Newborn supports the Global Strategy

Who? Global mechanisms for coordinated action and advocacy Some examples:

UN Commission on Life Saving Commodities

Health Sector Strategic & Investment Plan

Integrated National RMNCH Plan

Increasing access and use of FP

Ending preventable

newborn deaths

Ending preventable deaths from pneumonia and

diarrhoea (GAPPD)

Ending preventable

maternal deaths

Every Newborn prioritizes focus on birth within existing national strategies and plans; not a new stand alone plan

Countries, donors, civil society groups, professionals, and businesses are leading this effort in support of Every Woman Every Child. Every Newborn builds on key platforms like FP2020, A Promise Renewed, the Commodities Commission, and Commission on Information and Accountability.

A comprehensive consultation process whereby all stakeholders are given an opportunity to feed into the plan and countries identify specific bottlenecks and solutions

All stakeholders have a role to play

Photo credit: Save the Children

April 2013 – June 2014 National and regional consultation and technical

inputs to the development of the plan

20-25 January 2014 Discussed at the WHO Executive Board

February 2014 Open consultation on draft Every Newborn by

stakeholders and inputs incorporated into final draft

May 2014 Lancet series (update from 2005 and giving the

analyses which are the basis for the Every Newborn)

Draft plan presented to the 67th World Health Assembly

June 2014 Action Plan launched at PMNCH Partners’ Forum,

Johannesburg

Every Newborn Process

Photo credit: Save the Children

We are building a movement…

All stakeholders have a role to play…

Get involved!Join the online consultation

now at: http://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en

or email [email protected]

For more informationvisit www.everynewborn.org