World Prematurity Day 2013
Dr. Elizabeth Mason, Director Maternal,
Newborn, Child and Adolescent Health
World Health Organization
on behalf of the Steering Committee
1 | KMC Accelleration Convening |
Version Nov 2013
Istanbul, 21 - 22 October 2013
Born too Soon: Global Action Report on Preterm birth
• First estimates of preterm birth by country.
• Key points:
– 15 million babies are born preterm annually;
> 1 in 10 live births.
– Preterm birth leading cause of newborn
deaths
– > 1 million babies die annually due to preterm
complications. 75% could be saved with
current, cost-effective interventions — even
without intensive care.
– Boys are more likely to be born preterm than
girls but more likely to survive their first month
World Prematurity Day 2013
2000-2011: improved understanding of newborn mortality
and importance of preterm birth
2000
Other
29%
2011
ARI
20%
GLOBAL OVERVIEW
3 million
Diarrhoea
12%
Measles
5%
Perinatal
causes
22%
Malaria
8%
HIV/AIDS
4%
Malnutrition contributes to 60% of newborn deaths
World Prematurity Day 2013
43%
Who is a preterm birth baby?
Late and moderate
preterm 32 to <37 weeks
84%
Baby born alive before 37
completed weeks of
pregnancy
Very preterm
28 to <32 weeks
10%
Extremely preterm
< 28 weeks
5%
World Prematurity Day 2013
What is the burden of preterm birth?
• 15 million preterm births/year
• > 50% neonatal deaths occur
among preterms
• Direct cause of 35% of all
neonatal deaths
• Significant disability risk:
• Visual impairment
• Hearing loss
• Chronic lung disease
• Developmental delay
• NCDs
World Prematurity Day 2013
135 million newborns and 15 million premature babies
- health system needs and human capital outcomes
World Prematurity Day 2013
Every Newborn: Outline
1
Why are 3 million newborns dying? Can we change?
2
Where do we want to be in 2035?
[Target setting and other analyses discussion]
3
How can we change outcomes for Every Newborn in every
country? [Strategic objectives]
4
What is the Every Newborn Action Plan?
5
What is the process for building a Movement and a Plan?
Who needs to be involved? [Discussion]
Our delivery goal
No
newborn is
born to die
~ 280,000 die
3 million die
No
baby
stillborn
2.6 million die
10 million deaths
3.5 million within a few days of birth
No
child
stunted
or dying
2.9 million die
We can reduce the main causes of death
Newborn Survival Solutions – 3 by 2
1
Preterm birth
1. Preterm labor management including antenatal corticosteroids*
2. Care including Kangaroo mother care, essential newborn care
2
Birth complications (and intrapartum stillbirths)
1. Prevention with obstetric care *
2. Essential newborn care, resuscitation*
3
Neonatal infections
1. Prevention, essential newborn care, breastfeeding,
Chlorhexidine*
2. Case management of neonatal sepsis *
* 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
We have proof of change at scale
Some Li countries are “bending the curve” for newborn survival
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
MDG 4
MDG 5
Neonatal mortality rate
Av 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
Outline
1
Why are 3 million newborns dying? Can we change?
2
Where do we want to be in 2035?
[Target setting and other analyses discussion]
3
How can we change outcomes for Every Newborn in every
country? [Strategic objectives]
4
What is the Every Newborn Action Plan?
5
What is the process for building a Movement and a Plan?
Who needs to be involved? [Discussion]
Child survival target by 2035 in A Promise Renewed
Under 5 mortality = 20/1000
100
Mortality rate (per 1,000 live births)
90
A PROMISE RENEWED TARGET
• Global av U5MR of 15/1000 with
every country below 20/1000
• Global av NMR 7/1000 with every
country below 10/1000
80
70
9.6 m deaths in
2000
60
6.9 m child deaths in 2011
3m are neonatal (43%)
U5M current trajectory: AAR 2.5%
50
40
30
20
MDG 4
NMR current trajectory: AAR 2.2%
10
0
1990
1995
2000
2005
2010
2015
2020
2025
2030
Unless we achieve major acceleration for newborn survival,
we cannot reach our goal for ending preventable child deaths by 2035
Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report
2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035
2035
1
3
Outline
1
Why are 3 million newborns dying? Can we change?
2
Where do we want to be in 2035?
[Target setting and other analyses discussion]
3
How can we change outcomes for Every Newborn in every
country? [Strategic objectives]
4
What is the Every Newborn Action Plan?
5
What is the process for building a Movement and a Plan?
Who needs to be involved? [Discussion]
Strategic objectives
1. Invest in care during labour, childbirth and the first days of life.
2. Improve the quality of maternal and newborn care.
 This requires investment, especially for effective care at birth. Skilled
workers are the key to change
3. Reach every woman and every newborn and reduce
inequalities
 achieve universal coverage and equity.
4. Harness the power of parents, families and communities to
mobilise change.
5. Count every newborn - measurement, oversight and
accountability

improve and use the data.
Care at birth, analysis from The Lancet Stillbirth series
Childbirth care
Basic
antenatal
Deaths prevented:
Advanced
antenatal
Stillbirths 1.1 million (45%)
Newborn deaths 1.4 million (43%)
Maternal deaths 201,000 (54%)
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.
TRIPLE RETURN ON INVESTMENT
Quality of care is essential
 The quality gap is a contributor to
slow progress towards MDG 4 and 5
and leads to significant morbidity as
well as mortality.
 Increased coverage of facility care at
birth is an opportunity to ensure
that all women and babies receive
effective, safe respectful care
 Programmatic change is possible and
will also require better data to drive
change.
Outline
1
Why are 3 million newborns dying? Can we change?
2
Where do we want to be in 2035?
[Target setting and other analyses discussion]
3
How can we change outcomes for Every Newborn in every
country? [Strategic objectives]
4
What is the Every Newborn Action Plan?
5
What is the process for building a Movement and a Plan?
Who needs to be involved? [Discussion]
Why Every Newborn?
• Country demand for guidance and
action, country driven
• Large problem but huge potential
for rapid change since we know
what to do and can develop clear
context specific guidance on HOW
• Harmonize global response which
so far has been slow and needs to
link to many existing initiatives for
reproductive, maternal, child and
adolescent health care, scaling up
global attention and action
How it fits together in countries for sharpened RMNCH plans
Health Sector Strategic & Investment Plan
Sharpened and Integrated National RMNCH Plan
Increased
access and
use of FP
Ending
Ending
Ending preventable
preventable
preventable
child deaths for A
maternal deaths newborn deaths Promise Renewed
COMMODITIES, HUMAN RESOURCES etc.
Building a movement
• Building on Born Too Soon, A Promise
Renewed for Child Survival
• Outreach: Senior policymakers,
parliamentarians, civil society, media
• Reaching across communities:
reproductive, maternal + newborn and
child
• Advocacy and communications
through all partners: National, regional,
global – 500+ PMNCH partners
Every Newborn consultations – Countries
• Countries events:
– 17 country consultations between July – September
2013
– Other countries have undergone high level meetings e.g.
Ghana, South Africa, Zambia
• Regional consultations:
– West Africa (UNICEF Dakar office) 9th-12th July
– Asia (Kathmandu UNICEF office) 30th August – 1st September
• Upcoming consultations
– Cameroon, Niger
– Regional consultation in East and Southern Africa
Country consultations
1. India
2. Nigeria
3. Pakistan
4. China
5. DRC
6. Bangladesh
7. Afghanistan
8. Uganda
9. Kenya
10. Senegal
11. Malawi
12. Nepal
13. Thailand
14. Sierra Leone
15. Myanmar
16. Philippines
17. Vietnam
Learn more about these events at EveryNewborn.org
The way forward
May – September 2013
• Global and regional events
• National and regional consultations
October 2013 – May 2014
• Present to the WHO Executive Board
• Finalize Every Newborn including production and
translations
May 2014
• Launch linked to 67th World Health Assembly
• Lancet series (update from 2005 and giving the
analyses which are the basis for the Every
Newborn)
Online: www.everynewborn.org
Send your inputs! Join the action!
Be part of the action
for newborns
#EveryNewborn