Progress in newborn survival has been slow, and even more so for reductions in stillbirths.
To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths
per 1000 births in every country by 2035 will necessitate accelerated scale-up of
the most effective care targeting major causes of newborn deaths. We have systematically
reviewed interventions across the continuum of care and various delivery platforms,
and then modelled the effect and cost of scale-up in the 75 high-burden Countdown
countries. Closure of the quality gap through the provision of effective care for
all women and newborn babies delivering in facilities could prevent an estimated 113,000
maternal deaths, 531,000 stillbirths, and 1·325 million neonatal deaths annually by
2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person).
Increased coverage and quality of preconception, antenatal, intrapartum, and postnatal
interventions by 2025 could avert 71% of neonatal deaths (1·9 million [range 1·6-2·1
million]), 33% of stillbirths (0·82 million [0·60-0·93 million]), and 54% of maternal
deaths (0·16 million [0·14-0·17 million]) per year. These reductions can be achieved
at an annual incremental running cost of US$5·65 billion (US$1·15 per person), which
amounts to US$1928 for each life saved, including stillbirths, neonatal, and maternal
deaths. Most (82%) of this effect is attributable to facility-based care which, although
more expensive than community-based strategies, improves the likelihood of survival.
Most of the running costs are also for facility-based care (US$3·66 billion or 64%),
even without the cost of new hospitals and country-specific capital inputs being factored
in. The maximum effect on neonatal deaths is through interventions delivered during
labour and birth, including for obstetric complications (41%), followed by care of
small and ill newborn babies (30%). To meet the unmet need for family planning with
modern contraceptives would be synergistic, and would contribute to around a halving
of births and therefore deaths. Our analysis also indicates that available interventions
can reduce the three most common cause of neonatal mortality--preterm, intrapartum,
and infection-related deaths--by 58%, 79%, and 84%, respectively.
Copyright © 2014 Elsevier Ltd. All rights reserved.