NEW THIS SUNDAY: STATE OF THE WORLDS MOTHERS

Saturday, 25th of May 2013

_{STATE OF THE WORLDS MOTHERS 2013}

Annual report, Save the Children Fund

Excerpts below; full text is at http://www.savethechildren.org.uk/sites/default/files/images/State_of_World_Mothers_2013.pdf

From the Executive Summary

Key Findings

1) The first day of life is the most dangerous day for mothers and babies.

Worldwide, the day a child is born is by far the most dangerous day in a childs life. Save the Childrens first-ever Birth Day Risk Index compares first-day death rates for 186 countries and finds that in most countries, children are at greatest risk on the day they are born. Babies in Somalia have the highest risk of dying on their birth day. First-day death rates are almost as high in Democratic Republic of the Congo, Mali, and Sierra Leone. Mothers in these four countries are also at high risk on this day. Mothers in Somalia and Sierra Leone face the second and third highest lifetime risk of maternal death in the world, respectively.

(To read more, turn to pages 27-35.)

2) The first day is also a day of unequaled opportunity to save lives and set the stage for a healthy future. Most newborn and maternal deaths could be prevented by ensuring that mothers and newborns have access to low-cost, lifesaving interventions through improved and expanded health care systems.

Ensuring access to well-trained and equipped health care workers during childbirth is part of the solution. According to the United Nations, four products could greatly assist health workers in saving many newborn lives. An original analysis by Save the Children estimates that within the first month of life, more than 1 million babies could be saved each year with universal access to these products, which cost between 13 cents and US$6 each and are ready for rapid scale-up now. The products are:

••steroid injections for women in preterm labor (to reduce deaths due to premature babies breathing problems);

••resuscitation devices (to save babies who do not breathe at birth);

••chlorhexidine cord cleansing (to prevent umbilical cord infections); and

••injectable antibiotics (to treat newborn sepsis and pneumonia).

Other low-cost interventions such as kangaroo mother care and early and exclusive breastfeeding would save many more babies. Such interventions, as part of strengthened health care systems, not only can dramatically reduce maternal and newborn deaths, but also can prevent a lifetime of negative health consequences such as long-term disabilities, intellectual impairment and increased vulnerability to illness. Poor health is not only costly for individuals and their families, it can also impede a nations efforts toward economic growth.

(To read more, turn to pages 37-49.)

3) Mothers and babies in sub-Saharan Africa face the greatest risks. Maternal, child and newborn death rates have declined across the developing world since 1990, but progress has been slowest in sub-Saharan Africa. Save the Childrens annual Mothers Index assesses the well-being of mothers and children in 176 countries. The bottom 10 countries on the Mothers Index are all in sub-Saharan Africa. Not surprisingly, many of these same countries also have very high rates of first-day death, and sub-Saharan Africa also occupies the 10 worst spots on the Birth Day Risk Index. Seven countries – Central African Republic, Chad, Côte dIvoire, Democratic Republic of the Congo, Mali, Sierra Leone and Somalia – score in the bottom 10 on both indices. While mothers and babies struggle for survival in much of sub-Saharan Africa, a number of countries have demonstrated that progress is possible despite great challenges. For example, Malawi has reduced its newborn mortality rate by 44 percent since 1990. And Mali, Tanzania and Uganda have made important policy changes to improve their readiness to expand newborn health programs. (To read more, turn to pages 27-35 and 65-74.)

4) In South Asia, mothers and babies die in great numbers. An estimated 423,000 babies die each year in South Asia on the day they are born, more than in any other region. South Asia accounts for 24 percent of the worlds population and 40 percent of the worlds first-day deaths. In India – where economic growth has been impressive but the benefits have been shared unequally – 309,000 babies die each year on the day they are born (29 percent of the global total). Bangladesh and Pakistan also have very large numbers of first-day deaths (28,000 and 60,000 per year, respectively.) Mothers in South Asia also die in large numbers. Each year, 83,000 women in South Asia die during pregnancy or childbirth. India has more maternal deaths than any other country in the world (56,000 per year). Pakistan also has a large number of maternal deaths (12,000). (To read more, turn to pages 27-35 and 65-74.)

5) Babies born to mothers living in the greatest poverty face the greatest challenges to survival. At the heart of the newborn survival problem is the

widening gap between the health of the worlds rich and poor. Virtually all (98 percent) newborn deaths occur in developing countries, and within many of these countries, babies born to the poorest families have a much higher risk of death compared to babies from the richest families. A new analysis of 50 developing countries found babies born to mothers in the poorest fifth of the population were on average 40 percent more likely to die compared to those in the richest fifth. Disparities within countries like Bolivia, Cambodia, India,

Morocco, Mozambique and the Philippines are especially dramatic. Many newborn lives could be saved by ensuring services reach the poorest families in developing countries. For example: If all newborns in India experienced the same survival rates as newborns from the richest Indian families, nearly 360,000 more babies would survive each year. Closing the equity gaps in Pakistan and Democratic Republic of the Congo would similarly save the lives of 48,000 and 45,000 newborns each year, respectively. (To read more, turn to pages 15-21.)

6) Funding for newborn survival programs does not match the need. The majority of health funding in most developing countries is from domestic

resources. Many developing nations recognize their primary role in providing for the health of mothers and newborns and the importance of eliminating financial barriers that limit access to care. Within this context, development assistance can play an important role in helping to improve newborn health.

While global support for maternal, newborn and child health has been rising since 2000, it remains very low and does not match the need given the 3 million newborn deaths and 2.6 million stillbirths that occur worldwide every year. More specifically, donor funding for newborn care is extremely small compared to the burden, apart from a few leading donors. (To read more, turn to pages 51-53.)

7) In the industrialized world, the United States has by far the most first-day deaths. Only 1 percent of the worlds newborn deaths occur in industrialized countries, but the newborn period is still the riskiest time, no matter where a baby is born, with the first day being the riskiest time of all in most, if not all, countries. The United States has the highest first-day death rate in the industrialized world. An estimated 11,300 newborn babies die each year in the United States on the day they are born. This is 50 percent more first-day deaths than all other industrialized countries combined. When first-day deaths in the United States are compared to those in the 27 countries making up the European Union, the findings show that European Union countries, taken together, have 1 million more births each year (4.3 million vs. 5.3 million, respectively), but only about half as many first-day deaths as the United States (11,300 in the U.S. vs. 5,800 in EU member countries). In Australia, Austria, Canada, Switzerland and the United States, 60 percent or more of babies who die in their first month die on their first day. Current data do not allow for analysis of first-day death rates among disadvantaged groups in wealthy countries, but newborn and infant mortality are often higher among the poor and racial/ethnic minorities, and populations with high newborn mortality rates also tend to have high first-day death rates. Poor and minority groups also suffer higher burdens of prematurity and low birthweight, which likely lead to first-day deaths in the U.S. and elsewhere. (To read more, turn to pages 55-57.)

2013 Mothers Index Rankings

Top 10 Bottom 10

RANK Country RANK Country

1 Finland 167 Côte dIvoire

2 Sweden 168 Chad

3 Norway 169 Nigeria

4 Iceland 170 Gambia

5 Netherlands 171 Central African Republic

6 Denmark 172 Niger

7 Spain 173 Mali

8 Belgium 174 Sierra Leone

9 Germany 175 Somalia