Preventing Newborn Deaths with Low-Cost Pregnancy Interventions

Executive Summary

Vulnerable women, vulnerable newborns, vulnerable societies

The foundations of human well-being are laid before birth. Unfortunately, many babies experience adversity during this intrauterine period. As a result, they may be born premature or suffer fetal growth restriction and be born small for gestational age (SGA). Both preterm birth and fetal growth restriction can lead to low birth weight (LBW).

Children born premature, SGA, or with low birth weight have a markedly increased risk of stillbirth, neonatal death, and subsequent infant mortality. Furthermore, these conditions are associated with multiple morbidities with adverse short- and long-term consequences for newborns, their families, and society in general, resulting in a large loss of human and economic capital. Therefore, prevention of preterm birth and SGA is critical for global child health and social development.

However, progress on primary prevention has been slow, despite several global commitments and goals since 1990. The lack of progress is related to the inability of the global community to prioritize preventive interventions and address all vulnerable newborns. , including those who are not low birth weight. We propose a new conceptual framework that brings together preterm birth, SGA, and LBW under the term “small vulnerable newborns” (SVN). This framework can inform programming for the prevention and care of “vulnerable young newborns” (VNL), and contribute to healthier and more prosperous women, newborns, children, adults, and societies.

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Eight proven low-cost, easily implementable interventions for pregnant women in 81 low- and middle-income countries (LMICs) could prevent an estimated 566,000 stillbirths and 5.2 million babies a year from being born premature or small for birth. gestational age, some with low birth weight, whose impacts would also affect long-term health and economic production, says a new series of four articles published in The Lancet.

These interventions have the potential to prevent 476,000 newborn deaths. The Series estimates the cost of implementing these interventions at $1.1 billion in 2030.

In a new analysis, The Lancet Series on Vulnerable Small Newborns estimates that of the 135 million babies born alive in 2020, one in four (35.3 million) were born premature or small for gestational age, some with low birth weight at birth. The series brings this group together under a new term: small vulnerable newborns (SVN). These babies were born in all countries, with the majority in sub-Saharan Africa and South Asia.

The authors highlight that, in all regions, progress in reducing preterm births and low birth weight is a flat line and outside the reach of the goals: the Global Nutrition Target calls for a 30% reduction in babies with low birth weight by 2030 from a 2012 baseline, however, the estimated annual rate of reduction is only 0.59%.

In a global call to action, the series advocates for better quality of care for women during pregnancy and childbirth, and specifically for scaling up pregnancy interventions in 81 low- and middle-income countries, which are estimated to be of the series could prevent approximately 32% of stillbirths, 20% of newborn deaths, and 18% of all VNS births in those countries.

With more than 80% of births taking place in facilities, the authors emphasize that better data collection and use is now possible, ensuring that each pregnancy is dated with the accurate gestational age and that all newborns, as well as all stillbirths, are weighed and classified by SVN type. In addition to helping ensure good quality care, the Series says better data collection is essential to inform progress and drive accountability. Counting stillbirths is important to capture the total burden, as new analyzes of the series highlight that 74% of stillbirths were premature in a subset of countries.

Professor Per Ashorn, from the University of Tampere, Finland and lead author of the Series, said: “Despite several global commitments and targets aimed at reducing SVN outcomes since 1990, every fourth baby in the world is ’born too small’. ’ or ’born too early’. Our Series suggests we already have the knowledge to reverse the current trend and save the lives of 100,000 babies a year at a cost of $1.1 billion, a fraction of what other health programs receive. We need national actors, with global partners, to urgently prioritize actions, advocate and invest.”