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© UNICEF/UN062341/Zammit

A newborn baby sleeping at a hospital partially supported by UNICEF's ECD programme.

Last year, close to one million babies died on their first day of life, and 2.7 million during their first 28 days. Almost half of all under-five deaths took place during this newborn period. And 2.6 million babies were stillborn. These first hours, days and weeks constitute the most dangerous period in a human life. In the poorest, most marginalized communities, they often prove deadly.

Ending preventable newborn deaths and stillbirths is a moral imperative. It also contributes to healthier, more prosperous societies: the first month of life is a foundational period for lifelong health and development. Healthy babies grow into healthy adults who can thrive and contribute to their communities and societies.

© UNICEF/UNI195710/Mawa

A pre-term baby is on the lap of a specially trained nurse in Special Care Newborn Unit (SCANU) at Tangail Medical College Hospital. Tangail, Bangladesh.

Action at the country level is critical to ending preventable newborn mortality. Recognising this, in 2014, 194 UN Member States launched the Every Newborn Action Plan (ENAP), a roadmap to ending preventable newborn deaths, and committed to achieving a set of concrete milestones by 2020. Now, at the halfway point, 51 high-burden countries are taking stock of progress. Their updates are presented in the Every Newborn Report on Country Progress, launched today by UNICEF and WHO.

The report shows strong progress toward the ENAP milestones: countries are adapting national plans, training healthcare workers, setting ambitious new targets and stepping up efforts to better understand the causes of newborn deaths.

Three areas of work are particularly worth mentioning. The first is the global effort to improve quality of care. Quality of care is critical to promoting newborn and child survival. Even when medical facilities exist, if staff are not trained, supplies are lacking and infrastructure below standard, risks remain unacceptably high. Where quality is poor, demand for health services often falls, and mothers may choose to deliver their baby at home, or with an untrained birth attendant.

In Feuary 2017, nine countries launched a new network to promote quality, equity and dignity in health care, and to promote cross-country exchange and planning around quality of care. The network is driving efforts across the countries to promote quality of care, especially for mothers in marginalised communities, and generating important lessons for other countries battling high rates of newborn mortality.

The second area of work is improving data collection. Without robust, disaggregated, national data, it is impossible to identify gaps in equity and in quality, and to target efforts where they can save the most lives. Under the banner of ENAP, countries are stepping up action on data collection and analysis. New coverage indicators have been developed, and a study led by Makerere University in Uganda is working in five countries to compare survey methods for pregnancy outcomes in a study of 70,000 births.

The third area is building community empowerment to promote healthy behaviours and choices. WHO and UNICEF are working together to strengthen community health worker provision, to scale-up mothers groups, and to support initiatives focusing on social and behavioural change.. These approaches aim to harness the power of communication and community engagement to promote newborn survival, protection and participation.

These steps are encouraging, and will drive progress toward achieving the goals and targets set out in the Sustainable Development Goal Agenda and the Global Strategy for Women’s, Children’s and Adolescents’ Health. But there is still much work to do. Newborn mortality is declining at a slower rate than under-five mortality, and efforts to prevent stillbirths have been inadequate. Concerted action and leadership, from international donors, to country governments, to community leaders, to individual mothers and families, will be critical in driving progress. Together, we can achieve the ambitious goals set out in the Every Newborn Action Plan, creating a safer, healthier world – for every newborn.

Stefan Peterson is currently Chief of Health Section for UNICEF globally, based in New York. He’s a Professor of Global Health at Uppsala University and, prior to that, at the Global Health Division of Karolinska Institute.  He has also been visiting professor at Makerere University in Uganda. As a health systems researcher and medical doctor, he has done extensive field work in Tanzania and Uganda, and has worked with different ministries of health, organizations such as WHO, and implemented projects supported by Sida, the Gates Foundation, and the European Union. He was also a co-founder of Medecins Sans Frontieres Sweden and the CCM Task Force Operations Research Group.

Dr Anthony Costello is currently Director of the Department of Maternal, Child and Adolescent Health at the World Health Organization. Until 2015 Costello was Professor of International Child Health and Director of the Institute for Global Health at University College of London. He was an attending paediatrician at University College Hospital and the UCL Pro-Provost for Africa and the Middle East. He is best known for his work on improving survival among mothers and their newborn infants in poor populations of developing countries.