6 million deaths at birth

JOY LAWN: We’re now going to start by looking at the critical time of birth. And here we are in 2015, the end of the Millennium Development Goal era. And despite the fantastic progress that we’ve heard about for maternal deaths during the last part of this course there are almost 300,000 women who still die while giving life. This number has halved during the time period at the MDGs. But these deaths are preventable. And we know the causes. And we have seen that these can, and must be, reduced. But was has changed as well as the halving of these deaths is the social norms around maternal deaths. This statement says no women should die while giving life.

And as we travel around the world today, as we go to places like the African Union, this is the common statement. In fact, for African leaders this is probably the highest priority issue for them in 2015, the statement that no woman should die while giving life. In this same time period of the Millennium Development Goals we’ve seen remarkable progress for child deaths, a halving. In fact, if we look at these deaths after the first month of life around three million still dying despite a halving or more of deaths in this time period. And many of these deaths are related to children who are stunted.

And we’ll be looking at this in particular as we progress on to the child health module. But only just coming onto the agenda at the MDGs are newborn deaths. 2.7 million dying in their first month of life. And this is on the agenda because this is now 45% of child deaths. So for children dying in the first five years 45%, close to half of them, happen in this first month of life. And the child survival goal and the rapid progress for reducing deaths, particularly due to infections, after the neonatal period has really driven increased focus on this time period. And yet still missing, not included on any goal during the Millennium Development Goal era are stillbirths.

At least 2.6 million dying. And this is just measuring stillbirths during the last three months of pregnancy, so after 28 weeks of gestation 2.6 million dying, and most unacceptably more than one million who die during labour. A woman who goes through the whole nine months of pregnancy goes into labour with a live baby kicking at the beginning of labour who dies during labour. And these deaths count for women. They count for families. And yet haven’t counted in our goals to date. And this is something that is not just about the data. The social norms that have changed for women dying, that have changed for children dying, that are starting to change for newborns dying are yet to shift for stillbirths.

And so at the end of remarkable progress during the Millennium Development Goals we have this huge agenda, still of nine million deaths for women and children. And 2/3 of these are directly related to birth most of them entering the world and leaving without a birth or a death certificate. And so the data to drive these, and particularly the data to drive the newborn and stillbirth reduction, are really critical. And that’s what we’re going to be looking at in more detail. But as well as the data we have to recognise that at every level the shift in social norms that these deaths shouldn’t happen is critical. So I was born in the bush in Northern Uganda.

My mother had an obstructed labour. After more than 24 hours in labour she was taken in to the local hospital no running water, no electricity. During the night that she was in a hospital bed the women in the bed next to her died. The next morning a midwife was able to find a doctor who had once observed a Caesarean Section. This is task shifting in the extreme. And this doctor came to the hospital. My mother was anaesthetized with chloroform. She had a Caesarean Section where they cut her from xiphisternum to pubis. She survived. I survived. And the reason that we survived is because there were people who believed that my mother shouldn’t die and that I shouldn’t die.

And what I hope is by the end of this module you will be part of a movement that makes newborns and stillbirths unacceptable, that we will use the data and use our voices to change this cause of preventable deaths.

So as we pass forward into the Sustainable Development Goal era there is an increasing movement for addressing these deaths. The Every Newborn Series was launched in Lancet in 2014 and led to the Every Newborn Action Plan, which has had wide consultation, more than 80 organisations coordinated by UNICEF and WHO, many country governments, an active debate, and a resolution that was unanimously passed at the World Health Assembly, and high level leadership from the UN Secretary General’s office. And these link intimately to the need to end preventable maternal mortality. The baby is within the mother and then sits with the mother. And mothers and newborns their care and ending these deaths shouldn’t be separated either in policy, in programmes, or in life.