Ending preventable childhood and newborn deaths and stillbirths by 2030

JOY LAWN: We’re now going to start by looking at where we want to be at the end. So by 2030, where do we want to be for ending preventable newborn deaths linked to child deaths and ending stillbirths? So during the Millennium Development Goal era, we have had remarkable progress for child deaths. And we can see the child mortality trajectory here in the green line at the top coming down to where we are now in 2015. And the dotted line at the top shows what will happen if we carry on with current progress for child deaths. And we need to be more ambitious for this.

There’s been a target set that by 2030 every country should have a neonatal mortality rate of 22 or less. And if we look below, even just eyeballing the graph, we can see that the neonatal deaths in the turquoise blue below are going at a slower rate. The reduction for neonatal mortality rate is slower. And if we look at the line projected out, that’s what will happen if we don’t change what we’re doing now, if we carry on doing the same. But if we want to hit a target commensurate with the under-five mortality rate, then a national neonatal mortality rate of 12 or less in every country by 2030 is the target.

Now these targets differ from what was done during the Millennium Development Goal era when it was a proportionate reduction, every country to have 2/3 reduction. And that applied to all countries. The disadvantage of the new approach of an absolute target is that, in fact, around 100 countries have already met these targets going forward. They already have a lower mortality rate than this. And the critical issue now is reducing equity gaps in every country. Even countries with low mortality, there are equity gaps. But the other disadvantage of an absolute target is that those countries that currently have the highest mortality and the slowest rates have the furthest to go.

So there are 26 countries that need to more than double their rate of change for neonatal deaths. And those are countries that we’ll be looking at in more detail and seeing what needs to be done there and also what needs to be done worldwide. But one of the big differences that we have seen is that stillbirth progress is slower. So if we look at this trajectory for stillbirth rate reduction, the average annual rate of reduction is extremely slow, between 1% and 2% per year globally. And the change required is considerably more.

And in fact, if you look at the line at the top, the reason that it looks like a flat line is not just that the rate of reduction is slow, but the rate of reduction is slowest where fertility rates remain highest. And linking this with family planning is also critical. But the reality is women will not change their desired family size if their babies are still dying. So these two things need to go together. And we need to be much more ambitious in what we do to reduce stillbirths at the same time as addressing family planning.

But if we look forward to what it will take to change this in countries, a critical marker is national commitment but also global commitment. And this slide shows us the donor funding trends for maternal, newborn, and child health tracked by Countdown to 2015. And what we know is that this donor funding has more than doubled during the last decade of the MDGs, and particularly for child health. And in fact, we’ll be looking in more detail during the child health module at what this funding goes to and where it has been particularly linked to change. And 2/3 of this donor funding for child health goes to vaccines and to infectious conditions such as HIV and malaria.

The donor funding for maternal health has made less progress. But what you can see here– and this is from a special analysis by Catherine Pitt at the London School of Hygiene & Tropical Medicine– is that before 2005 when we had the first Lancet series on neonatal deaths, there was almost no mention of newborns in any of this donor funding. And as we’ve gone forward, that mention has changed from around 50 or so even single mentions per year to hundreds of mentions per year. And yet the donor funding linked to that is still extremely small. And this is only funding that is mentioning the word newborn.

In fact, the most common mention of it is in the term maternal, newborn, and child health. So it could just be reflecting a change in philosophy to a continuum of care, maternal, newborn, and child health, without doing the specific things. But most shockingly across these donor disbursements, across all this time period, millions of single donor disbursements and billions of dollars, the word “stillbirth” occurs less than five times. So here we have data that shows us that on the global agenda as shown by donor mentions and what they’re investing in, stillbirths remains lacking, and this is even just the mention, not necessarily using the data to invest in what would end preventable stillbirths.