Each year, one million babies die on the day they’re born

In Pakistan, nearly one in 20 newborn babies won’t survive their first month. In Japan, however, that number is one in 1,000: 50 times the chance of survival. The difference is the result not of anything inherent, but of healthcare, nutrition and poverty.

Despite significant strides forward in public health over recent decades, the scale of infant mortality around the world remains staggering high, and staggeringly unequal. Every year, 2.6 million infants die within one month – including one million on the very day they are born – and 2.6 million more are stillborn.

These figures come from UNICEF’s “Every Child Alive” newly-published report, which shows extreme global inequalities in the ability of countries to tackle infant mortality. The report points out that, though deaths among children aged one month to five years old have fallen dramatically in recent decades, progress against newborn deaths has been far slower.

"The vast majority of newborn deaths are preventable"

The worst-affected nations are Pakistan, the Central African Republic (CAR) and Afghanistan, while babies in Japan are most likely to survive infancy, followed by those in Iceland and Singapore.

While these results imply a neat distinction between low- and high-income countries, the story is far more nuanced than that. The United States, for example, has a newborn mortality rate, only marginally better than lower-middle-income countries like Sri Lanka and Ukraine, where five newborns per 1,000 die within a month.

The vast majority of newborn deaths are preventable. More than 80% are caused by premature birth, complications during labour and delivery, and infections such as sepsis, meningitis and pneumonia. Access to high-quality healthcare, along with the right nutrition, sanitation and clean water, could save millions of lives.

Many look to Rwanda for inspiration. In 1990, 41 out of every thousand babies died in infancy, which would put it third worst in the latest UNICEF report. By 2016, however, Rwanda's rate halved to 17, through a coordinated effort in which the government aligned its ministries and developmental partners to tackle newborn health.

What are the solutions?

There is no easy fix in preventing infant mortality. While many interventions are simple, saving newborns on a large scale requires systemic improvements to healthcare.

"The Central African Republic has just three skilled health workers per 10,000 people"

UNICEF summarises efforts to improve quality and provide access into four principles. The first is "Place": ensuring mothers and their babies have functional and clean health facilities within easy reach. Secondly, they need "People": a sufficient number of health professionals capable of saving newborn lives. The CAR, for example, has just three skilled health workers (doctor, nurse or midwife) per 10,000 people, and a newborn mortality rate of 42. By comparison, Norway has 218 per 10,000, and just two babies die per 1,000 births.

Thirdly, they highlight the need for the right "Products": life-saving drugs and equipment. UNICEF has a list of ten must-haves, such as chlorhexidine, an antiseptic applied to the umbilical cord which reduces infection. And finally, women and families need to have the "Power" to demand access to high quality healthcare.

Reducing the number of babies who die in infancy is not a question of making scientific breakthroughs or developing new wonder drugs. The solutions already exist, and are available in many countries around the world.

(Picture credit: UNICEF Ethiopia)