Neonatal survival: a call for action

This paper, the fourth and last in The Lancet neonatal survival series, calls on countries to take action now to improve newborn survival. The authors stress that complex technology is not essential. Low-cost effective interventions already exist that could reduce neonatal mortality by up to 70 per cent if provided universally. These include tetanus toxoid vaccination, exclusive breastfeeding, kangaroo mother care for low birthweight infants, and antibiotics for neonatal infections. They highlight success stories from countries with fairly low GDP, and evidence which shows that neonatal mortality can be greatly reduced by community-based interventions.

Key recommendations include: greater attention to newborn health in safe motherhood and child survival programmes; increased community engagement and promotion of demand for skilled care; and the establishment of national action plans for neonatal survival. The authors estimate that running the selected packages of care at 90 per cent coverage in the countries with highest mortality would cost an additional US$4.1 billion a year. However, 70 per cent of this money would also benefit mothers and older children and substantially reduce the rate of stillbirths. They conclude that without commitment from donors and governments to improve neonatal care, the millennium development goals for maternal and child health will not be met.