03 September 2020

Understanding Global Newborn Health: Q&A With Hema Magge of the Gates Foundation

Today, WHO and UNICEF launched their Every Newborn Coverage targets and milestones for newborn health and ending preventable stillbirths by 2025 on the path to 2030. Countries and partners convened to discuss how to meet these targets and milestones, the challenges faced and the support required from regional and global partners. Ahead of the event, Every Woman Every Child interviewed Dr. Hema Magge—a senior program officer at the Bill & Melinda Gates Foundation and the newborn health lead—about COVID-19 and the challenges and opportunities that remain.

1.What is the state of global newborn health right now? What progress has been made in the past few decades?

Over the last few decades, the world has made great progress in reducing newborn deaths. In 2000, there were 31 neonatal deaths for every 1000 live births. By 2018, that number had almost been cut in half, falling to 17 deaths for every 1000 live births.  

While this is certainly good news, we need to accelerate this progress – and quickly – if we want to achieve the Sustainable Development Goal targets on newborn mortality. To do this, we need to understand why some babies are still dying in their first month of life and design and implement interventions to address these root causes. 

We’re especially focused on the most vulnerable newborns: those born too soon and too small. 

More than a third of neonatal deaths worldwide are due to severe bacterial infections, and yet more than 70% of infants who could have these infections don’t receive proper treatment because they may live too far from the nearest hospital or because their parents simply cannot afford the cost of care. Today, these conditions are being better managed because health workers are able to diagnose these cases locally and offer treatments even within first-line or community-based facilities. 

We’ve also learned that simple interventions like Kangaroo Mother Care (KMC) – which provides skin-to-skin contact between a mother and her baby – can be very effective at improving newborn outcomes. Although typically initiated at health facilities, more than a fifth of births occur at home, so when KMC is expanded within communities, the impact has been shown to be even greater. 

Beyond expanding access to life-saving, essential interventions and medicines, we need to redesign health systems to improve the quality of care newborns receive since evidence suggests that poor-quality care accounts for the majority of neonatal and maternal deaths particularly in low and middle income countries. Every mother should be supported throughout her pregnancy and have a healthy and respectful birth experience with skilled midwives; should complications arise, she should receive high-quality, life-saving care from skilled and compassionate health care workers who have tools and resources needed to do their jobs well. 

2.How has COVID-19 affected maternal and newborn health? Which services have been the most disrupted?  

In times of crisis, women, children and newborn are especially vulnerable as essential health services become increasingly disrupted – particularly labor and delivery services and newborn care. Modeling shows that if these disruptions are severe, we could see as much as a 45% increase over existing child mortality levels, including for newborns.  

These disruptions are not hypothetical, they’re happening today. Pregnant women and frontline health workers are unable to reach health facilities due to lockdowns and travel restrictions, or they may not seek care out of fear of contracting the virus. Many health workers are being redirected to the COVID-19 response, while others may not have the personal protective equipment they need to provide care safely, so some have understandably abandoned their posts. Supply chain disruptions have led to stock-outs of key medicines and supplies critical to maternal and newborn care. And we’re already seeing the impact this is having on women: a recent study from Nepal saw dramatic reductions in health facility deliveries and disturbing increases in neonatal deaths and stillbirths during the pandemic. 

Many women were also fearful of contracting COVID-19 and passing it onto their babies, including while breastfeeding. Given the importance of breastfeeding for a baby’s development and growth, experts have recommended that all mothers – even those sick with COVID-19 – should be encouraged to breastfeed their newborns while taking all possible precautions to avoid spreading the virus. Recent research continues to support this advice, and early studies of lactating women with COVID-19 found no traces of the virus in their breast milk. 

Beyond the impacts to health, the pandemic has been devastating to the livelihoods of women around the world, especially those already living in or on the brink of poverty. Lost income and overburdened social safety nets are pushing vulnerable women further into poverty, thereby increasing financial barriers to health care. 

3.What are some of the challenges to ending preventable stillbirths and what are some of the opportunities? 

More than two million stillbirths occur every year – nearly all of them (98%) in low and middle-income countries. These numbers are alarmingly high, particularly since we know that almost all stillbirths are preventable. 

About half of stillbirths occur in the intrapartum period – after labor has started, but before delivery. Most health systems – particularly those in remote communities– do not enable high-quality childbirth care that could detect fetal distress early enough to offer women the immediate care and labor management needed to prevent stillbirths. 

Part of the problem is that the current global standard of care – that a baby must be delivered within 30 minutes of fetal distress – is not attainable in many remote health facilities. Women are laboring and giving birth without access to the lifesaving interventions and support they need to respond to complications. This would be unacceptable in high-income countries, and yet we know this is happening in many communities around the world. That’s why we need to support leaders at every level to re-design their health systems to meet their communities’ needs, and ultimately eliminate all preventable maternal and newborn deaths and stillbirths. We must develop truly equitable health systems that deliver on their promise to women and children globally – this should be our ‘north star.’