HIGH BIRTH RISK IN POOR NATIONS
Babies born in the world’s poorest countries, most of them in Africa, still face alarming risks of death that can be 50 times as high as those in the richest countries, according to a Unicef report
Given that the majority of these deaths are preventable, clearly we are failing the world’s poorest babies Henrietta Fore, Unicef executive director
islamabad — The UN children’s agency in a report released on Tuesday singled out Pakistan as the riskiest country for newborns, saying that out of every 1,000 children born in Pakistan, 46 die at birth.
“It’s abysmal,” said Dr Ghazna Khalid, a leading obstetrician in Pakistan’s northwestern Khyber Pukhtunkhwa Province. “We don’t need front-line medical doctors. We have plenty of them. We need skilled midwives.”
The report, with its dismal figures that show South Asia and subSaharan Africa as the worst places for a child to be born, is part of Unicef’s new campaign, launched to raise awareness to bring down neonatal mortality rates.
Henrietta H. Fore, Unicef’s executive director, said after the report’s release that though the world has “more than halved the number of deaths among children under the age of five in the last quarter century, we have not made similar progress in ending deaths among children less than one month old.”
“Given that the majority of these deaths are preventable, clearly, we are failing the world’s poorest babies,” she said.
Unicef’s report said that after Pakistan, the Central African Republic is the next riskiest country for newborns, and Afghanistan is the third.
“Babies born in Japan, Iceland and Singapore have the best chance at survival, while newborns in Pakistan, the Central African Republic and Afghanistan face the worst odds,” it said, noting that “more than 80 per cent of all newborn deaths are caused by three preventable and treatable conditions.”
The three are premature births, complications such as lack of oxygen at birth and neonatal infections, including sepsis and pneumonia.
Unicef says as many as 3 million children could be saved each year with an investment in quality care at delivery.
In Pakistan, Dr Khalid said 80 per cent of newborn deaths could be prevented with skilled birth attendants.
“I feel that no matter what tools we send, or how much money you spend, unless you improve the quality and the skill of midwives,” babies in Pakistan will continue to die, she said.
“We have midwives in government hospitals who cannot deliver a baby,” she added. “We don’t need more doctors we need more skilled midwives.”
Unicef also appealed on properly training midwives and allowing better “access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition.” Khalid, who has conducted extensive research into mother and child health and has written international papers on the subject, said that lack of funding, corruption and misplaced government priorities all contribute to insufficient investments in the training of midwives.
“Every year, 2.6 million newborns around the world do not survive their first month of life,” said Fore. “One million of them die the day they are born.”
“We know we can save the vast majority of these babies with affordable, quality health care solutions,” Fore said.
In general, babies born in richer countries fare far better, but there are differences within countries. Babies born to the poorest families are 40 per cent more likely to die than those born to the least poor.
Sadly typical was the story of Mary James, an 18-year-old from rural Malawi.
When her labour started, she and her sister made the long trek to a health centre on foot. When her baby was delivered, he was small and terribly weak. She says an overstretched staff did its best, but by night the child was gone.
“I felt like my heart was breaking,” James told Unicef staff. “I had a name for the child but he never opened his eyes.” Since improvements to health care can be expensive, “it is crucial to invest the money in a smart way,” Unicef ’s global maternity and newborn programme chief Willibald Zeck said.
That can mean something as simple as ensuring that a pregnant woman who has walked three days to a health care facility is received with “dignity,” so she remains long enough to receive proper postnatal care.
But the dearth of expensive equipment matters. Zeck, who worked as an obstetrician/gynecologist in Tanzania, said women were often unsure how pregnant they were, and he would have to use his hands to estimate whether a fetus was premature or seriously underweight.
Still, among countries that have made dramatic improvements is low-income Rwanda, which more than halved its rate from 1990 to 2016, illustrating that “political will to invest in strong health systems... is critical,” the report said.
Education matters, too. Babies born to mothers with no education face nearly twice the risk of early death as babies whose mothers have at least a secondary education.
The United States — generally affluent, but with considerable income inequality and wide variations in access to health care — was only the 41st safest country for newborns.
The countries with the lowest newborn mortality rates, after Japan, are mostly well-off countries with strong education and health care systems: Iceland (a one in 1,000 chance of death), Singapore (one in 909), Finland (one in 833), Estonia and Slovenia (both one in 769), Cyprus (one in 714) and Belarus, Luxembourg, Norway and South Korea (all with risks of one in 667). — AFP, AP