Developing World: Maternal and Neonatal Mortality

Lord Patel Excerpts

Thursday 15th January 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, I join the noble Baroness, Lady Hayman, in the tribute that she paid to DfID for the work that it has done and continues to support in areas of reducing maternal and child mortality. I emphasise that in the hope that DfID will not now stop but put extra vigour in joining other partners in delivery until we achieve the goals.

As has already been said, the statistics—which will be cited by others—are horrendous. A woman giving life should neither die nor go through childbirth only to have the heartbreak of losing her child at birth or in infancy. The noble Baroness, Lady Hodgson, described her experiences, which I well understand. Yet for many mothers and their children this is a reality. Three hundred thousand women die every year during pregnancy. For children, the statistics are worse. There are 131 million births a year; of these, 6.3 million children die before the age of five. That is 17,000 deaths of children every day. One million babies are stillborn. Two million die in the first week of life, and for 1 million babies the day of their birth is the day of their death. While progress in reducing maternal and infant deaths has been significant over the past two decades, many millions continue to die, and 223 million children under five died between 1990 and 2013. Four out of five deaths of children aged under five occur in sub-Saharan Africa.

While the number of deaths of children under five has declined, the decline in the number of deaths around birth and in the first month of life is not so striking. Neonatal deaths now account for 44% of deaths of children under five. There has been no noticeable reduction in neonatal deaths. Some interventions focused on the 24 hours after birth hold great potential for reducing maternal and neonatal deaths. We know the causes of death and how to prevent them, but we have not succeeded in delivering health interventions widely and consistently throughout the world or in developing sustainable health systems.

Two-thirds of neonatal deaths occur in 10 countries, and 48%—nearly half—occur in four countries: India, China, Nigeria and Pakistan. Two-thirds occur in only two countries, India and Nigeria, and both of them are capable of developing health systems that would stop them, so what must we do to encourage them to strengthen their health systems?

The causes of neonatal deaths are pre-term births, complications at birth, infections and sepsis and congenital abnormalities. Basic, cost-effective care in the first hour after birth results in significant reductions in maternal and neonatal mortality. For example, breastfeeding in the first hour of life reduces deaths by 40%, yet only 50% of newborns are breastfed in the first hour of life, particularly in vulnerable parts of the world. Skilled attendants at birth and the use of a maternal and neonatal checklist which includes simple tasks, such as cord care, dramatically reduces neonatal mortality, yet 44% of women in some countries do not have skilled attendants, and even when there are attendants at birth, simple interventions are not delivered. For example, only 10% of babies delivered by skilled attendants received seven key neonatal interventions, so we must ask why, even when there are skilled attendants, they do not happen. Hence, we have developed a checklist for maternal and child health at the time of birth to try to make sure that those interventions, including breastfeeding, can be delivered.

The charity, SafeHands, of which I am a patron, as is the noble Baroness, Lady Kennedy of The Shaws, who is not in her place, tries to use education using visual media in rural villages in Ethiopia and other countries to deliver messages about the importance of basic care and attendants at birth, which can have dramatic effects.

What of the future? The world needs to fulfil the promise made to the children of this world in 2000. The MDG 4 target will not be met in 2015. At the current rate, it will not be met until 2026. We need a new commitment, not just the targets of 2015, even if we could meet them in 2026. We need a new commitment to children going beyond MDG 4 that by 2035 every country will see a neonatal death rate of 10 per 1,000 births and a stillbirth rate of 10 per 1,000 births. The challenge could be 20 by 2035, to mothers and their babies underpinned by helping to establish sustainable health systems.

The UK Government have done so much to advance these causes and lead the world. What commitment will they make beyond 2015 towards efforts to reduce maternal and childhood deaths?