One of the Millennium Development Goals — a set of goals to improve global well-being by 2015 — is to reduce by two-thirds the mortality rate of children under age five. The good news for MDG progress is that the under-five mortality rate has been cut nearly in half, from 90 deaths per 1,000 live births in 1990 to 48 in 2012. The bad news is that 6.6 million young children still die every year, and those deaths are concentrated in the world’s poorest regions. Eight-one percent of these deaths occurred in Sub-Saharan Africa and Southern Asia, many of them in babies’ first 24 hours of life.

A new report from Save the Children proposes a strategy for improving newborns’ survival: assuring the presence of skilled birth attendants. Ending Newborn Deaths: Ensuring every baby survives reports 51% of births in sub-Saharan Africa, and 41% in southeast Asia, “were not attended by a midwife or other properly qualified health worker.” If essential health services were distributed more equitably, they calculate that 950,000 newborn deaths each year could be prevented. Skilled birth attendants with appropriate facilities can help avert and respond to premature birth and birth complications such as prolonged labor, pre-eclampsia, and infections.

The report identifies eight essential services that midwives and other skilled health workers should provide during labor, delivery, and the hours following delivery in order to prevent intrapartum stillbirth and reduce newborn mortality:

1. Skilled care at birth and emergency obstetric care (including assisted vaginal delivery and caesarean section if needed) ensuring timely care for women and babies with complications
2. Management of preterm birth (including antenatal corticosteroids for mothers with threatened preterm labour to reduce breathing and other problems in preterm babies)
3. Basic newborn care (focus on cleanliness including cord care, warmth, and support for immediate breastfeeding, recognition of danger signs and care seeking)
4. Neonatal resuscitation for babies who do not breathe spontaneously at birth
5. Kangaroo mother care (skin-to-skin, breastfeeding support especially for premature and small babies)
6. Treatment of severe newborn infections (focus on early identification and use of antibiotics)
7. Inpatient supportive care for sick and small newborns (focus on IV fluids/feeding support and safe oxygen use)
8. Prevention of mother-to-child transmission of HIV (during pregnancy, labour and the immediate newborn period).

Access to skilled health workers to provide these services is not distributed equally; women in rural areas of low-income countries are least likely to have skilled birth attendance. While some countries, such as Malawi and Rwanda, have made impressive progress over the past decade, global coverage of skilled birth attendance increased at a rate of just 1.1% per year between 2000 and 2009. The report notes that if this rate of progress were doubled, the world could achieve universal coverage of skilled birth attendance by 2025, rather than by 2043 at the current rate of progress.

To reach the Millennium Development Goal and improve birth outcomes worldwide, Save the Children calls on world leaders, philanthropists, and the private sector to commit to a “Newborn Promise” that involves the following steps:

• Governments and partners issue a defining and accountable declaration to end all preventable newborn mortality, saving 2 million newborn lives a year and stopping the 1.2 million stillbirths during labour
• Governments, with partners, must ensure that by 2025 every birth is attended by trained and equipped health workers who can deliver essential newborn health interventions
• Governments increase expenditure on health to at least the WHO minimum of US$60 per capita to pay for the training, equipping and support of health workers
• Governments remove user fees for all maternal, newborn and child health services, including emergency obstetric care
• The private sector, including pharmaceutical companies, should help address unmet needs by developing innovative solutions and increasing availability for the poorest to new and existing products for maternal, newborn and child health.

The World Health Organization has made a draft “Every Newborn Action Plan” available for review online, and an updated draft will be submitted to the World Health Assembly for its May 2014 meeting in Geneva.

Carolyn Miles, President and CEO of Save the Children, commented at the release of her organization’s report, “The first day of a child’s life is the most dangerous, and too many mothers give birth alone on the floor of their home or in the bush without any life-saving help.” She added, “The solutions are well-known but need greater political will to give babies a fighting chance of reaching their second day of life.”