March 28, 2014 — Summary of "Every Newborn, Every Mother, Every Adolescent Girl," The Lancet, March 1, 2014.
When it comes to reducing neonatal mortality rates, "the 'N' in the reproductive, maternal, neonatal, and child health (RMNCH) agenda needs to be more than just a letter," according to an editorial in The Lancet, which adds that it is also "time to add the letter 'A'" -- for adolescents, who account for millions of pregnancies worldwide each year.
Citing a Save the Children report -- part of the organization's No Child Born to Die Campaign -- as a "powerful reminder of the reasons for neonatal deaths," the editorial calls for "concerted and integrated action plans, political will, and dedicated funding" to implement the recommendations. In addition to the eight areas of interventions outlined in the report, the editorial notes that pregnancy among adolescent girls "deserves more attention" in efforts to improve neonatal outcomes.
Neonatal Mortality Causes and Prevalence
The editorial notes that deaths among children younger than age five are almost 50% lower than in 1990, but "progress in the reduction of neonatal deaths has been much slower than that of children older than 4 weeks."
Currently, 44% of deaths among children younger than five are neonatal deaths, compared with 38% in 2005. About 2.9 million newborns died within 28 days of birth in 2012, and an additional 1.2 million stillbirths occurred just before or during labor. The editorial notes that the most common causes of infant mortality include prematurity-related complications (34%); intrapartum-related complications (24%); sepsis, meningitis or pneumonia (22%); and inherited abnormalities (9%).
The Save the Children report suggests eight areas of intervention, which were developed from The Lancet's 2005 Neonatal Survival Series and the Every Newborn Bottleneck Analysis Tool.
The eight interventions include "skilled care at birth and emergency obstetric care"; "management of preterm births"; "basic neonatal care," such as immediate breastfeeding and general hygiene practices; "neonatal resuscitation"; "kangaroo mother care"; prompt identification and antibiotic treatment of serious infections; "inpatient care for small and sick newborns"; and "prevention of mother-to-child transmission of HIV," according to the editorial.
Focus on Adolescent Girls
In addition, the editorial urges "dedicated and targeted intervention" to address births among adolescents girls, an area that is only "mentioned in passing" in the report.
Pregnant adolescents are "in fact children bearing children," the editorial states. Adolescent girls have a "higher risk of adverse maternal and birth outcomes, including stillbirths, neonatal deaths, preterm births, small-for-gestational-age babies, and complications during birth" than women who give birth at ages 19 or older, the editorial adds.
The "prevention of child marriage and unwanted births, comprehensive access to sexual and reproductive education (including contraception), keeping girls in secondary education and therefore delaying age at the birth of the first child, and empowerment to make the right choices for health and wellbeing" should all be included in interventions aimed at reducing pregnancies and births among adolescent girls, the editorial states.
The editorial argues that investing in girls will produce "not only an acceleration of progress towards ending maternal, neonatal, and child mortality, but also a better educated future generation of women who will contribute to the skilled workforce and so the economic development of their countries." It adds, "The continuum of care needs to become a lifecycle of care."
"Prevention of stillbirths and neonatal mortality and morbidity must include greater attention to adolescent girls in particular" the editorial continues, concluding, "It is time to add the letter 'A' to RMNCH."