Evidence-based interventions to address stillbirths and neonatal mortality worldwide

There have been substantial reductions in maternal and child mortality over the years but the Millennium Development Goals (MDG) 4 and 5, remain largely unfulfilled. The global under five mortality rates have fallen by 53% since 1990, but still a large number of children are dying, with the largest numbers and highest rates of under-five deaths concentrated in countries of Sub-Saharan Africa and South Asia. The decline in neonatal mortality and stillbirths has been far slower than under-five mortality and the contribution of these neonatal deaths is rising to the total under-five deaths and in 2015; 2.8 million or 44% of the total under-five deaths occurred in the neonatal period and an estimated 2.6 million stillbirths occurred in 2015. These stillbirths and neonatal deaths also cause a heavy burden of direct and indirect psychosocial and economic cost, as these effect women, families, caregivers and society. Major risk factors for these neonatal deaths and stillbirth are well known and often overlap, including maternal undernutrition, maternal infections, non-communicable diseases, fetal growth restriction, preterm labor, post-term pregnancy, and suboptimal care. There are known effective interventions to prevent and manage the conditions that lead to stillbirth and neonatal deaths and high-income countries have used such interventions to markedly reduce their stillbirth and neonatal mortality burden. These interventions are effective for a range of risk factors and are implemented at various stages of life including preconception, antenatal, intrapartum, postnatal and the neonatal period. Most neonatal deaths and stillbirths could be prevented with improvement in coverage of these existing interventions along with health system improvements: through high quality antenatal and intrapartum care within the continuum of care for women and children and evidence has suggested that these strategies are cost effective. Neonatal deaths and stillbirths are gaining greater attention globally and the targets set in Every Newborn Action Plan and Sustainable Development Goals call for a marked reduction, but this would require a consolidated focused effort of the global community.