No one will ever know the names of the 17 million babies who didn't die last year. Nearly all of them live in the developing world and nearly all of them would have been lost to preventable conditions like measles, cholera or malaria. But that didn't happen. Instead, they were born healthy and most of them stayed healthy and will be celebrating their first birthdays sometime this year.
That's part of the very, very good news about childhood mortality, defined as the death of children before their fifth birthday. Since 1990, when the United Nations drafted its Millennium Development Goals—eight broad targets for human health and equality—childhood mortality rates have fallen 47%, which, when corrected for population growth, yields those 17 million lives saved last year. But that means that 6.6 million babies and small children still died. That's the equivalent of 18,000 every day, day after day, until the year ended. Unless things change, that pattern will repeat itself in 2014, 2015 and beyond.
The answer, however, isn't simply doubling down on the strategies that have worked so far, like getting vaccines, antimalarial bed nets, cholera rehydration fluids and more to the people who need them. Those interventions must continue, but as Melinda Gates, co-chair of the Bill and Melinda Gates Foundation, made clear in an address to the World Health Assembly in Geneva today, they've worked so well that the overwhelming share of the remaining deaths are caused by other problems entirely—ones that occur far earlier in the babies' very short lives.
Each year, Gates said—citing, in part, exhaustive new studies by The Lancet—2.9 million children die in the first month of life and 1 million of those die almost immediately after birth. Worse, an additional 2.6 million babies each year are stillborn at some point in their third trimester—a death toll that is not even counted in the 6.6 million figure.
But, Gates stressed, the majority of newborn deaths are preventable. "I want to be very clear about what I mean when I say preventable," she added. "I don't mean theoretically preventable under ideal but unrealistic circumstances. I mean preventable with relatively simple, relatively inexpensive interventions."
In most cases, actually, those interventions are entirely free. There are five protocols neonatal health experts recommend to cut newborn mortality dramatically and three of them are simply drying the baby completely after birth to prevent hypothermia, breastfeeding within the first hour of life and breastfeeding exclusively for the first six months if possible, and practicing what's known as kangaroo care—or skin-to-skin contact between a baby and its mother or at least another adult caregiver as much as possible. Even in the developed world, kangaroo care is only now being broadly appreciated and adopted, particularly in neonatal intensive care units, where studies show that respiration, heart rate, blood pressure and a whole range of other vitals strengthen and stabilize when babies are held. Kangaroo care also increases the flow of breast milk in the mother, thanks mostly to elevated levels of the hormone oxytocin—colloquially known as the cuddle chemical.
Also important is the availability of resuscitation masks for babies who stop breathing at birth or shortly after. A mask and basic training in its use cost only about $5—nothing at all compared to the cost of caring for a sick or dying baby over the longer term. Finally, health specialists call for universal availability of the antiseptic chlorhexidine—at a cost of just a fews cents per application—to clean the end of the umbilical cord after it's been cut and prevent what can be fatal infections.
"These are the best practices that work everywhere," Gates said, "but that aren't being used optimally anywhere."
Inevitably, questions of cost are raised, but as with nearly all preventive measures, intervening early is almost always cheaper than dealing with problems later. In the U.S., an estimated $10 billion is spent each year to help babies deal with the health effects of not being sufficiently breast-fed. In the developing world, studies show that every $1 of neonatal intervention pays back $9 down the line, as families grow healthier, countries grow more stable, and economies are allowed to flourish.
Money, of course, is only one of many considerations—and a lesser one at that. It's the moral component, the human component that we'd like to think will govern our choices. Even if saving the lives of babies were more expensive than it is, can you name a way that that money could be better, more humanely spent? The policymaker who can answer that question 'yes' is perhaps a policymaker who needs another job.