Improving Newborn Survival in Low-Income Countries: Community-Based Approaches and Lessons from South Asia

Until about twenty years ago, child survival meant the survival of children rather than newborn infants. With a steady worldwide decline in under-5 deaths— most of the lives saved being those of infants and children over the age of a month—the newborn period has come into focus as a relatively intransigent source of mortality. The ‘‘child survival revolution’’ increased child survival [1], but newborn infants went largely unnoticed. Neonatal mortality (0–28 d) now accounts for about two-thirds of global infant (0–1 y) mortality and about 3.8 million of the 8.8 million annual deaths of children under 5 [2]. Most of these deaths (98%) occur in lowand middle-income countries [3]. The last two decades have seen a rise in advocacy—a call for attention to the newborn infant along with her mother and siblings—and an incremental growth in the evidence for potential interventions [4–6]. Reducing neonatal mortality is both an ethical obligation and a prerequisite to achieving Millennium Development Goal 4, the target of which is a reduction in child mortality by two-thirds between 1990 and 2015. A 2008 report found only a quarter of relevant countries on track to reach this target [7].