Survival convergence: bringing maternal and newborn health together for 2015 and beyond.

When WHO published the Mother-Baby Package in 1996, mothers and newborn babies were viewed as a dyad, and it was assumed that what was good for the mother was good for the baby. Basic interventions to deal with newborn complications were included, but neonatal mortality received little attention from the broader public health community, or even from the maternal health and child health communities. Although global attention to newborn health began in 2000 with the launch of the Saving Newborn Lives initiative, and accelerated with the publication of the Lancet Series on Neonatal Survival in 2005, reductions in neonatal mortality lagged behind maternal and under-5 mortality. Worldwide, 44% of deaths in children younger than 5 years now occur in the fi rst month of life, a huge and highly inequitable burden. The Every Newborn Series in The Lancet highlights many of the future opportunities and challenges in forging true integration between the maternal and newborn health communities. The fi rst opportunity is in defi ning new goals and targets. As we shift from the Millennium Development Goals (MDGs) to the post-2015 era, there will probably be a single overarching health goal, with measurable targets relating both to the unfi nished agenda of the health MDGs and to major new challenges in responding to the burden of non-communicable diseases. As noted by Elizabeth Mason and colleagues in this Series, targets for ending preventable newborn deaths and stillbirths must be included in the post-2015 agenda, along with targets for ending preventable maternal and child deaths, as well as for sexual and reproductive health. Ideally a cohesive set of targets on reproductive, maternal, newborn, and child health will be clustered in the agenda so that their linkages across the continuum of care are clear. The second opportunity is the emerging expansion of country ownership in setting priorities, designing programmes, and defi ning goals. As countries adopt more integrated approaches to designing, implementing, and funding health services and health systems, there is less appetite for externally driven initiatives that promote dealing with health challenges in vertical silos. In keeping with country preferences, the Every Newborn Action Plan calls for including or strengthening a specifi c newborn focus within maternal, child, and reproductive health plans. The third opportunity is increased clarity on the most eff ective technical interventions for saving the lives of newborn babies, and what is needed to deliver those interventions. Maternal and newborn health need strong, functional health systems with an educated, enabled workforce in suffi cient numbers; functioning commodity systems; attention to quality of care; and eff ective mechanisms for recording, analysing, and using data. However, interventions and technologies specifi c to newborn babies must also be available to improve newborn health and survival. Experience shows that health-worker training programmes or commodity systems for maternal or child health will not automatically include those interventions and technologies—they must be explicitly and consciously included in planning and budgeting. To achieve optimum integration of maternal and newborn health requires that we must recognise and respond to the remaining challenges, especially in the political realm. The fi rst is the centrality of reproductive health to maternal and newborn health and wellbeing. The newborn and child health communities have recently begun to acknowledge that access to quality, comprehensive contraceptive services is important for For the Lancet 2005 Series on neonatal survival see http://www.thelancet.com/ series/neonatal-survival