Let’s make childbirth safe

Every two minutes, nine newborns and one mother die from complications related to pregnancy and childbirth. This year, 2.4 million newborns will die in the first month of their life and 295,000 women from pregnancy complications.

This represents 2.7 million annual tragedies for families and communities. For societies, the deaths are also losses that undermine growth and prosperity. For the world’s low-income and lower-middle-income countries, they add up to a loss of almost $500 billion yearly or six per cent of their annual GDPs.

In 2015, world leaders promised to fix maternal and newborn health, along with hunger, peace, education and every other major problem area by 2030, in the Sustainable Development Goals (SDGs). Sadly, we are far off-track on virtually all the promises.

For mothers and their babies, progress is far slower than it should be. Given current trends, by 2030, some 131,000 mothers and 900,000 infants will die yearly that wouldn’t if we achieved the promises.

But it doesn’t have to be this way. In a world without fiscal constraints, all governments would invest lavishly across all the SDGs. In the real world, they can only moderately increase investments in some policies.

New research by Copenhagen Consensus shows a focused investment in maternal and newborn health can deliver astonishing returns to society, saving lives and delivering an astounding $87 of social benefits back for every dollar spent.

Potential policies

The researchers focus on the 55 countries that suffer almost all the global deaths of mothers and newborns. They investigate a plethora of potential policies: Making more pregnancy check-ups, prescribing more iron supplements or paying for more health worker visits to counsel mothers after birth.

The very best investment is to increase access to family planning and, most importantly, improve access to a package of simple procedures known as Basic Emergency Obstetric and Newborn Care (BEmONC). This means delivering better care at a low cost, often with nurses and midwives instead of the costlier doctors. 

For example, BEmONC ensures access to neonatal resuscitation. This requires only a hand pump or resuscitator, which costs around $65. Used 25 times a year, the cost per use is just $2.60. Adding the health worker’s time, the cost of saving a child’s life is in the order of $5. Neonatal resuscitation can avoid 30 per cent of deaths associated with asphyxia, a leading cause of newborn mortality.

Another approach under the BEmONC package is kangaroo mother care, which promotes skin-to-skin contact between mother and baby, a simple act that could halve mortality in premature children.

A large part of the cost of increasing BEmONC comes from ensuring better access for pregnant women in birth facilities, which lowers death risks for both mother and child.

Two-thirds of women in those 55 countries give birth in such facilities. In Kenya, the WHO puts the figure at 61 per cent. The researchers’ proposal is to drive investment to get 90 per cent of women into these facilities.

Importantly, 217 million women who want to avoid pregnancy still don’t have access to safe and effective family planning methods. If 90 per cent of women in the 55 hardest-hit countries had access to such services, fewer would become pregnant and 87,000 fewer mothers would die yearly.

The annual financial cost is $2.1 billion and women’s additional time costs $1.6 billion. Yet, this modest total cost of just $3.7 billion a year can each year avert 161,000 maternal deaths, more than 1.2 million newborn deaths, and almost as many stillbirths in the 55 countries. The reduction in fertility can yield a benefit equivalent to $28 billion yearly.

Adding up all that, the annual cost of just $3.7 billion will deliver overall benefits of fewer deaths and higher economic growth worth $322 billion yearly.

Dr Lomborg is the president of the Copenhagen Consensus and Visiting Fellow at Stanford University’s Hoover Institution. [email protected]. @ Bjorn-Lomborg https://lomborg.com.