These are the world's safest – and most dangerous – places to be born

The arrival of a newborn baby should be a joyous moment in all parents’ lives.

But around the world too many newborn children are dying, and it is parents in the poorest countries who are suffering the most, according to UNICEF’s report Every Child Alive.

Every year, 2.6 million babies die before they are a month old. A million of these children take their first and last breaths on the day they are born.

However, what is starkly obvious from UNICEF’s findings is that wealth inequality is still one of the main indicators of whether a child will live or die.

And, despite a significant reduction in the deaths of children under five, UNICEF says there has been less progress in reducing the deaths of babies less than a month old, as 7,000 of them still die every day.

“This is partly because newborn deaths are difficult to address with a single drug or intervention – they require a system-wide approach. It is also due to a lack of momentum and global commitment to newborn survival,” the report says.

“We are failing the youngest, most vulnerable people on the planet – and with so many millions of lives at stake, time is of the essence.”

Eight of the 10 most dangerous places to be born are in sub-Saharan Africa, the report says, as pregnant women are much less likely to receive assistance during birth due to poverty, conflict and weak institutions. Despite this, a non-African country is the worst performer.

“Children born in Pakistan face the worst odds. Of every 1,000 babies born, 46 die before the end of their first month – almost 1 in 20,” UNICEF says.

“Babies born in [high-income] Japan stand the best chance of surviving, with just one in 1,000 dying during the first 28 days,” the report says.

“High-income countries have an average newborn mortality rate (the number of deaths per 1,000 live births) of just 3.3. In comparison, low-income countries have a newborn mortality rate of 27.”

But as important as wealth is the political will to improve health systems. The report found that Kuwait and the United States, both high-income countries, had newborn mortality rates of four per 1,000 live births, only slightly better than lower-middle-income countries such as Sri Lanka and Ukraine, where the newborn mortality rate is five.

Rwanda, a low-income country, has reduced its newborn mortality rate from 41 per 1,000 in 1990 to 17 in 2016, putting it ahead of upper-middle-income nations like the Dominican Republic, where the mortality rate is 21.

“This illustrates that the existence of political will to invest in strong health systems, that prioritize newborns and reach the poorest and most marginalized, is critical and can make a major difference, even where resources are constrained,” UNICEF said.

Things to do better …

The study added that good medical practices were crucial to reducing deaths and highlighted successes such as women attending health centres in the remote Benishangul-Gumuz region of Ethiopia to give birth. While still above the national average, the region’s newborn mortality rate fell from 65 deaths for every 1,000 live births to 35, between 2000 and 2016.

Malawi, meanwhile, enjoyed strong backing from policy-makers and non-state partners to build robust community health systems. As a result, 90% of women who gave birth there in 2013 did so with the support of a medical practitioner; the mortality rate fell from 41 deaths per 1,000 live births in 1990 to 23 in 2016.

UNICEF linked the publication of its report with the launch of a petition calling on attendees at the UN’s World Health Assembly in May 2018 to do more to reduce infant mortality. It also published a list of priority steps governments and businesses in the health sector needed to take, which included:

Recruiting, training, retaining and managing sufficient numbers of doctors, nurses and midwives with expertise in maternal and newborn care

Guaranteeing clean, functional health facilities equipped with water, soap and electricity, within the reach of every mother and baby

Making it a priority to provide every mother and baby with the life-saving drugs and equipment needed for a healthy start in life

Empowering adolescent girls, mothers and families to demand and receive quality care.

UNICEF also called for more to be done to prevent stillbirths. It said that every year about 2.6 million babies are stillborn, the majority in low and middle-income countries. Half of the stillborn babies died during the process of labour.

“Many of the interventions and approaches that prevent newborn deaths can prevent stillbirths as well,” UNICEF said.

“The Every Newborn Action Plan, a comprehensive initiative launched in 2014 to prevent newborn mortality and stillbirth, estimated that the lives of 3 million mothers, newborns and stillborn babies could be saved each year by improving care around the time of birth and providing special care for small and sick newborns.”