Box 4.7Reducing Newborn Deaths Is Possible in Low-Income Countries

Sri Lanka achieved neonatal mortality of 11 per 1,000 live births in 2000 despite a low GNP per capita of US$800 and less than US$1.50 per capita per year of health spending on maternal and neonatal health. In 1959, maternal and neonatal mortality were high, with a neonatal mortality rate (NMR) of 50 per 1,000 live births, and GNP per capita was US$290. Maternal and infant mortality were halved by 1980 because skilled childbirth care was scaled up and because prenatal, childbirth, and postnatal and newborn care services were provided close to communities and without user charges. The period 1980–2000 saw a further 50 percent reduction in the neonatal mortality rate without the use of intensive care, apart from one unit in the capital.

Malaysia also followed a policy of rapid scale-up of the coverage of skilled care at birth. It trained large numbers of midwives and encouraged collaboration with traditional birth attendants to promote a gradual transition to skilled care over several decades. The NMR is now 6 per 1,000 live births, and 95 percent of women deliver with a skilled attendant.

Source: Adapted from DCP2, chapter 27.

From: Chapter 4, Cost-Effective Strategies for the Excess Burden of Disease in Developing Countries

Cover of Priorities in Health
Priorities in Health.
Jamison DT, Breman JG, Measham AR, et al., editors.
Copyright © 2006, The International Bank for Reconstruction and Development/The World Bank Group.

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