On the eve of Canada’s international summit on maternal and newborn health, Maclean’s spoke to Zulfiqar Bhutta of the Centre for Global Child Health at the Hospital for Sick Children in Toronto. Bhutta, one of 55 experts to contribute to a new series on newborn survival in The Lancet, will be speaking at the summit alongside other big names including Melinda Gates, Ban Ki-moon and the Aga Khan. He told Maclean’s why investing in the health of mothers and newborns is critical—and how many lives could be saved for just $1.15 a day.
Q: Why this focus on neonatal survival?
A: If you look at inequalities around the world, nowhere are they as evident as in newborn and maternal health. [More than 75 per cent] of newborn deaths are clustered in a handful of countries in sub-Saharan Africa and Asia, and some of these are not the poorest of the poor: they have economies that could sustain reasonable programs to address health, like Nigeria, India, and Pakistan. The period in and around childbirth—just those few hours—is when 46 per cent of all maternal deaths, and 40 per cent of stillbirths and newborn deaths, occur. Seventy-five per cent of newborn deaths are in the first week [after birth]. One million babies die on the day they’re born.
If [policy-makers] wanted to invest in improving the lot of mothers and newborns, they could. But the case hasn’t been made convincingly, and people think it’s too difficult. It’s not. Some of these numbers should persuade policy-makers to sit up and take notice, and this sadly hasn’t happened. The issue is out of sight, out of mind.
[A focus on newborn and maternal health] is critical not only to reduce the gap between haves and have-nots, but for human development in those countries. For every baby who dies, many more are left with a handicap. A baby who’s premature or small at birth, because of mother malnutrition, is at high risk of dying; but is also at risk of less-than-optimal educational achievement, of not joining the workforce, of not contributing to the economy. It’s an agenda for human development, to pull these countries out of poverty.
Q: What sort of solutions are needed, and what about cost?
A: There are three big killers of newborn babies. Firstly, babies who are born before their time, and small. There are babies who don’t breathe at birth, because of complications during childbirth or [other causes]. They require help at the time of birth, or they’d die, or survive with brain damage. That’s the second big cause. Both of these are clustered very early, in the first days after birth. The third cause, however, spreads throughout the newborn period, and that’s related to infection: whether during childbirth or after, infection is a hugely important cause of newborn death.
We’d like to ensure that we have a balance of interventions to address these killers, ranging from simple things like making sure babies are kept warm after birth; kept with their mothers; that they are not bathed [too] early; that they have good cord care to prevent infection of their belly buttons; that they have assistance with breathing if needed, by a skilled attendant. Some of these interventions, like early breastfeeding and keeping the baby warm, are common sense. They don’t require big hospitals or intensive-care units. Within the facilities we have, we can improve quality of care through simple things, like making sure that people wash their hands before they touch the baby.
These solutions are incredibly low cost. We estimate the cost to be no more than a dollar per person, $1.15, to be exact. I don’t think there’s a single investment out there that’s more effective.
Q: What’s your opinion on Canada’s contribution to the maternal and newborn health agenda?
A: Canada has played a very important role. Outside of Norway, and to some extent the U.K., Canada has been very vocal in addressing maternal child health and survival. Some wish that Canada had a wider span than the 10 countries it’s targeted [including Afghanistan, Haiti, Mozambique and Bangladesh], but for whatever reason, Canada did that and we’re grateful it did. We hope that Canada will expand its investments, particularly with a focus on reducing the gap between haves and have-nots. It’s a hugely important investment for development over the next 30 or 40 years. We made the case that if you increase health expenditure by $5 per person per year, in 74 countries, it would give you nine times that value in economic and social benefits. These returns would be: increased GDP, enhanced productivity, and an end of needless deaths. That would be a two per cent increase over current spending.
Q: Canada’s received criticism for not including access to abortion as part of its plan.
A: [Family planning is] a very important part of maternal health, but in the global development community, not everybody has to do everything. I can understand why Canada wanted their own mission around [maternal health]. There was a very critical paper in The Lancet recently, about Canadian investments. I don’t necessarily agree with it, but I think it’s food for thought in terms of what else needs to be done. It’s easy to criticize, but every institution, every organization, has to look upon this as incremental investments.
We need to support the Canadian government for continuing its investment in this space. We need to constructively criticize them for restricting some of these interventions, perhaps where there are economic interests. Australia and Canada are two countries where external assistance is increasingly linked to their own policy interests. That may be fine as a component of external assistance, but the whole idea was that you would reach those who were not being reached. What about people living in the deserts of Africa? They have no mineral wealth or economic interests for developed countries; does that mean they receive no assistance? I don’t think that’s an ethically plausible or acceptable argument.
My plea would be that we should encourage Canada to increase its external assistance reasonably. We’re not asking for double or triple, but for an increase in evidence-based areas where it can help a broader swath of people to be lifted out of poverty. That, in turn, will be to Canada’s benefit. Every country that improves its economy becomes a potential trading partner. There’s interest in lifting all the boats.