The least and most dangerous countries to be a newborn

Every year around the world, about 2.6 million babies die within their first month of life – and some countries see more of those tragic deaths than others.

A UNICEF report released Tuesday ranks countries by their newborn mortality rates in 2016.

The report found that the country with the highest newborn mortality rate was Pakistan, which saw about one in every 22 infants die before turning 1 month old.

The country with the lowest newborn mortality rate was Japan: only one death in every 1,111 births.

A baby born in Pakistan was almost 50 times more likely to die during his or her first month than a baby born in Japan – or Iceland, which ranked second lowest, or Singapore, which ranked third lowest, according to the report.

The report also showed that the United States and the United Kingdom had higher mortality rates among newborns than several other countries, including Cuba, Germany, Israel, South Korea and Singapore.

Top 10 countries with the highest and lowest rates

The UNICEF report was based on data from the United Nations Inter-agency Group for Child Mortality Estimation. The data was from 1990 (or earlier, depending on the country) to 2016.

Based on those data, the 10 countries with the highest newborn mortality rates in 2016 were:

Many of those countries are war-torn, have limited access to clean water at health facilities or have been affected by natural disasters, said Dr. Stefan Peterson, chief of health at UNICEF, who helped conduct the technical analysis and review for the report.

“That is a tremendous challenge for these countries to begin with. Then they also face challenges of not investing sufficiently in health services,” he said. “Some of them only spend 1% of gross domestic product on health, while the national recommendation is to spend at least 5% of public resources on health.”

The 10 countries with the lowest newborn mortality rates in 2016, according to the report, were:

“These are countries that have for a long time had political will to tackle the quality of maternal and newborn care,” Peterson said.

“They’ve educated women,” he said. “They’ve tackled adolescent pregnancy, and they have quality health services centered around midwives who actually are able to wash their hands in health facilities and have access to the basic treatments and drugs.”

The UNICEF report notes that newborn survival appears to be closely linked to a country’s income level.

On average, high-income countries have a newborn mortality rate of about one in 333, compared with low-income countries’ newborn mortality rate of about one in 37, according to the report.

Babies born to the poorest families are more than 1.4 times more likely to die during this newborn period than those born to the richest families, according to the report.

Yet income is only one of the factors influencing newborn mortality.

In Kuwait, the newborn mortality rate is about one in 227, and in the US, it’s about one in 270. Though those are both high-income countries, their newborn mortality rates are only slightly lower than those of lower- to middle-income countries such as Sri Lanka, which has a rate of 1 in 189, and Ukraine, which has a rate of 1 in 185.

“For all countries, it’s about giving people access to good quality health services,” Peterson said.

“Obviously, money helps in that regard, but in respective of income level, it’s also a question of how you organize that access and the quality of health services,” he said. “For any country that has discrepancies between poor people and well-to-do people, that will of course pull the average down” when it comes to the newborn mortality rate.

Last month, a separate study published in the journal Health Affairs ranked the overall child mortality rate among the United States and comparable nations in the Organisation for Economic Co-operation and Development, a group of 35 countries founded to improve economic development and social well-being around the world.

In that study, the US ranked worst, falling behind Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland and the United Kingdom.

UNICEF’s new report is “credible,” said Lindsay Stark, an associate professor of population and family health at Columbia University’s Mailman School of Public Health.

As she has noted in response to previous reports, such as the Health Affairs study, the United States appears to lag behind other nations in terms of child and newborn mortality because of perinatal mortality, or mortality specifically around the time of a baby’s birth, including maternal conditions affecting a fetus or newborn.

So by focusing on improving maternal health, the US and other countries could improve infant health, she said.

Reducing infant mortality ‘starts with the midwife being able to wash her hands’

The UNICEF report notes that the primary causes of newborn deaths in the first month include being born prematurely, complications around the time of birth and infections such as sepsis, meningitis and pneumonia. Many of those causes are preventable or treatable.

Reducing such deaths would involve guaranteeing access to clean water and functional health facilities for families, making the top 10 life-saving drugs and medical equipment available for every mother and baby, and empowering women to demand and receive quality health care, according to the report.

Those factors are described as the “four Ps,” involving improvements in places such as health facilities, access to people or health care providers, access to products, and power – as in empowering adolescent girls and mothers.

“That starts with the midwife being able to wash her hands and light herself with electricity during delivery and having basic drugs,” Peterson said.

“And you do the right things, which include breastfeeding within the first hour of life,” he said. “That singularly is the most important thing you can do actually for child survival is to start breastfeeding early. So there are a number of issues that we can call on governments around the world to do, both within health services and beyond health services.”

For instance, according to the report, in Malawi, slightly more than half of women who gave birth in 2000 did so with the support of a doctor, nurse or midwife. By 2016, that percentage rose to about 90%.

In correlation with that increase, Malawi’s newborn mortality rate fell from about one in 25 in 2000 to one in 43 in 2016, a 44% decline, according to the report.

“When we talk in the cold language of statistics – of rates, averages, percentages, indicators – it is easy to forget that we are talking about the lives and deaths of real babies – babies who deserve to survive, to grow up healthy and contribute to their societies,” the authors of the report wrote.

“Action in the four areas outlined in this report – Place, People, Products, Power – must be an urgent priority for every government, driving forward progress towards a world with universal health coverage, where no newborn dies of a preventable cause,” they wrote.