WASHINGTON • Babies born in the world's poorest countries - most of them in Africa - still face "alarming" risks of death that can be 50 times as high as those in the richest countries, according to a Unicef report released yesterday.
Its findings show that Pakistan, Central African Republic and Afghanistan are the three most dangerous places to be born in, while babies in Japan, Iceland and Singapore have the best chance of survival.
Unicef executive director Henrietta Fore said that although the last 25 years have seen broad improvements in older children's health, "we have not made similar progress in ending deaths among children less than one month old".
"Given that the majority of these deaths are preventable, clearly we are failing the world's poorest babies," she said.
The differences are stark.
A baby born in Pakistan - the country with the worst newborn mortality rate - faced a one in 22 chance of death, while a newborn baby in Japan had only a one in 1,111 risk of dying, the report said.
Of the 10 highest-risk countries, eight are in sub-Saharan Africa, countries where "pregnant women are much less likely to receive assistance", because of poverty, conflict or weak institutions.
Those eight countries are the Central African Republic (a one in 24 chance of death); Somalia, Lesotho, Guinea-Bissau and South Sudan (all with a one in 26 chance); Cote d'Ivoire (one in 27 chance); and Mali and Chad (both with a one in 28 chance).
Each year, about 2.6 million babies do not survive their first month and one million babies die the very day they are born.
"We know we can save the vast majority of these babies with affordable, quality healthcare solutions," said Ms Fore.
Unicef's report was released in conjunction with the launch of its global campaign, called Every Child Alive, aimed at ensuring "affordable, quality healthcare solutions for every mother and newborn".
More than 80 per cent of newborn deaths can be prevented "with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition", said the report.
But shortages of properly trained health workers and midwives are a major problem in poorer nations.
While a rich country such as Norway has 18 doctors, nurses or midwives for every 10,000 people, impoverished Somalia has only one.
In general, babies born in richer countries fare far better, but there are differences even within nations. Babies born to the poorest families are 40 per cent more likely to die than those born to the least poor.
A MOTHER'S GRIEF
I felt like my heart was breaking. I had a name for the child but he never opened his eyes.
MS MARY JAMES, an 18-year-old from rural Malawi who made the long trek to a health centre when her labour started, on losing her baby, who was small and weak, despite the best efforts of the staff.
Sadly typical was the story of 18-year-old Mary James from rural Malawi. When her labour started, she and her sister made the long trek to a health centre.
She said an overstretched staff did its best, but by night her baby - who was small and terribly weak - was gone.
"I felt like my heart was breaking," Ms James told Unicef staff. "I had a name for the child but he never opened his eyes."
Since improvements to healthcare can be expensive, "it is crucial to invest the money in a smart way", Unicef's global maternity and newborn programme chief Willibald Zeck said.
That can mean something as simple as ensuring that a pregnant woman who has walked three days to a healthcare facility is received with "dignity", so that she remains long enough to receive proper postnatal care.
But the dearth of expensive equipment matters.
...we have not made similar progress in ending deaths among children less than one month old. Given that the majority of these deaths are preventable, clearly we are failing the world's poorest babies.
MS HENRIETTA FORE, Unicef's executive director, on newborn mortality not seeing improvements similar to those achieved for older children's health in the last 25 years.
Dr Zeck, who worked as an obstetrician/gynaecologist in Tanzania, said women were often unsure how pregnant they were, and he would have to use his hands to estimate whether a foetus was premature or seriously underweight.
Still, among countries that have made dramatic improvements is low-income Rwanda, which more than halved its newborn mortality rate from 1990 to 2016, illustrating that "political will to invest in strong health systems... is critical", the report said.
Education matters, too. Babies born to mothers with no education face nearly twice the risk of early death as babies whose mothers have at least a secondary education.
The United States - which is generally affluent, but with considerable income inequality and wide variations in access to healthcare - was only the 41st safest country for newborn babies.
The countries with the lowest newborn mortality rates, after Japan, are mostly well-off countries with strong education and healthcare systems: Iceland (a one in 1,000 chance of death), Singapore (one in 909), and Finland (one in 833).