Of the 9.7 million children who die every year before reaching their fifth birthday, about 3.7 million are newborns who do not survive their first four weeks of life. The majority of these newborns live in developing countries and most die at home. Three major causes—infections, birth asphyxia and complications related to preterm/low birth weight—account for 86% of neonatal deaths.  Two-thirds of these deaths can be prevented if mothers and newborns could receive known, effective interventions during pregnancy, childbirth and the first hours and days after birth. However, more needs to be done to better deliver these life-saving interventions in low-resource settings.

Strategies that promote universal access to antenatal care, skilled birth attendance, and early postnatal care contribute to sustained reduction in maternal and neonatal mortality. Such interventions have existed for years, but the coverage remains very low or non-existent in most developing countries. For instance, care for asphyxiated or sick newborn infants, and those with infections, is limited to a few tertiary and/or secondary health facilities. In addition to these post-delivery interventions, antenatal and intrapartum interventions—such as skilled birth attendance and improved care for pre-eclampsia/eclampsia—further contribute to the reduction of neonatal mortality.

MCHIP and Newborn Health MCHIP’s newborn health team supports and strengthens interventions that contribute to the reduction in the global burden of neonatal mortality and, in turn, towards the progress made in attaining the Millennium Development Goal 4. MCHIP supports accelerated and sustainable improvements to neonatal health by scaling up evidence-based, high-impact interventions integrated wherever appropriate with maternal health interventions.

MCHIP’s newborn health program focuses on the three major causes of neonatal mortality and prioritizes the first week of life, when most of these deaths occur. The Program implements high-impact interventions that address these leading causes of death through the following:

• Essential newborn care (ENC), including hygienic cord care, maintenance of warmth, and immediate and exclusive breastfeeding;
• Neonatal resuscitation, which is a component of ENC (and prevention of asphyxia through appropriate intrapartum care);
• Kangaroo Mother Care (KMC) for low birth weight/preterm newborns;
• Management of neonatal sepsis; and
• Handwashing with soap (integrated with all other newborn interventions).

Results
In order for high-impact newborn interventions to be implemented at scale, MCHIP works directly with and through national Ministries of Health to ensure that they own and lead the related processes. MCHIP also builds on existing delivery platforms and collaborates closely with other related national ministries, USAID and non-US government bilateral projects, the Saving Newborn Lives project, United Nations bodies, nongovernmental agencies, and other stakeholders.

With the goal of national coverage in mind, MCHIP supports countries to:

• Revise or strengthen their newborn policy and/or strategy;
• Develop or revise country plans for introduction and/or scale-up of selected newborn interventions;
• Appropriately shift certain curative newborn care elements, such as treatment of sick newborns with newborn sepsis to lower-level cadres of health workers (including community health workers), where appropriate;
• Strengthen quality improvement systems for newborn health care services;
• Incorporate selected newborn indicators in national health information systems for improved monitoring and evaluation of newborn interventions; and
• Strengthen program coordination at national,district and community levels including referral services.

Global Leadership
MCHIP provides global and regional technical leadership in newborn health to advance learning and advocacy, as well as to leverage resources for the scale-up of high-impact interventions. MCHIP is the lead partner for two USAID Global Development Alliances (GDAs) listed below: 

• Helping Babies Breathe (HBB) addresses birth asphyxia through strengthening basic newborn resuscitation knowledge and skills. This is a public-private alliance between USAID, The Eunice Kennedy Shriver National Institute of Child and Human Development, Save the Children, Laerdal Medical, and the American Academy of Pediatrics.
• Handwashing for Newborn Survival—a public-private alliance between USAID, MCHIP and Unilever’s Lifebuoy—is a behavior change program to help new mothers and health workers adopt and practice handwashing with soap. This includes partnerships with the London School of Hygiene and Tropical Medicine, the U.S. Centers for Disease Control and Prevention, and the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B) to conduct formative research.

In addition, MCHIP collaborates with and provides technical inputs to the following strategic partnerships and alliances: UNICEF; WHO (Departments of Child and Adolescent Health and Making Pregnancy Safer); Saving Newborn Lives/Save the Children; International Pediatric Association; the Partnership for Maternal, Newborn and Child Health (PMNCH); Countdown to 2015; the Child Health and Nutrition Research Initiative; The Bill & Melinda Gates Foundation; and the Global Alliance for Prevention of Prematurity and Stillbirths (GAPPS); and is an active member of the LAC Neonatal Alliance.

Integration
In addition to the primary postnatal interventions implemented by the Program, MCHIP supports the scale-up of antenatal and intrapartum care interventions that have significant impact on newborn survival. Through integration at the service delivery level, MCHIP aims to increase access to and improve the quality of high-impact interventions that benefit both the mother and newborn.

The Program seeks to prevent birth asphyxia through upgrading the knowledge and skills of health providers to appropriately detect and manage related antenatal/maternal conditions. Appropriate monitoring of labor through the correct use of partographs to facilitate recognition and treatment/referral of obstetric complications is also a priority.

MCHIP’s strategy for the prevention of preterm births and their complications is to ensure that proven interventions known to reduce the incidence of preterm births are included in all of its focused antenatal care (FANC) programs. The interventions are context-specific and may include: screening and treatment for syphilis, reproductive and urinary tract infections; use of insecticide-treated mosquito nets and intermittent presumptive treatment of malaria; and iron/folate supplementation and nutrition counseling. The Program is exploring the feasibility of increasing coverage of corticosteroid use for pregnant women in preterm labor in selected countries. With the exception of maternal steroids, all of these interventions are included in MCHIP’s FANC package.