Global Policy Forum

By Celia W. Dugger

More than four million newborns worldwide die each year in their first month of life, according to a Save the Children report.

Many of those infants could be saved with simple, inexpensive items, like sterile blades to cut umbilical cords, antibiotics for pneumonia and knit caps to keep them warm, the group said in "State of the World's Mothers 2006," a report released Monday. Ninety-nine percent of newborn deaths are in developing countries, where such items are often not widely available.

The deadliest time for children is in the hours after birth, and the deadliest places are the poorest corners of world. South Asia and Africa have the highest rates of newborn deaths, the report said. "The first day of life is the most dangerous day a human being has," said Charles MacCormack, president of Save the Children.

While many countries have significantly lowered mortality rates for children younger than 5 in recent decades, the group said, little progress has been made globally in preventing the deaths of newborns and their mothers.But researchers for Save the Children, a private group that works in more than 40 countries, found that some developing countries that made newborn and maternal health a priority had succeeded in cutting newborn death rates, among them Indonesia, Eritrea, Nicaragua and the Philippines.

Countries that are performing worse than expected compared with nations at similar levels of wealth include Angola, Mali, Pakistan and Sierra Leone. In the United States, 4.7 newborns die out of every thousand born, compared with 12 per thousand in Vietnam and in Colombia, tied for the lowest rate for developing countries, and 65 per thousand in Liberia, which has the highest rate.

"Three out of four newborn deaths could be avoided with simple, low-cost tools that already exist," Melinda Gates, a philanthropist whose husband is Bill Gates, the Microsoft chairman, wrote in an introduction to the report. Their foundation has given $110 million to Save the Children.

President George W. Bush's budget for the U.S. government's fiscal year that begins Oct. 1 proposes spending $323 million on maternal and child health programs, less than the $356 million that Congress appropriated last year. MacCormack said the amount of such aid has been flat through the past three administrations. While the Bush administration's proposed budget would reduce spending for such programs within the Agency for International Development, administration officials said it would sharply increase spending on AIDS and malaria, diseases that kill hundreds of thousands of babies and children, particularly in Africa. Countries with reduced child mortality have made providing prenatal care a priority, have trained birth attendants and have created strong immunization programs to prevent tetanus in newborns and mothers, the report said.

Parents must also be educated about the importance of breast-feeding, the group recommended, and of not introducing liquids or foods that contain dirty water, which can cause diarrhea. Another element of a strategy to reduce deaths is to give women access to modern contraceptives, the group said. Birth control lets women plan to have children with enough time between births to preserve the mother's health and to reduce the likelihood that their babies are born with low birth weights.

Bush's budget proposal for next year reduces spending on family planning outside the United States to $357 million from $436 million. In testimony before Congress on April 26, Randall Tobias, new head of the Agency for International Development and director of foreign assistance at the State Department, was asked about those cuts. "It's an example of some very difficult choices that we have had to make," he said. "There has been pressure, particularly in the health area, with malaria, with avian flu and with balancing a number of other considerations."

Advance prescription urged

The largest U.S. gynecologist group recommends that American women obtain an advance prescription for emergency contraception, The Associated Press reported from Washington.

A new campaign announced Monday by the group, the American College of Obstetricians and Gynecologists, aims to increase access to the morning-after pill after the Bush administration refused to allow it to be sold over the counter in the United States. The morning-after pill is a high dose of regular birth control pills. It cuts the chances of pregnancy up to 89 percent if used within 72 hours of sexual intercourse.