Friday, March 11, 2005

Neonatal Mortality Examined;
A Case Study of National Solipsism

Our mare's udder is leaking, and there are various other signs of impending labor.  I won't bother you all with the anatomical details.  My wife has been cleaning the birthing stall, reading and re-reading about foaling, and otherwise engaging in nesting behaviors. 

I help her out; but overall, I am not too concerned.  Horses have been foaling for a really long time, mostly without human intervention.  Nonetheless, when deciding what to blog about, I find myself drawn to this topic:

The Lancet, which is the UK's version of the New England Journal of Medicine, recently completed a huge project.  They had several authors examine on different aspects of infant mortality.  The resulting papers have been published online, open-access (free registration required). 
"At The Lancet, we view this partnership between scientists, health workers, and journal editors as the most important public-health campaign we have taken part in for a generation." Richard Horton, Editor of The Lancet, introduces the Neonatal Survival Series [...]

3 million out of 4 million neonatal deaths could be saved each year by the implementation of low-tec and low-cost interventions, conclude authors of the landmark Lancet Neonatal Survival series published online Thursday March 3 2005.

99% of deaths in the first month of life (the neonatal period) occur in developing countries--yet virtually all published research on neonatal health concerns the 1% of neonatal deaths in the developed world. The Lancet's Neonatal Survival Series addresses a major gap in knowledge and provides new evidence detailing the causes of these deaths and the simple, effective interventions that are available to prevent them. The deaths of 10,000 newborn children every day--largely ignored in global public-health policy--demands immediate and sustained action from international agencies, professional organisations, and national governments of both rich and poor countries alike.

When, where and why are four million newborn babies dying each year?
The first article in the series details the extraordinary statistics of neonatal mortality:
  • Three-quarters of neonatal deaths occur in the first week of life, with the highest risk of death on the first day of life.
  • Of all deaths in children under the age of five years, nearly 40% occur during the first month of life.
  • South-central Asia has the highest number of neonatal deaths, while sub-Saharan Africa has the highest rates. Two-thirds of deaths occur in just 10 countries The major direct causes of neonatal deaths globally are
  • Infections (36%)
  • Premature birth (28%)
  • Asphyxia (23%)
They are not kidding when they say this is an important public health project.  According to their authors, three out of the four million infant deaths are preventable.  They catalog 16 interventions, at an estimated cost of $4.1 billion dollars per year, that could prevent three million neonatal deaths every year. 

Aside: Four point one billion dollars is a lot of money: it is almost as much as we spend in one week, fighting the war in Iraq. 

Some of the articles in the series are highly technical, meaning that most, but not all, of the high school juniors and seniors that I know could understand them.  Even if they are hard to read, everyone should read them. 

I'll close by citing the editor:
While the infant and the mother have been at the centre of efforts to protect early childhood, the newborn period has been relatively neglected. This marginalisation is difficult to square with the bare numbers. 8 million children are either stillborn or die each year within the first month of life. This figure never makes news.

The reason is cruelly straightforward. Despite the rhetoric of poverty reduction and aid that marks much of today's foreign-policy debate, the life of a child in a low-income country is worth less to those with political power than the life of a child in a high-income country. Those lives are worth less to those with political power because they are worth less to the people who elect politicians into power--either through ignorance or through a conscious decision to weigh life differently for different peoples. This lamentable vision was never more stark than in the way democratic nations sanctioned what came to be the reckless killing of children in Iraq.4

The aim of the present Lancet series is to erase the excuse of ignorance for public and political inaction once and for all. If we now continue to fail children under threat, we will be delivering a verdict of wanton inhumanity against ourselves. We will be a knowing party to an entirely preventable mass destruction of human life. The weapon that will be wielded in this crime will not be a bomb, a biological agent, or an aeroplane. It will be something far more sinister--withdrawal from the universe of human reason and compassion into a national solipsism that degrades the values that we claim to revere.
That says it all.