Childbirth does not have to be this deadly

Every two minutes, nine newborn babies and one mother die from complications related to pregnancy and childbirth. In total, this year 2.4 million newborn babies will die within the first month of their lives and 295,000 women will die from pregnancy-related complications.

These deaths represent 2.7 million annual tragedies that are immeasurable for families and communities. For societies, the deaths also represent losses that undermine growth and prosperity. For the world’s low-income and lower-middle income countries, these deaths add up to a loss of almost half a trillion dollars each year, or 6 per cent of their annual GDPs.

In 2015, world leaders promised to fix maternal and newborn health, along with hunger, peace, education and virtually every other major problem area by 2030 in what has become known as the Sustainable Development Goals (SDGs). Unfortunately, we are far off-track on virtually all the promises.

For mothers and newborn babies, progress is happening far slower than it should. Given our current trends, by 2030 some 131,000 mothers and 900,000 infants will die each year that would not have if we had achieved the promises.

It does not have to be this way. In a world without fiscal constraints, all governments would invest lavishly across all the SDGs. In the real world, governments can only moderately increase investments in some policies. My think tank, Copenhagen Consensus, has undertaken extensive research with dozens of the world’s top economists to discover where extra resources can do the most good. Maternal and newborn health is one of those areas.

In fact, new research published this week shows that a focused investment in maternal and newborn health can deliver astonishing returns to society, saving lives and delivering an astounding $87 of social benefits back for every dollar spent.

The researchers focus on the 55 countries that suffer almost all the global deaths for mothers and newborns. They investigate a vast plethora of potential policies: Making more pregnancy check-ups, prescribing more iron supplements, or paying for more health worker visits to counsel mothers after birth.

The research demonstrates that the very best investment is to increase access to family planning, and most importantly, increase access to a package of simple procedures known as Basic Emergency Obstetric and Newborn Care. This package, known by the term BEmONC, means delivering better care at low cost, often with nurses and midwives instead of more costly doctors.

For example, BEmONC ensures access to neonatal resuscitation. This requires only a hand pump or resuscitator, which costs around $65. If this is used 25 times in a year, the cost per use is just $2.60. Adding the health worker’s time, the total cost of saving a child’s life is in the order of $5, a tiny amount spent to achieve amazing good. Neonatal resuscitation can avoid 30 per cent of deaths associated with asphyxia, one of the leading causes of newborn mortality.

Another example of an approach delivered under the BEmONC package is kangaroo mother care, which promotes skin-to-skin contact between mother and baby, a simple act that could halve mortality in premature children.

A large part of the cost of increasing BEmONC comes from ensuring better access for pregnant women in birth facilities, which lowers death risks for both mother and child. Today, two-thirds of women in those 55 countries give birth in such facilities. The researchers’ proposal is to drive investment in order to get 90 per cent of women into these facilities.

Family planning is an important part of the package because an estimated 217 million women who want to avoid pregnancy still do not have access to safe and effective family planning methods. If 90 per cent of women in the 55 hardest-hit countries had access to such services, fewer would become pregnant, and 87,000 fewer mothers would die each year.

The annual financial cost is $2.1 billion with women’s additional time costs valued at $1.6 billion. Yet, this modest total cost of just $3.7 billion a year can each year avert 161,000 maternal deaths, more than 1.2 million newborn deaths, and almost as many stillbirths across the 55 countries.

On top of saving millions of lives, a reduction in mortality and fertility can also lead to a significant increase in income per capita, because fewer but healthier children become more productive. This is known as the “demographic dividend”. In total, the reduction in fertility is estimated to yield a benefit equivalent to $28 billion annually.

When adding up all the returns to society, it turns out that the annual cost of $3.7 billion will deliver overall benefits of fewer deaths and higher economic growth worth $322 billion every year.

The death toll of mothers and young infants in the world’s poorest countries is an unacceptable and largely avoidable tragedy. Investing just $3.7 billion annually in BEmONC and family planning is not only low-cost but one of the very best ways the world can invest to deliver on our global promises.

Bjorn Lomborg is president of the Copenhagen Consensus and Visiting Fellow at Stanford University's Hoover Institution