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Neonatal Mortality: Observation of a 21st Century Global Crisis

Have you ever heard a pregnant mother add this saying to the end of a sentence: “as long as my baby is healthy”? Did you ever question why it was mentioned? What could occur after birth that leaves this voiced concern amongst mothers?

For many high-income countries, which include the United States, Japan, New Zealand, Canada, and Australia, the mortality of infants is not common within health-related discussions. Even when discussed, as shown with the saying above, it is typically demonstrated as a mere afterthought. It may also be uncomfortable for many to think about. After all, as long as the mother does not seem to have any sort of genetic predisposition or condition that could negatively impact the birth and development of the infant, this topic does not seem to fall under the priority of concern for most mothers.

But should it?

Much of the diminished perception of severity within neonatal mortality stems from the quantitative data collected within these countries. Nationally, for every 1,000 live births, an average of 18 infants pass away from varying complications between their first day and fourth week of their life. In the United States, only 4 out of every 1,000 live births succumb to neonatal mortality. Canada and New Zealand, with only 3 out of every 1,000 live births presenting neonatal-oriented deaths, also have a much lower incidence rate than the current global statistical data. Australia takes the next step forward in challenging the global average, with only 2 out of every 1,000 births. Japan, in conjunction with other countries such as Andora, Belarus, Estonia, Finland, Montenegro, Norway, and San Marino, yields the lowest neonatal mortality rate, with only 1 out of every 1,000 live births eventually resulting in fatal complications within the four-week lifespan.

However, when one looks away from the data collected from high-income countries and starts investigating low-income country data, an opposing quantitative picture emerges. Low-income countries such as Somalia, South Sudan, India, Pakistan, and Lesotho, currently have neonatal mortality rates that are much higher than the average. Keeping in mind that the national average neonatal mortality rate is 18 per 1,000 live births, India currently holds a rate of 22 per 1,000 live births. Somalia appears to have a neonatal mortality rate that is double that of the national rate with a staggering 37 per 1,000 live births. Even more concerning is the rate presented for South Sudan, indicating a 39 per 1,000 live birth infant mortality rate within four weeks of the infant’s life. Lastly, Pakistan and Lesotho, the two countries with the highest neonatal mortality rates, represent neonatal mortality rates of 41 per 1,000 live births and 43 per 1,000 live births, respectively.

Through the observation of this data, it is clear that neonatal mortality is a greater concern in these low-income countries, and the discussions of potential mortality amongst infants within the beginning of these lives are much more impactful in this regard. However, this may lead to a myriad of new questions. Why do these countries have a higher neonatal mortality rate? If this topic is a large concern in these countries, why is this issue not commonly discussed? What initiatives could be utilized to help these countries reduce this deadly rate?

In terms of why these countries seem to have a substantial increase from the global average, there is variation as to what may be the causes of early infant death. According to the World Health Organization, 2.4 million newborns fell to the neonatal mortality statistic in 2019, and it would be very inaccurate to assume that one singular cause is the main culprit of such high numbers. However, patterns could be discerned from these countries. In particular, the lack of access or awareness of services or care that could increase the chances of birthing a healthy baby, lack of exclusive breastfeeding, and difficult implementation of prenatal care are present concerns within these countries.

This resulting pattern tends to lead to severe consequences. Lack of transportation, presence, or knowledge of essential newborn care services, pre-term or low-birth-weight support, and medical centers for sick or HIV-inflicted newborns prevent mothers from seeking the help and assistance they need to save their babies from potential mortality. If a mother chooses to not exclusively breastfeed, is highly dependent on non-nutritive baby formulas, or struggles to give the baby any sort of natural or artificial milk, the baby will have a much lower chance of survival, as its nutritive needs will not be substantive. Babies without complete natural milk tend to also have stunted growth, digestive problems (like diarrhea and bloating), or may experience early organ failure. Negative health behaviors, such as smoking, drinking, or being obese, are typically not brought to light within certain communities, which explains the insufficiencies of their prenatal care strategies.

Although it may be frustrating to realize that this topic is not addressed as much as it should, it is usually uncommon because the actions that could dramatically decrease these rates require financial spending, which many of these low-income countries do not have the current ability to implement. Constructing new initiatives within these countries is difficult at the community level when resources are relatively scarce. However, these countries may still be able to find some support. In high-income countries, the increase of international nonprofit organizations could aid in providing the information that is lacking within the low-income communities. In addition, encouraging community organization efforts to amplify the voices of concern for these topics could also yield long-term benefits for these communities as well.

Thank you so much for reading!

Ashlyn Southerland


The World Bank. (2019). Mortality rate, neonatal (per 1,000 live births). UN Inter-agency Group for Child Mortality Estimation.

World Health Organization. (2020, September 19). Newborns; improving survival and wellbeing.


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