Grace Tutiwe Ngoto, a Malawian public health worker, waited nearly seven years to have a baby. But when her daughter, Tuntufye, was born in February 2006, she arrived two months early, weighing only 2.2 pounds. "I was even afraid myself to touch her," says Grace. "I felt very bad because I didn't know that she would survive."

Tuntufye did survive, and is now a bright, impish little girl who's already going to school, where she's learning her ABCs and how to count to 10. She has lots of friends and loves to dance, according to Save the Children, which has been supporting a method of caring for premature babies, known as Kangaroo Mother Care, in the country since 2002.

Originating in Colombia in the 1970s, it's a low-tech, low-cost way of incubating tiny infants by binding them to their mother's chest with cloth. This regulates the baby's body temperature, reduces infections, encourages breast-feeding and bonding, and allows the mother detect any problems quickly. Tuntufye's mother is so convinced of its benefits, she has promoted the method to her neighbours, church group and women at the local health centre.

Save the Children is also introducing Kangaroo Mother Care in Ghana, one of 18 countries - including nine in Africa - where it runs programmes to save the lives of newborn babies.

"Lack of awareness is a big problem. People need to realise there are also solutions," explained Joy Lawn, a paediatrician who advises Save the Children on policy and research. "In Ghana, I was told it was all an equipment problem, but a lot can be achieved with simple resuscitation techniques, Kangaroo care, antibiotics and routine visits after birth."

Around 40 percent of child deaths occur in the first four weeks of life (the neonatal period), and nearly 4 million newborn babies die each year, three-quarters of these in South Asia and sub-Saharan Africa. Premature (or pre-term) birth is the leading cause of neonatal deaths, according to the Seattle-based Global Alliance to Prevent Prematurity and Stillbirth (GAPPS).

Prematurity accounts for one million deaths every year - killing more children under five than AIDS, malaria or tuberculosis. And pre-term babies who survive have a higher risk of infections, cerebral palsy and brain injury, as well as respiratory, vision, hearing, learning and development problems.

U.N. GOAL OUT OF REACH

Save the Children says the U.N. Millennium Development Goal of a two-thirds reduction in child mortality by 2015 will not be achieved unless newborn deaths are cut by at least half. The aid agency estimates that providing essential care for mothers and children before, during and after birth in countries with high mortality rates would cost less than one dollar per person.

"There is a huge disparity in terms of care for pre-term babies between rich and poor countries," said Lawn. "In low-income countries, a baby born at 32 weeks (of pregnancy) has a 50 percent chance of dying."

Craig Rubens, executive director of GAPPS, says both prematurity and stillbirth have been neglected by policy makers and donors. Many of the medical causes remain a mystery and the limited amount of available data is weak, especially from Africa.

An estimated 3.2 million stillbirths occur each year, and many are linked to the death of the mother, according to GAPPS. Most occur in south Asia, sub-Saharan Africa and east Asia.

"Mothers and children don't have political leverage," Rubens told AlertNet. "But now people are starting to pay attention. Studies, for example, show that community prosperity can be traced back to the health of women and children."

Rubens hopes international efforts to combat prematurity and stillbirth will be boosted by a GAPPS conference last month in Seattle that was sponsored by global health organisations, including the Bill & Melinda Gates Foundation, Save the Children, UNICEF and the World Health Organisation (WHO).

"It is time to break the silence that surrounds stillbirths," said Daisy Mafubelu, WHO assistant director-general for family and community health. "Most of these deaths are avoidable and in many cases could be prevented through better care during childbirth."

INVOLVING POOR COUNTRIES

One of the conference's most important outcomes, according to Rubens, will be a push to carry out more research and pilot projects in poorer countries in Africa and Asia. This could lead to faster and more efficient development of drugs and preventive care, as well as building health infrastructure in places where it is sorely needed.

"Lower-income countries want us to look at interventions that could be scaled up for health facilities and community settings quickly," he said. "They include nutrition, ante-natal care, labour and delivery care, access to emergency obstetrics, and training of community health workers."

Rubens is also encouraged by U.S. President Barack Obama's announcement in early May of a $63 billion, six-year health initiative to help people in the world's poorest countries. While the details remain hazy, Washington has said some of the money will go towards improving maternal health, as well as efforts to fight AIDS, tropical diseases and other illnesses.

Internationally, the GAPPS coalition aims to drive prematurity and stillbirth up the political agenda and strengthen links with the wider field of maternal and newborn health. One way of achieving this would be to push for the introduction of formal targets for reducing premature and stillbirth into the Millennium Development Goals, according to Rubens.

Lawn argues that, in recent years, the focus within reproductive health has tended to be on the mother rather than the child. "There is a false division, which we need to get beyond," she said.

Save the Children points out that 70 percent of the money needed to provide care for newborn babies in high-mortality countries would also help save mothers' lives, for example. And there is a wider benefit to society because women with healthy babies have fewer pregnancies, smaller families and more money to invest in their children's futures.

When it comes to stillbirths, which are under-reported and largely absent from data records and national policy, experts say there is also a need to tackle the social and emotional consequences for women, particularly in developing nations. Studies show that, even 20 years after experiencing a stillbirth, women experience unresolved grief, according to Lawn.

"In low-income countries, the numbers are overwhelming at around 9,000 a day, with 3,000 a day occurring during birth. Behind each death, families suffer the pain of loss, often compounded with guilt, but societal taboos keep this grief hidden," she said.

For more information, visit the GAPPS website or Save the Children's web page on its Saving Newborn Lives programme.

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