Bill & Melinda Gates Foundation

The Tree of (Newborn) Life

April 15, 2013

When you were a child, did you get to plant a tree seed in a paper cup, give it water, make sure it got sun, and then watch it grow little by little? In some cases, that small tree sapling eventually grew large enough to be planted outside. In even fewer cases, that sapling has grown into a large tree that is now providing fruit and shade in your family’s garden or in a park far away somewhere. I like to think of caring for a newborn as similar to the process of a tree growing. It starts with a small seed, essentially a pregnancy that must be nurtured and cared for. And, as in the case of a tree seed, as the baby is born and grows, she requires care and nurturing throughout her life.

Globally, seven million children less than five years old die every year; 40 percent of these deaths occur during the 28 days after birth. Why do so many newborns in poor rural communities die? What are they dying from? What can be done to reduce these risks?

Almost half of all newborn deaths occur on the first day after birth. Thus, if mothers deliver their babies at home, far away from skilled health care, doctors and midwives are simply not available at the time when the mother and baby need the most help. Both mom and baby have risks during this time associated with prolonged labor, obstructed labor, bleeding, asphyxia and prematurity.

The first 24 hours after birth is also the time when healthy behaviors are reinforced to the mother and family members. This is an opportunity for frontline health providers to promote immediate and exclusive breastfeeding, hygienic care of the umbilical cord and keeping the baby warm. During these critical 24 hours, frontline health providers have the opportunity to remind families to go to the clinic or hospital if they notice early warning signs of neonatal illness such as difficulty with breastfeeding, lethargy and jaundice.

For premature babies that need extra attention, the first few days of life are crucial for unique interventions and health education related to keeping them warm, feeding and monitoring for illness.

Just like tiny seedlings popping out of the earth need delicate green thumbs to tend to them, newborns need special care and attention. If the appropriate care and attention are provided to newborns reliably during this vulnerable period, many more of them would survive beyond the first week after birth and through the first month.

And if families and health workers continue appropriate care and increase the chances of survival into the second month after birth, and then the second year and next thing you know… they will be five years old.

So what is appropriate care and attention at that point?

Prevention and treatment of common childhood illnesses such as pneumonia, diarrhea, malnutrition, and malaria are the most obvious. Avoidance of vaccine-preventable diseases such as measles, diptheria and pertussis through vaccination is also key.

How can we assure reliable care and attention as the child is growing up? It requires families understanding the medical (vs. spiritual) causes of childhood illnesses as well as strategies to prevent and treat them. Understanding is only the beginning, though. They must also have the means to undertake those strategies available to them at home and in their communities. These involve clean water, environmental sanitation, insecticide-treated bed nets to prevent malaria, appropriate weaning foods to support healthy growth, and oral rehydration solutions to treat simple cases of diarrhea.

When the needs go beyond these strategies, families must have access (geographic, financial, and cultural) to health services that are of a reasonable standard provided by trained health professionals who are paid reliably at an reasonable rate and are adequately equipped to perform their job at a quality standard of care with support from their managers.

With all of these components, that newborn can have a strong start to life, can grow up as a healthy child and have more opportunities to become a healthy, productive adult and have her own healthy newborn to start the cycle again.

Just as a tree sapling, once planted outside still needs water, sun and a healthy environment to grow strong, produce seeds, and start the cycle again, the care of a newborn doesn’t end when he or she passes the 28-day mark. The care needed changes, and different interventions and approaches are prioritized. But it’s still care provided by the entire system. 

Public health at its core is about the overall health system providing prevention and treatment to improve health and the quality of life throughout a person’s life. It’s the same public health that has been practiced for decades in other parts of the world. It’s time to make it work reliably throughout Africa. As we plant seeds and tend to them to ensure they grow into healthy trees, we must do so for our newborns, in Africa and everywhere.

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