BJORN LOMBORG: Childbirth doesn’t have to be this deadly
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
Every two minutes, nine newborn babies and one mother die globally from complications related to pregnancy and childbirth. In total this year, 2.4-million newborns 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 $500bn each year, or 6% 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 present trends, by 2030 some 131,000 mothers and 900,000 infants will die each year who wouldn’t have if we had achieved the promises.
It doesn’t 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 policy institute, 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.
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 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 shows that the 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 about $65. If it 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% 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 to get 90% 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 don’t have access to safe and effective family planning methods. If 90% 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 $2.1bn, with women’s additional time costs valued at $1.6bn. Yet this modest total cost of just $3.7bn a year can avert 161,000 maternal deaths, more than 1.2-million newborn deaths, and almost as many stillbirths across the 55 countries each year.
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 $28bn annually.
When adding up all the returns to society it turns out that the annual cost of $3.7bn will deliver overall benefits of fewer deaths and higher economic growth worth $322bn 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 $3.7bn annually in BEmONC and family planning is not only low-cost, but also one of the best ways the world can invest to deliver on our global promises.
• Dr Lomborg is president of the Copenhagen Consensus and visiting fellow at Stanford University's Hoover Institution. This article is part of a series on what the world needs to do to achieve the UN sustainable development goal targets.
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