Pediatrician Dr. Joy Lawn credits a quick-thinking midwife with saving her life when she was born in northern Uganda more than four decades ago.
The bush hospital where Lawn's mother was trying to give birth in the mid-1960s had no electricity or running water.
But the midwife attending her was clever enough to know that because the baby had not moved into the right position for delivery after 24 hours of labor, only a Cesarean section would save infant and mother. She sought help from a doctor.
"I survived the odds because people expected me not to die," Lawn said Tuesday in a telephone interview from her base in Cape Town, South Africa. "We need health workers, we need governments not to expect newborns to die."
Lawn, who works with the non-governmental organization Save the Children, and researchers from the World Health Organization, drive that point home in a new study looking at comprehensive global mortality rates for newborn babies.
Published on Tuesday in the journal PLoS Medicine, the study shows that babies under 4 weeks old account for 41 percent of child deaths worldwide.
Lawn said the United Nations and other international organizations must pay closer attention to the newborn mortality rates in order to save more children's lives. The U.N. reports annually on deaths of children under ages 5 and 1, but estimates for newborn deaths are released only sporadically.
Lawn said the three leading causes of newborn death are preterm delivery, asphyxia and severe infections _ all problems easily prevented with proper care.
"Training more midwives and other community health workers could save the lives of many more babies," she said. "We know that solutions as simple as keeping newborns warm, clean and properly breast-fed can keep them alive."
The London School of Hygiene and Tropical Medicine also participated in the study, which covers all 193 WHO member countries over 20 years.
It shows that from 1990 to 2009, annual newborn deaths decreased from 4.6 million to 3.3 million. But the study's authors say progress is too slow, especially in Africa.
The study shows that newborn babies in countries including Malaysia, Cuba, and Poland now have a better chance of survival than those born in the United States. "It's not that things are worse in the United States than before, it's that the U.S. isn't making progress like other countries," Lawn said.
Because of improvements in infant care in some countries, newborns in Qatar, Croatia and the United Arab Emirates now die at about the same rate as those in the United States, the figures show.
The United States now trails 40 other countries when it comes to risk of newborn death with a newborn death rate of 4.3 per 1,000 live births. In 1990 the United States had the 28th lowest risk.
Globally, Afghan babies face the greatest risks, with one of every 19 dying in the first month of life, according to the statistics. India has the greatest number of newborn deaths overall _ more than 900,000 annually.