Data can be used to calculate this indicator from surveys with detailed information on mothers’ newborn health care behaviors or from independent and prospective studies on mothers’ health care seeking behaviors. At present, large-scale, population-based surveys, such as the Demographic Health Survey (DHS) and the UNICEF Multiple Indicator Cluster Survey (MICS) do not have the level of detail to calculate this indicator for newborns. The data can be disaggregated by the type of skilled provider and/or type of facility visited (i.e., public, private, non-governmental, community-based), and other factors such as district or urban/rural location.

Data Source(s):

Specialized surveys with detailed information on mothers’ health care behaviors for their newborns; independent studies on mothers’ newborn health care seeking behaviors.

Purpose:

This indicator measures women’s healthcare seeking behaviors for their newborns when the infants show signs of sickness. The indicator relates directly to the achievement of Millennium Development Goal #4 to reduce infant and child mortality.  Many newborn infants are born at home or returned home shortly after delivery, and they can become ill and die before ever reaching medical care. Until recently, newborn health was not a priority in both the international child health and safe motherhood movements, largely due to the general lack of awareness of the sheer numbers of early infant deaths. WHO estimates that each year nearly 3.3 million babies are stillborn, and more than 4 million others die within 28 days of being born. Newborn deaths contribute to about 40% of all deaths in children under five years of age globally, and more than half of infant mortality (WHO, 2005). Nearly all of these deaths occur in developing countries, and although post-neonatal mortality has declined substantially, neonatal deaths have declined only slightly (Gage, et al., 2005).

Issue(s):

Newborn illness is often difficult to recognize because infants often present with relatively non-specific symptoms, such as poor feeding and lethargy. In many settings, few facilities or skilled providers may be accessible and affordable and, even where mothers can access skilled providers, adequate diagnostic and/or treatment resources may not be available. Given these barriers to accessing adequate newborn care, mothers may choose to not seek skilled providers. Mothers may also report the recommended behavior rather than actual practice, particularly in areas where communication programs have been promoting healthcare-seeking behaviors for mothers and their newborns (Gage et al., 2005). Surveys rely on recall of events and this indicator is subject to recall bias, which is likely to increase with the length of the recall period. Recall bias can be minimized by keeping the reference period short.  Another issue is small sample sizes – even in large surveys, few women may report that their newborn suffered from sickness, thus reducing the denominator for this indicator.  Results should therefore be interpreted with caution, especially in surveys with small sample sizes.

Keywords:

newborn (NB), behavior

References:

Gage A, Ali D, Suzuki C, 2005, A Guide for Measuring and Evaluating Child Health Programs, Chapel Hill, NC: MEASURE Evaluation. https://www.measureevaluation.org/resources/publications/ms-05-15

Save the Children, 2010, Report of a Technical Working Group Meeting on Newborn Health Indicators, Washington, DC: Save the Children.

WHO, 2005, The World Health Report 2005: Make every mother and child count, Geneva: WHO. http://www.who.int/whr/2005/media_centre/facts_en.pdf