Neonatal mortality refers to deaths in children within 28 days of birth; it encompasses the effect of socio‑economic and environmental factors on newborns and mothers, and the capacities and responsiveness of national health systems. The neonatal period accounts for 47% of all under-five deaths in 2020 (UN IGME, 2022[1]).
Indicators such as the level of education of the mother, quality of antenatal and childbirth care, preterm birth and birthweight, Early Essential Newborn Care (EENC), and feeding practices are important determinants of neonatal mortality. EENC is evidence‑based, cost-effective, and comprises feasible interventions provided during childbirth and in the postnatal period. The First Embrace is the core of EENC, defined as a life‑saving practice that promotes skin-to-skin contact immediately after birth between mother and child for no less than 90 minutes. Other EENC interventions include: (1) ensuring the presence of a birth companion; (2) adopting a position of choice; (3) providing adequate food and fluids; (4) using evidence‑based criteria for episiotomy, and other procedures; (5) eliminating harmful or unnecessary practices such as fundal pressure, forced pushing, and enema; (6) administering oxytocin within one minute of birth. EENC has been introduced and scaled up across countries and territories in Asia-Pacific (WHO WPRO, 2022[2]).
The leading causes of neonatal mortality are premature birth, birth complications such as asphyxia or trauma, neonatal infections, and congenital anomalies (WHO, 2024[3]). Undernutrition continues to be amongst the leading causes of death in both mothers and newborns [see section “Child malnutrition (including undernutrition and overweight)” in Chapter 4]. The leading causes of neonatal mortality can differ in high-income countries, such as Australia with 2.3 deaths per 1 000 live births, where causes such as preterm birth and congenital anomalies account for more than 60% of neonatal mortality, and perinatal infection accounts for only 4% of neonatal deaths (Australian Institute of Health and Welfare, 2024[4]). In the Asia-Pacific region, 72% of the deaths in the first year of life occurred during the neonatal period in 2020 (UN IGME, 2022[1]).
Sustainable Developing Goals set a target of reducing neonatal mortality to 12 deaths or less per 1 000 live births by 2030. In 2022, the average amongst lower-middle- and low-income countries and territories in Asia-Pacific was 15.6 deaths per 1 000 live births, decreasing by almost a third the rate observed in 2010, but still above the SDG target (Figure 3.4). Upper-middle-income Asia-Pacific countries have maintained the SDG target reporting a rate – on average – of 9.4 deaths per 1 000 live births in 2010, which then decreased to 7.3 in 2022. High-income Asia-Pacific countries and territories reported neonatal mortality rates similar to those of the OECD, with an average of 1.9 deaths per 1 000 live births in 2022.
In general, high-income countries and territories in Asia-Pacific experienced lower neonatal mortality rates than lower-middle- and low-income countries and territories in the region. Japan, Macao (China), Singapore and Korea reported less than two deaths per 1 000 live births in 2022, whereas neonatal mortality rates were higher than 20 per 1 000 live births in Lao PDR, Papua New Guinea, Myanmar and Pakistan; the latter with 38.8 deaths per 1 000 live births.
In 2022, most Asia Pacific countries and territories evidenced a decrease in neonatal mortality rates compared to 2010, the exception was Fiji reporting an increase from 9.3 in 2010 to 13.9 deaths per 1 000 live births in 2022. (Figure 3.4). Since 2010 the rate in China and Macao (China) more than halved by 2023.
Amongst the main determinants of neonatal mortality rates across countries and territories, we find income status, geographical location, and mother education. In most Asia Pacific countries herein reported, neonatal mortality is higher in households with the lowest income quintile (Figure 3.5). The greatest absolute gap between income groups is seen in India, Nepal, Bangladesh, Indonesia and Philippines where neonatal mortality is more than 10 deaths per 1 000 live births higher in the lowest income quintile compared to the highest. The difference in neonatal mortality between income groups is smaller for DPRK, Fiji and Mongolia. As in wealth quintiles, differences in neonatal mortality are found based on mother’s education, with higher mortality rates seen when mothers’ report no education. The smaller absolute gaps in this social determinant are found in Lao PDR, Mongolia and Bangladesh, and the wider gaps are evidenced in India and Pakistan, where neonatal mortality is more than 15 deaths per 1 000 live births in the group reporting no education compared to the group reporting secondary education or higher. Geographical location is another determinant of differences reported in neonatal mortality in the region, though relatively less impactful in comparison to households’ income and mother’s education. For example, neonatal mortality rate in rural areas of the Lao PDR, Nepal, Myanmar, India and Pakistan were more than 5 deaths per 1 000 live births higher than the rate reported for urban areas.
Neonatal mortality rates recede through cost-effective and appropriate interventions. These include neonatal resuscitation training, prevention, and management of neonatal sepsis, reducing mortality from prematurity, and prioritising the roles of breastfeeding and antenatal corticosteroids (Conroy, Morrissey and Wolman, 2014[5]). Reductions in neonatal mortality will require not only the aforementioned strategies, but also ensuring that all segments of the population benefit from these (Gordillo-Tobar, Quinlan-Davidson and Lantei Mills, 2017[6]).
