• Millennium Development Goals;
  • neonatal death;
  • quality improvement;
  • stillbirth

Key content

  • Millennium Development Goal 4 (MDG4) set targets to reduce by two-thirds the number of deaths of children aged <5 years by 2015 compared with 1990. In 2010, 7.7 million of these children died. Progress is accelerating but many countries will not meet targets.
  • Stillbirths account for 2.65 million deaths but are not addressed in international targets.
  • Possible solutions including ‘kangaroo mother care’, neonatal resuscitation and breastfeeding are identified; a difference can be made with basic training and resources.
  • Political leadership is required to make significant health gains.
  • The evidence for improving peri- and neonatal mortality exists. The challenge is in the implementation.

Learning objectives

  • To understand MDG4 and the variation in pregnancy outcomes for neonates globally.
  • To increase knowledge of simple interventions and key barriers to improve peri- and neonatal mortality.
  • To help UK doctors understand the health background of inward migrants.

Ethical issues

  • The increasing divide in health outcomes between rich and poor, both within and between countries.
  • Gender inequalities may contribute to poor access to care.
  • Resource limitations are compounded by external factors such as the ‘brain drain’ of health workers.