Closing the survival gap for newborns
Ethiopia has made notable strides in maternal and child health over the past two decades. Maternal and child deaths have fallen sharply since 2000, thanks to expanded health services, vaccination drives and a growing corps of community health workers. Yet a stark reality remains: too many babies still die before their first birthday.
Official data show the country’s infant mortality rate (IMR) is projected to reach 27.19 deaths per 1,000 live births in 2025 — down from 35.7 in 2023 and a further drop from the estimated 28.36 in 2024. Preterm births account for most of these deaths.
Beneath those improvements lies a more troubling trend. Neonatal mortality — deaths within the first 28 days of life — is declining far more slowly. By 2025, the country’s neonatal mortality rate is forecast to stand at 23.2 deaths per 1,000 live births. The main culprits are familiar and preventable: birth asphyxia, infections and complications from premature birth.
Health experts say these figures highlight the limits of Ethiopia’s progress. A lack of quality prenatal, obstetric and postnatal care, particularly in rural areas, continues to stymie further reductions in maternal and infant deaths.
This demographic reality took center stage at a recent high-level Clinical Symposium on the Management and Prevention of Apnea of Prematurity and Neonatal Respiratory Support. Organized by SAH Pharmaceuticals in partnership with Chiesi Global Health, an Italian company focused on neonatal outcomes in sub-Saharan Africa, the event convened neonatologists, pediatricians, nurses, policymakers and other health professionals to share strategies for reducing neonatal deaths.
Despite Ethiopia’s national efforts, participants said, the current infant death rate underscores that existing measures have not gone far enough. Among the challenges flagged was the country’s limited capacity to train infant-care specialists. Access to medicines and equipment alone, they stressed, is not enough: empowered professionals and coordinated action are equally vital.
“The majority of infant deaths in our country are among babies born prematurely,” said Gesit Metaferia (MD), a pediatrician at St. Paul’s Hospital Millennium Medical College, who presented a study at the symposium. He cited birth asphyxia, infection and preterm birth as the leading causes of infant mortality.
“Preterm births and birth asphyxia are problems we have not been able to control,” he added. “Preterm children die because the medical resources needed for their treatment are insufficient. Often, when preterm children are born at health centers, they are referred to hospitals for better care. This is why we have not seen a significant reduction in the mortality rate.”
While roughly 80 percent of babies born in Ethiopia each year do not need intensive medical support, the remaining 20 percent require critical assistance to survive, Gesit said. Updating essential newborn delivery equipment across health institutions and strengthening training for health professionals, he added, are key to reversing the trend.
Preterm birth remains the single largest driver of infant mortality in the country. The causes are layered: inadequate antenatal care, short birth intervals, and stark socio-economic and geographic disparities. Babies born to mothers in rural areas or from poorer households are still far more likely to die than those born in cities. Persistent barriers to quality healthcare make it difficult to deliver the critical care these fragile lives need to survive.
That challenge is not unique to Ethiopia. At the European level, the Union of the European Neonatal and Perinatal Society (UENPS) has long worked to align medical practices and share expertise across borders. “Within Europe, this collaboration forms the foundation for initiatives designed to strengthen healthcare systems globally,” said Corado Moretti (Prof.), a leading neonatologist with UENPS.
Despite a marked reduction in child mortality over the past quarter century, neonatal deaths remain a stubborn global challenge. “More than 2.3 million deaths occurred in 2022,” Moretti noted, emphasizing prematurity as a major contributor. “This underscores the critical need for continued, targeted interventions during the first days of life.”
Drawing on site visits to Ethiopia, Moretti highlighted severe shortages of technical equipment essential for safe births and neonatal stabilization. Addressing these gaps, he argued, requires both supply-side investments and stronger hospital-level coordination. “A key strategy involves building capabilities progressively—starting with critical supplies to reduce complications and improve reliability before implementing more complex solutions,” he said.
Private-sector actors are also playing a role. Linda Storari, vice president of global health at the Chiesi Group, said the company is pursuing a long-term, partnership-driven strategy to strengthen pediatric care in Ethiopia. That strategy includes training nurses in standardized clinical protocols and sponsoring Ethiopian specialists to attend international meetings for knowledge exchange. Close collaboration with established NGOs such as QUAMM and Ethiopia’s national pediatric society, she added, is essential.
“Our goal is to contribute to sustained improvements that reduce unnecessary drug usage through better diagnostics, training, and systems,” Storari said. The approach prioritizes a stepwise rollout, beginning with restoring essential hospital utilities and improving organizational coordination before introducing more advanced interventions.
The symposium signaled a renewed commitment among Ethiopia’s health leaders to close the survival gap for newborns. Whether that momentum translates into fewer deaths on the ground, however, will depend on whether the country can scale up both technology and trained hands where they are needed most.
Ethiopia’s own Health Sector Transformation Plan (HSTP-II) sets an ambitious target: lowering the neonatal mortality rate to 21 deaths per 1,000 live births by 2025. Achieving that goal will require intensified, targeted action — expanding access to essential medical services, upgrading neonatal care units nationwide and continuing to build the capacity of healthcare workers. Experts stress that a data-driven approach offers the most viable path to ensuring more infants survive and thrive.
