A global analysis spanning 194 countries reveals a mixed picture for newborn survival: deaths caused by birth asphyxia, trauma, and prematurity have declined markedly since 2000, yet progress is slowing in many low- and middle-income countries, particularly across sub-Saharan Africa. Researchers warn that without accelerated intervention, some of the world's most vulnerable regions will remain far from achieving international child survival targets by 2040.More than 2.4 million newborns died in 2019, and intrapartum complications together with preterm birth remain the leading killers. The Sustainable Development Goal 3.2 aims to reduce neonatal mortality to less than 12 per 1000 live births by 2030, but recent assessments indicate that 64 countries are off track. Low- and middle-income countries have seen a worrying deceleration in neonatal mortality decline, partly because high-cost neonatal resuscitation programs and intensive care models are difficult to implement in resource-limited settings. Based on these challenges, there is an urgent need to understand country-specific trends and to project future scenarios that can inform targeted policy.
A team led by researchers at Kyung Hee University College of Medicine, Seoul, South Korea, published (DOI: 10.1007/s12519-026-01045-2) the findings on May 28, 2026, in World Journal of Pediatrics. Using the cause-of-death data from United Nations Inter-Agency Group for Child Mortality Estimation , they analyzed neonatal and under-5 mortality from birth asphyxia or trauma and prematurity across 194 countries between 2000 and 2021, then projected outcomes to 2040 under three different scenarios.
Globally, neonatal mortality from birth asphyxia/trauma fell from 7.52 to 4.18 during 2000–2021, while prematurity-related neonatal deaths dropped from 10.63 to 6.49. Yet the reduction slowed between 2010 and 2021 compared with the previous decade. The disparity between regions remains striking. In 2021, newborns in West and Central Africa were nearly 30 times more likely to die from birth asphyxia or trauma than those in North America. Eastern and Southern Africa and West and Central Africa also showed the smallest percentage declines since 2000. In contrast, East Asia and Pacific and Eastern Europe and Central Asia achieved the largest reductions. South Asia, which had the highest rates in 2000, made substantial progress. The study further found that countries with lower scores on the Human Development Index, Universal Health Coverage service coverage index, and Healthcare Access and Quality index experienced slower mortality declines. Interestingly, the greatest improvements occurred not in the wealthiest nations but in those at intermediate-to-upper levels of socioeconomic development, suggesting that targeted investments can yield rapid gains. Under a "regional best-performer" scenario, global neonatal mortality from these causes could fall below 1 by 2040, a dramatic improvement from current trends.
"World has made real progress, but the slowdown in Africa is a wake-up call," the authors said. "If West and Central Africa had the same rate of decline as the best-performing country, neonatal deaths from birth asphyxia could drop to near zero by 2040. But under current trends, they will remain devastatingly high. This gap between where we are and where we could be is massive. We don't need futuristic technology, instead, we need scale up low-cost, proven tools like the Helping Babies Breathe program and make sure midwives are trained and supported. Our projections show the accelerated progress is absolutely achievable."
The study provides one of the most comprehensive assessments to date of global trends in mortality related to birth asphyxia, trauma, and prematurity, offering policymakers a roadmap for prioritizing investments in newborn health.. The authors stress that scaling up midwife-delivered interventions could prevent up to 64% of neonatal deaths, even without expensive equipment. For low-resource settings, programs such as Helping Babies Breathe and continuous positive airway pressure for preterm respiratory distress are effective but require reliable training, equipment, and referral systems. Countries with the highest mortality need to shift delivery care from homes to facilities that have skilled staff, emergency obstetric services, and neonatal resuscitation. Strengthening health systems, ensuring 24/7 availability of skilled birth attendants, and empowering midwives are the most cost-effective strategies to close the equity gap by 2040.
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References
DOI
10.1007/s12519-026-01045-2
Original Source URL
https://doi.org/10.1007/s12519-026-01045-2
Funding information
This work was supported by a grant from Kyung Hee University in 2025 (KHU-20251285).
About World Journal of Pediatrics
World Journal of Pediatrics is a monthly, peer-reviewed academic journal that publishes original research articles, reviews, and special reports covering all aspects of pediatrics. It welcomes contributions from pediatricians and researchers worldwide, focusing on the latest developments in pediatric clinical practice, pediatric surgery, preventive child healthcare, pharmacology, stomatology, and biomedicine, as well as basic and experimental sciences. The journal provides an international platform for academic exchange and dissemination of medical research findings. All submissions undergo rigorous peer review by at least two experts. Committed to efficient manuscript processing, the journal aims to deliver final decisions within two months, with outstanding papers or special reports potentially accepted within one month for priority publication.