Donor aid mentioning newborns and stillbirths, 2002-19: an analysis of levels, trends, and equity

Abstract

Background: Global aid for reproductive, maternal, newborn, and child health has stagnated in recent years, and aid mentioning newborns or stillbirths has previously represented a very small proportion of aid for reproductive, maternal, newborn, and child health. Neonatal survival targets have been set by 78 countries, and stillbirth prevention targets have been set by 30 countries, to address the 4·4 million newborn deaths and stillbirths globally. We aimed to generate novel estimates of current levels of, and trends in, aid mentioning newborns and stillbirths over 2002-19, and to assess whether the amount of aid disbursed aligns with the associated mortality burden.

Methods: For this analysis, we did a manual review and coding of the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System database from 2002 to 2019 using key search terms for aid mentioning newborns and stillbirths. We compared these findings with estimates of aid for reproductive, maternal, newborn, and child health for 2002-19 based on the Muskoka2 method. Findings are presented in 2019 US$ according to the OECD's Development Assistance Committee deflators, which account for variation in exchange rates and inflation in donor countries.

Findings: We identified 21 957 unique records in the 2002-19 period. Aid mentioning newborns and stillbirths comprised approximately 10% ($1·6 billion) of reproductive, maternal, newborn, and child health funding overall in 2019 ($15·9 billion), with a small decrease in value between 2015 and 2019. 1284 (6%) of 21 957 records and 3·4% ($535 million) of their total value mentioned aid focused only on newborn health. Ten donors contributed 87% ($13·7 billion) of the total value of aid mentioning newborns and stillbirths during 2002-19. Aid mentioning newborns and stillbirths was inequitably allocated in the least developed countries (as defined by the UN), ranging from $18 per death in Angola to $1389 per death in Timor-Leste. Stillbirths were not mentioned in any funding in 2002-09, and they were only mentioned in 46 of 21 957 records in 2010-19, comprising $44·4 million of aid disbursed during this period.

Interpretation: Aid mentioning newborns and stillbirths is poorly matched to their corresponding mortality burden (representing 10% of aid for reproductive, maternal, newborn, and child health overall, yet accounting for approximately 50% of mortality in children <5 years) and across recipient countries (with substantial variation in the amount of aid received per newborn death and stillbirth between countries with similar health and economic needs). Our findings indicate that aid needs to be better targeted to populations with the highest mortality burdens, creating greater potential for impact.

Funding: John D and Catherine T MacArthur Foundation, Bill & Melinda Gates Foundation, ELMA Philanthropies, Children's Investment Fund Foundation UK, Lemelson Foundation, and Ting Tsung and Wei Fong Chao Foundation.

Translation: For the French translation of the abstract see Supplementary Materials section.

Figure 1

Flow diagram for identification of records mentioning newborn health or stillbirths CRS=Organisation for Economic Co-operation and Development Creditor Reporting System.

Figure 2

Trends in global aid mentioning and focused on newborns and on stillbirths for 2002–19 Global aid including and focused on newborns for donors reporting in any year (A) and in both 2002 and 2019 (B). Global aid including and focused on stillbirths reporting in any year (C) and in both 2002 and 2019 (D). Not all donors in the database reported in every year, and the number of donors reporting has increased over time. As such, the donors reporting in any year figure shows a more complete list of items mentioning newborns and stillbirths. However, it is possible that those that reported only in later years did fund these health areas in earlier years but those funds were not reported and thus are not captured in this analysis.

Figure 3

Trends in global aid mentioning newborns in the context of aid for reproductive, maternal, newborn, and child health, 2002–19 The manually coded estimates for global aid mentioning newborns are shown with Muskoka2 estimates of reproductive, maternal, and child health (which do not mention newborns and stillbirths). This figure includes all donors reporting over any subset of the 2002–19 period.

Figure 4

Trends in global aid mentioning newborns by donor, 2002–19

Figure 5

Equity assessment comparing amount of aid received by recipient country against need (burden of newborn deaths and stillbirths, 2002–19) The 41 least developed countries (as defined by the UN) with more than 10 000 births annually are shown, and the countries are ordered by the size of their cumulative burden of stillbirths and newborn deaths in 2002–19 on the left of the graph. Aid mentioning newborns or stillbirths, or both combined, and focusing on newborns and stillbirths is displayed on the right. Source of neonatal and stillbirth deaths: UNICEF, 2023.