Every year, the World Health Organization (WHO) publishes its World Health Statistics Report. Mortality rates of children show that newborns are at highest risk not to survive. The newest numbers reveal that in 2018, 47% of under-five deaths occurred within the first 28 days of life, also called the neonatal period.
The situation for newborns is the most severe in low-income and lower middle-income countries where in 2017 approximately 5% of children died within their first month of life. The situation was already better in upper middle-income countries which had a neonatal mortality rate of approximately 2,5%. However, in high-income countries, the mortality rate did not even reach the 1%-level. This means that a baby born in a family that lives in a low-income or lower-middle income country is over 5 times more likely to die within its first weeks of life than a baby born in a family in a high-income country. What are the reasons for having these large differences among different countries?
The most frequent cause of neonatal deaths worldwide in 2018 was prematurity. At the event of prematurity, the chance of a baby to survive seems to depend a lot on where this baby was born. In high-income countries, less than 10% of extremely preterm born babies die. In contrast, the rate of low-income countries amounts to more than 90%.
According to the WHO, a premature baby can still be saved through the provision of basic health care before, during and after the birth of a child.
Poverty and the use of healthcare
Newborns receiving healthcare before and at childbirth basically means pregnant women receiving healthcare. A poor person however is less likely to make use of basic health care and women are at a higher risk to face poverty than men.
Let’s take a closer look at the consequences of poverty for the use of healthcare services. What everyone easily understands is that poverty reduces a person’s capability of making high out-of-pocket health care expenditures. But there is also another potential consequence.
A person’s brain has an automatic system for small everyday processes that we do not think about much. A more complex system is used for thinking processes for which we need our concentration and logical thinking.
It has to be pointed out that poverty leads to stress. This has an impact on a person’s decision making process. If a person is stressed then this person is less likely to be able to make use of the second system. In other words, a person’s cognitive resources decrease in the event of poverty.
Making smart decisions about preventive healthcare or the conclusion of an insurance belong to those decisions for which system 2 must be activated.
The fact that poor people are less likely to be insured and to seek preventive health care might therefore not only be a direct result of poverty due to the lack of money. It might also be an indirect result in consequence of stress that occurs due to poverty. This knowledge must be kept in mind if one looks at the use of healthcare services by pregnant women and newborns in low-income countries.
Implications for the provision of healthcare
Provision of free health care services for pregnant women and newborns in low-income and lower middle-income countries through the offer of a free of charge membership in a health insurance has been recognized as an instrument to increase their use of healthcare. What has not been enough recognized is the fact that people living in poverty are at risk not to think about these things as they require system 2 and therefore do not register with the insurance. This risk must be eliminated by making pregnant women and their newborns automatic members of a health insurance so that poor women do not need to actively insure themselves in the event of pregnancy.
The urge for a free of charge health insurance for pregnant women and newborns in the fight against neonatal mortality has been recognized. But the urge for obtaining the membership automatically has not. However, this aspect should also be taken into account in order to save the lives of newborns.
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