How to Reduce Neonatal Mortality in Iran?

IntroductionNeonatal mortality rate, has significantly declined in Iran over recent decades. The national neonatal mortality rate (NMR) has decreased from around ۳۰ per ۱,۰۰۰ live births four decades ago to approximately ۹ per ۱,۰۰۰ in recent years, with Iran aiming to reduce it to under ۷ per ۱,۰۰۰ by ۲۰۲۵-۲۰۲۶. (۱,۲)The country has already achieved Sustainable Development Goal (SDG) ۳.۲ targets for neonatal and under-۵ mortality in most provinces, though regional disparities persist, particularly in areas like Sistan and Baluchestan and Azerbaijan. This short review outlines key contributing factors and evidence-based strategies to further reduce neonatal mortality, based on recent data up to ۲۰۲۶. (۳,۴)According to the World Health Organization report published on March ۱۴, ۲۰۲۴; although neonatal deaths have decreased by ۴۴% since ۲۰۰۰. However, in ۲۰۲۲, approximately ۲.۳ million neonatal deaths occurred, accounting for ۴۷% of all deaths among children under ۵ years old in the neonatal period, and approximately ۶,۵۰۰ neonatal deaths occur daily. Furthermore, progress has significantly slowed since ۲۰۱۰, and ۶۴ countries will fail to achieve the Sustainable Development Goals target for neonatal mortality by ۲۰۳۰ unless urgent actions are taken.(۱)Additionally, inequities in access to health services have resulted in children having different survival chances based on where they are born, with neonatal mortality rates in ۲۰۲۲ being about ۲۷ deaths per ۱,۰۰۰ live births in Africa, and ۲۱ in Central and Southern Asia. In other words, the risk of death in the first month of birth for a child born in the country with the highest mortality rate is about ۶۰ times higher than in the country with the lowest mortality rate.(۱)The lowest neonatal mortality rate in ۲۰۲۲ was about ۰.۷ deaths per ۱,۰۰۰ live births in Australia and New Zealand.(۱)Main Factors Contributing to Neonatal MortalityLeading causes include preterm birth complications, respiratory distress syndrome (RDS), birth asphyxia, congenital anomalies, and infections such as lower respiratory infections and sepsis. Prematurity and RDS are major contributors, while regional variations show higher rates in low-sociodemographic index (SDI) provinces. Other risk factors encompass maternal conditions like hypertension, eclampsia/ preeclampsia, and lack of antenatal care.(۲.۵.۶.۷)Strategies to Reduce Neonatal MortalityA comprehensive approach integrating infrastructure, training, prevention, and policy is essential:Enhancing Healthcare InfrastructureExpanding Neonatal Intensive Care Units (NICUs) and modernizing equipment like ventilators and monitoring systems can significantly lower mortality. Simulations indicate a ۲۰% increase in NICU capacity could reduce NMR by ۷-۳۵% in high-burden areas like Kerman and Bam. Upgrading surveillance systems for neonatal mortality, birth registries, and hospitalizations supports better detection and response.(۸.۹.۱۰)Capacity Building and TrainingTargeted training for healthcare providers, focusing on the "Golden Hours" post-birth, addresses staff turnover and skill gaps in high-risk provinces like Sistan and Baluchestan. Training over ۴۰۰ neonatal specialists and standardizing protocols have reduced ventilated newborn mortality from ۴۳.۶% to ۲۴% and shortened hospital stays.(۱۱) Preventive Measures and Prenatal CareReducing prematurity through preconception and antenatal care, including corticosteroids, genetic counseling, and surfactant administration, is critical. Promoting exclusive breastfeeding, vaccinations (e.g., rotavirus, pneumococcal), and maternal nutrition programs targets low birth weight and infections.(۱۲) Policy and Social InterventionsEstablishing a single national leadership entity, allocating dedicated budgets, and decentralizing NICUs to minimize transfers are recommended. Programs like the Rural Family Physician Plan, Every Newborn Action Plan (ENAP), and focus on refugee-dense areas promote equity. Digital health interventions post-NICU discharge can improve outcomes and maternal competence.(۱۳) ConclusionIran's progress toward SDG ۳.۲ is notable, with converging mortality trends linked to rising SDI. Achieving an NMR under ۷ per ۱,۰۰۰ by ۲۰۲۶ requires focused efforts on provincial disparities, infrastructure investment, and multi-sectoral collaboration with entities like UNICEF and WHO. Ongoing policy analysis and root cause assessments will ensure sustained reductions