Network advocacy and the emergence of global attention to newborn survival.

Globally 2.9 million babies die each year before reaching 28 days of life. Over the past quarter century, neonatal mortality has declined at a slower pace than post-neonatal under-five mortality: in consequence newborns now comprise 44% of all deaths to children under five years. Despite high numbers of newborn deaths, global organizations and national governments paid little attention to the issue until 2000, and resources, while growing since then, remain inadequate. This study examines the factors behind these patterns of policy attention: the delayed emergence of attention, its sudden appearance in 2000, its growth thereafter, but the dearth of resources to date. Drawing on a framework on global health networks grounded in collective action theory, the study finds that a newborn survival network helped to shift perceptions about the problem's severity and tractability, contributing to the rise of global attention. Its efforts were facilitated by pressure on governments to achieve the child survival Millennium Development Goal and by growing awareness that the neonatal period constituted a growing percentage of under-five mortality, a fact the network publicized. The network's relatively recent emergence, its predominantly technical rather than political composition and strategies, and its inability to date to find a framing of the issue that has convinced national political leaders of the issue's urgency, in part explain the insufficiency of resources. However, since 2010 a number of non-health oriented inter-governmental organizations have begun to pay attention to the issue, and several countries with high neonatal mortality have created national plans, developments which augur well for the future. The study points to two broader implications concerning how neglected global health issues come to attract attention: priority emerges from a confluence of factors, rather than any single cause; and growth in priority may depend on the creation of a broader political coalition that extends beyond the largely technically oriented actors who may first press for attention to a problem. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine