It’s time all babies had a Healthy Start

Fleur Anderson, WaterAid’s Global Head of Campaigns, explains why safe water, toilets and good hygiene are a matter of life or death for newborn babies in the world’s poorest communities. She outlines what can and must be done to stop more lives being lost in those first crucial moments.


17 Mar 2015

I’ve had four children – three born in hospital and one at home (on purpose!). Each time I didn’t have to worry about whether there would be clean water available to keep me and my baby clean. Once I got to the hospital my husband was never asked if we had brought our own water. I didn’t have to think about whether the delivery bed had been cleaned since the last new mother was there. And I didn’t need to inspect the scissors used for cutting the umbilical cord – I just trusted they were clean and wouldn’t infect my baby.

Shocking figures

In many developing countries, clean water and hygienic conditions in hospitals and birthing clinics are seen as ‘nice to have’ rather than essential for staff, mothers and babies. Sepsis is the cause of 18-20% of neo-natal deaths in Sub-Saharan Africa and South Asia. This invasive infection is normally caused by bacteria, and clean water, sanitation and hygienic practices can dramatically reduce the risk. Half a million babies die each year in their first month of life because they have been born into unhygienic conditions.

Before now, it was unknown how many clinics had clean water and safe sanitation, but this week new World Health Organization and UNICEF research shows us the true picture for the first time. Shockingly, it reveals that 38% of hospitals and clinics in 54 low and middle-income countries do not have access to any water source. And of the healthcare facilities that have some water access, only half of those have reliable or safe supplies. What’s more, 19% do not have any toilet facilities and over a third (35%) of hospitals and clinics lack anywhere for staff or patients to wash their hands with soap.

Alarming as these figures are, even if hospitals and clinics are defined as having access to water, the supply may be up to half a kilometre away from the facility, rather than piped into the premises. So although we now know a lot more – the situation is even worse that these statistics show.

A new campaign

Registered Nurse Esther Mongi examines 19-year-old Rose Vincent, 9-months pregnant with her first child. Mlali Health Centre, Mlali Village, Mvomeru Disctrict, Morogoro, Tanzania - August 2014
Registered Nurse Esther Mongi examines 19-year-old Rose Vincent, 9-months pregnant with her first child, at  Mlali Health Centre, Tanzania. Photo: WaterAid/ Eliza Deacon.

This World Water Day, we are launching a new report Healthy Start: the first month of life. It reveals the devastating impact of a lack of safe water and sanitation on newborn babies in developing countries, and the impact this has on staff. As Esther Mongi, a midwife a the Mlali Health Centre in Tanzania, says, “Previously when the health centre had no water we would advise relatives to bring three jerry cans of water when a mother came for delivery, but this was not clean and safe water. We felt bad and sometimes we felt demoralised because how can you work in a health facility without enough water?”

Healthy Start is also the name of WaterAid’s new four-year child health campaign. Together with healthcare professionals, we will be drawing attention to the need for healthcare policies to include safe water, sanitation and hygiene as essential for improving child health, and calling for action. The UN Sustainable Development Goals are close to being finalised, and this new research underlines the need for a water and sanitation goal, so that child health goals can be achieved.

We know that having safe water, sanitation and hygiene will save lives. We know that this is what healthcare professionals want. And we know that it is achievable if it is given priority by national and local governments – number four on this list would be a good place to start.

What needs to be done

  1. Safe water, sanitation and hygiene (WASH) services are embedded in all plans for reducing undernutrition, acute malnutrition, preventable childhood disease and newborn deaths, and/or in broader health systems plans that encompass any or all of these objectives. Finances are made available and used accordingly.
  2. International and national health and nutrition initiatives include WASH in their policies and  are financed, monitored and delivered.
  3. Every healthcare facility has clean running water, safe toilets for patients (separate for men and women, with locks and lights, child-friendly and accessible to people with disabilities), functional sinks and soap for health workers and patients in all treatment and birthing rooms.
  4. No new healthcare facilities are built without adequate, sustainable water and sanitation services.
  5. Healthcare workers are committed to including good hygiene practice and promotion in their professional training, plans and actions. Staff and patients are informed and empowered to practise good hygiene.
  6. Every birthing centre ensures basic hygiene and sterile conditions, particularly in delivery rooms and operating theatres – such as handwashing with soap, repeated cleaning and disinfection of facilities, and safe separation of human and medical waste from human contact.
  7. The monitoring and assessment of progress towards universal health coverage includes data on the availability of water, sanitation and hygiene services in healthcare facilities and households to inform strategies and planning.
  8. The Sustainable Development Goals include a dedicated goal for water and sanitation with ambitious targets for universal WASH access by 2030. The framework ensures integration between WASH targets and health targets, such as universal health coverage and prevention of under-five and maternal mortality.

Fleur Anderson is WaterAid’s Global Head of Campaigns. For global policy, practice and advocacy updates and discussion, follow @wateraid on Twitter.