Worldwide more than eight million babies die before or just after birth each year - four million are stillborn and a further four million die before one month of life.

These deaths could be averted by relatively simple measures and commitment to improving newborn health from policymakers. The benefits would be far-reaching - not just saving lives but increasing economic productivity and social contribution, reducing population growth, and saving governments millions in health expenditure later in life.

Newborn health has been neglected from the international health policy agenda but the call for a focus on the crucial perinatal period between 22 weeks of gestation and seven days of life is strengthening. There are a number of reasons why the newborn warrants special focus. Firstly newborn death is a significant problem. The World Bank estimates that perinatal deaths account for 7.3 per cent of the global burden of disease, a figure that exceeds the combined global burden of disease due to malaria and all vaccine preventable infections. As the recent State of the World's Newborns report states, 98 per cent of these deaths occur in developing countries. Recognition of the needs of the newborn and commitment to improving neonatal mortality rates exists on an international level. In September 2000 the United Nations set a number of Millennium Development Goals to reduce poverty related inequalities, and committed to achieving them by the year 2015. One of these eight targets was to reduce by two thirds the mortality rate among children under five. Newborn infants account for two thirds of infant deaths under one year, and 40 per cent of deaths under five. In many countries mortality declines are faltering, reflecting the policy gap that has kept neonatal mortality rates high whilst mortality rates in older children have seen dramatic improvements. Child survival strategies adopted in the last two decades produced a halving of infant mortality rates in Asia, but have had little impact on newborn health outcomes.

The worst threats to newborns are low birth weight, infections, complications arising from prematurity and lack of oxygen during birth. Many infections can be prevented by immunisation and clean delivery of the baby, or overcome by simple, low-cost antibiotics. Low birth weight relates to the health status of the mother before and during her pregnancy, but malnutrition is still widespread amongst mothers in the developing world. It is crucial to confront these threats, not simply for child survival, or because low birth weight and premature babies may suffer disabilities and are less likely to reach their full potential.

Intriguingly, malnutrition in pregnancy may also hold the key to preventing many adult diseases. The foetal origins hypothesis developed by David Barker and colleagues at Southampton University has identified a clear link between poor foetal growth and the risk of diabetes, hypertension and cardiovascular diseases in adulthood. This is particularly important as people live longer and these diseases become more common in the developing world. The burden of disease and accompanying high costs of hospitalisation, drugs and palliative care could be forestalled by health promotion converging on the pregnant mother and unborn child. There is also growing evidence for the importance of in-utero health for future cognitive development. Low birth weight infants (less than 2500g/5lb 7oz) do less well than normal weight newborns on educational and intelligence tests, with long-term implications for social and economic productivity. If a society is to possess a healthy workforce, these factors must be urgently addressed.

One simple way to improve health status of the newborn is to encourage mothers to exclusively breastfeed their baby and continue to the age of four months. Breastmilk is rich in nutrients that cannot be gained from formula milk and are essential for brain growth and a strong immune system. Many developing countries have adopted this stance but Unicef statistics show the UK has the worst breastfeeding rates in Europe: only 27 per cent of our mothers exclusively breastfeed for the recommended period.

Another positive benefit to be gained from improving newborn health is tackling population growth. In many developing countries, children are seen as security for the future. They can share the household chores, contribute to income through paid work, attract dowries through marriage and provide care for their parents in old age. They also represent the time and money invested in rearing them. Consequently, if children are sick or die before adulthood, many families believe it pays to have as many children as possible in the hope that at least some will survive to fulfil expectations. Fertility rates will stay high unless newborn survival is assured. Mothers are also prone to become pregnant again soon after suffering a perinatal loss due to the desire for a "replacement" baby.

However this cycle can be counterproductive. Babies born less than two years after a sibling are more likely to be smaller, and more at risk of infection and death than births spaced at greater intervals. Research shows mortality rates for these infants are 54 percent higher than those spaced between two and three years apart. Spacing pregnancies gives the mother's body time to recover from the previous pregnancy, particularly important when many women are anaemic or suffering nutritional deficiencies before conception. Similarly babies are healthier when the mother is between the ages of 20 and 45. The UK Department of Health's programmes to reduce teenage pregnancy recognise this fact and are contributing to the fight to lower neonatal mortality and fertility rates.

No population in the developing world has experienced a sustained decline in fertility rates without first experiencing a major decline in infant and child mortality. In settings where neonatal mortality rates drop, women are more likely to space their pregnancies, thus contributing to the demographic transition from high fertility and mortality to low fertility and mortality. Consequently there is a direct correlation between bigger, healthier babies and a slow down of population growth.

Many organisations, including DfID, WHO and the Gates Foundation, are working together to promote low cost, effective ways to reduce newborn mortality. But much greater investment is needed for mother and newborn health. The vision and skills to put these policies into practice is one of our biggest international health challenges, and an opportunity we can't afford to miss.