Declaration of the newborn's rights

Giving birth is both a political and social event. It belongs to the history of each individual newborn, the woman and man to whom the child is born and to society as a whole. The problems of perinatal medicine pose a surprising number of questions of an ethical nature. It is necessary for this issue to move out of the rooms of the people directly involved and become a topic of general discussion shared with the entire society, especially women. As I wrote previously and as I reaffirm, the way in which these fundamental principles are dealt with not only produces effects on the individuals specifically involved (patients and health operators), but it can also have long-lasting effects on humanity as a whole. The freedom and awareness of conceiving and generating a child entitle everyone to dialectically question the maternal-foetal-neonatal sciences to assess the beneficial aspects, in other words, the potentially harmful effects for the health and happiness of man [1]. These issues focus on the centrality of the interdependence between social values and ethical values.

Social and ethical values are central to any organisation, including the scientific world. What exactly do we mean by values and ethics? ‘Values are what we, as a profession, judge to be right’. Individually or organisationally, values determine what is right and what is wrong, and doing what is right or wrong is what we mean by ethics. To behave ethically is to behave in a manner complying with what is right or moral. However, both are extremely broad terms, and we need to focus on the aspects most relevant for perinatology. Perhaps the first places to look in determining what is right or wrong in our field are the scientific societies. Virtually every scientific society makes some definition of morally correct behaviour. Setting priorities for promoting an organisational culture is a problem for all educational teams, including medical associations. This is particularly true in view of the fact that the demand for educational activities often exceeds the supply of resources allocated to finance them. Many scientific institutions believe in the need to introduce ethical themes into their ‘training agendas’. Nevertheless, the level of importance via which ethics are perceived by professionals has never been explored. In today's scientific medical community it is stated that there are real benefits in building an ethical culture, however, this is very often simply perceived by the medical profession as theoretical principles of doctrine which many are unfamiliar and or feel to be outside their jurisdiction. Recently, it has been demonstrated that neonatologists and obstetricians perceive ethics in perinatal medicine as a framework of clinical cases rather than as a discipline per se [2].

The newborns and the women they are born to demand observance of their primary requirements to guarantee their maximum health potential. These unquestionable rights concern the first phase of life.

Over recent decades, profound socio-economic and health changes have generated significant issues which call for the defining and sharing of principles for standardising the sort of action to be taken.

These conditions interact with society as a whole and the decisions connected to the same focus on important human, ethical, social-economic and health aspects. The numerous documents containing statements regarding the rights of children fail to stress in an exhaustive manner the specific areas in defence of the rights of newborns. It is therefore necessary to initiate comparisons and discussions in the aim of stimulating open dialogue among senior policy makers and defining the basic human rights of newborns and their mothers.

The main issues are the following:

1. the newborn's right to be born in conditions of peace. The event of birth testifies to the continuation of the human species, the son of man is reborn, humanity is reborn. Wherever the son of man is born, man must not cause death. Wherever children are born in war zones, these zones must be considered as weapon-free areas.

2. The newborn's right to be born in conditions of justice. Man must fully apply concepts of social justice for the most significant paradigmatic event of his life: his birth. Justice should be applied to the entire society and ensure that mothers and newborns also receive fair treatment and a just share of the benefits of society.

3. The newborn's right to be born in conditions of safety. Disadvantaged populations are at an increased risk of a number of conditions or diseases with strong environmental components, including low birth weight and high infant mortality. The low-weight birth rate in developing countries is rising sharply. Contrary to industrialised countries where the phenomenon depends prevalently on preterm births, in developing countries this depends on delays in intrauterine growth.

4. The newborn's right to be nurtured in a healthy environment. The social environment encompasses lifestyle factors that may affect health. Environmental factors can influence newborn health. Consequences of human alteration to the natural environment, such as air pollution, are also part of the man-made environment. Newborn health focuses on health risks and hazards associated with the adverse man-made environment.

5. The newborn's right to receive appropriate care when ill. After birth, every newborn has the right to receive loving care and all necessary assistance, especially those with pathologies requiring medical care. Analgesia must be available whenever required, and all forms of aggressive therapy must be prevented. No newborns (and in particular extreme preterms) should be subjected to futile treatment, nor should they ever die alone [3–5].

6. The newborn's right not to lose its mother after birth.

7. This latter issue is the absolute antithesis of human experience: birth and death, death of the mother during childbirth. In the ancient world, maternal mortality related to childbirth and its consequences was extremely high, estimated by some sources as between 5 and 10%. It is no wonder that Medea (Euripides, Medea, 250–251) declares ‘I would have preferred to go to the front three times rather than give birth to a child’ thereby stressing its high risk. Even today in certain parts of the world maternal mortality is still prohibitive.

Despite the substantial progress in many middle-income countries, the levels of maternal mortality remain unacceptably high, especially in Africa and Southern Asia. Each year, more than 500,000 women worldwide die giving birth to a child due to complications during pregnancy or childbirth, an event that has become exceptional in the industrialised world. Each year at least 24,000 women die in Afghanistan from childbirth or related infections and it is estimated that 87% of these deaths could be avoided, 70% of women do not receive any medical assistance during pregnancy, 40% do not have access to emergency obstetric care, and 48% suffer from iron deficiency. In some areas of this country, one woman in six dies during childbirth (UN and WHO data, 2007).

Each year in the African continent approximately 250,000 women die during pregnancy or childbirth or immediately after birth. Women in sub-Saharian Africa have the highest probability in the world of dying during childbirth (1 in 13 vs. 1 in 4100 in industrialised countries). On average, one woman out of 75 still dies during childbirth today. One of the Millennium Development goals for 2015 is to reduce mortality related to childbirth by 75%. Overall, 38% of deaths are caused by obstetric complications, and 48% are caused by infectious diseases that are not directly connected with pregnancy and childbirth. Four diseases, AIDS, pyogenic pneumonia, severe malaria grave and pyogenic meningitis are the main cause of birth-related deaths in more than four women in 10. Of the deaths attributed to complications directly related to pregnancy and childbirth, the most common cause of death is heavy blood loss during childbirth. Consequently, deaths during childbirth in this part of Africa could be significantly reduced if effective treatments for AIDS, malaria and bacterial infections were adopted. Each year 4 million newborns die during the first month of life and 99% of these cases occur in countries with low to medium incomes. Children born in the poorest countries have the highest risk of death where there an infantile mortality rate 19–44% higher than in the high-income countries. In 70% of cases, death could be avoided if appropriate measures were implemented effectively. These interventions are not strictly related to advanced technologies, but rather, to the presence or absence of qualified personnel capable of providing the most suitable care. The main purpose of neonatal medicine is to promote and disseminate the study, research and knowledge of all aspects of this field, to attain, by all appropriate means, a higher level of physical and mental health for mothers and children by improving the quality and observance of their rights all over the world.

Measuring Ethical Culture: the same relationship exists between the power of speech and the disposition of the soul, as between the administration of drugs and the nature of the body. For while In fact, while some drugs elimate specific humours from the body, there are others that will stop the disease and others that will stop life. (Gorgia, Encomio di Elena, 483 ac.). This is an analogy between the word and the drug, now intended as either the remedy or the poison. With regard to speeches, some produce pain, others delight, others fear and some inspire courage in the listeners. In this case the words that provide the remedy are those of previous Secretary General of the United Nations: ‘The Millennium Development Goals, particularly the eradication of extreme poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And that means stronger efforts to promote women's rights, and greater investment in education and health, including reproductive health and family planning’ [6].