Worldwide, the riskiest day of a child’s life is the first day, says a report from Save the Children, which also suggests inexpensive strategies to reduce the annual toll of more than one million babies that die the day they are born.

The report released Tuesday compiles a list of birth-day death rates for 186 countries and provides an annual Mothers’ Index, which examines the best and most difficult countries in the world to be a mother.

Finland tops the ranking of 176 countries based on the health of women and children, education, economic well-being and female participation in politics, while Congo ranks at the bottom. Canada sits in 22nd spot, ahead of the U.S. in 30th place.

Although only one per cent of newborn deaths occur in industrialized countries, the U.S. has the highest first-day death rate among developed countries, followed by Canada and Switzerland.

Globally, child mortality has declined by more than half since 1970, the report says, even as the world population has doubled, but a rising share — 43 per cent — is occurring in the first month of life, a toll of 19,000 babies each day. Each year, about one million babies will die the day they are born — three million within the first month — and about three-quarters of those deaths are preventable, Save the Children says.

The report identifies three major causes of newborn mortality — birth complications, premature birth and infections — and says that universal access to products that cost between 13 cents and $6 each could save more than one million babies a year. The recommended products are:

Steroid injections for women in preterm labour (to reduce deaths due to premature babies’ breathing problems).

Resuscitation devices (to save babies who do not breathe at birth).

Chlorhexidine umbilical cord cleansing to prevent infections.

Injectable antibiotics to treat newborn sepsis and pneumonia.

U.S., Canada lag

By country, first-day deaths occur most in India (more than 300,000 each year), while the highest first-day death rate is in Somalia (18 per 1,000 live births). Luxembourg, Singapore and Sweden have the lowest death rate (less than 0.5 per 1,000 live births).

Although first-day mortality is most severe in the developing world, Save the Children notes that among industrialized countries the U.S. has by far the highest newborn mortality, with 60 per cent of first-day deaths but only 38 per cent of live births. Some U.S. counties have first-day death rates similar to those in developing countries, the report says.

The U.S. pre-term birth rate is the second-highest in the world, and complications from premature births are the cause of more than 35 per cent of newborn deaths in the U.S. The U.S. has the highest adolescent birth rate of any industrialized country, and teen mothers tend to be poorer, less educated and receive less pre-natal care.

Mothers' Index

European countries and Australia hold top position in Save the Children’s Mothers’ Index, while countries in sub-Saharan Africa rank at the bottom. The U.S. and Canada sit in 30th and 22nd spot respectively.

Finland ranks at the top of the Mothers’ Index, based on strong showings in all five indicators of the index, which are:

Lifetime risk of maternal death.

Under-five mortality rate.

Expected years of formal schooling.

Gross national income per capita.

Participation of women in national government.

Congo ranked in the bottom 12 per cent of countries in all five categories.

Patricia Erb, Save the Children's president and CEO, said research shows the importance of investing in mothers and children.

"The prosperity and stability of a country improves as women are better educated, have better personal incomes and are politically represented," Erb said in a release. "When women do better their children are healthier and do better in school. It starts a virtuous cycle of development. We have made great progress around the world but much more can be done to save and improve millions of the poorest mothers’ and newborns' lives."

In a foreword to the report, Melinda Gates of the Bill & Melinda Gates Foundation writes that saving newborn lives "will prevent incalculable suffering. It is also a vital piece of the global development agenda. The long-term economic prospects of poor countries depend on investments in the health, nutrition and education of the people, particularly the women and young children living there."