Across the world, a child's survival is a lot like drawing a lottery ticket. Factors based purely on chance — where a child is born, how much money his or her family has and what their ethnic background is — can determine if a child lives past age 5.

That's the conclusion from a report published last week by Save the Children, which looked at survival rates in 87 low- and middle-income countries. In 78 percent of the countries, efforts to reduce mortality have left out at least one ethnic group or economic class. At the same time, simple interventions are preventing deaths in countries like Malawi and Bangladesh.

MaMoni is one of the success stories. The program's name means "mother-child" in Bengali. The director, Dr. Ishtiaq Mannan, works with the government to train health care workers to help mothers in underserved districts safely deliver their babies, to educate families about how to care for a newborn and to get mothers the support they need as quickly as possible. Funding comes from the U.S. Agency for International Development.

Bangladesh still sees 129,000 deaths of children under 5 each year, but in the last two decades, the mortality rate has fallen from 144 deaths to 41 deaths per 1,000 births. And while gaps remain between different socioeconomic groups, families in hard-to-reach rural areas are getting more help.

The interview has been edited for length and clarity.

What is one of the most challenging things about saving a child?

In some districts where we've worked, there is a tradition, particularly in Muslim families, to bathe the child [right after] he is born. Without bathing the newborn, [the families] don't think he or she will be pure or holy. The problem is, the baby gets cold. The newborn is kept on the floor and not attended to for quite some time — 10 to 15 minutes. All the people in the delivery [room] are attending the mother. By that time, the newborn [risks] getting pneumonia. It took a lot of negotiation with the families to make them understand that you need to immediately dry, wrap and cover the newborn, and that the life of the newborn is more important [than the] religious ritual.

Are pregnant women able to get medical care when they need it?

There are not many service providers — facilitates, doctors or nurses — around in some areas. So there is not always care available in the right quality at the right time in the right place. In some hard-to-reach areas, it can take six to seven hours for families to travel to the nearest health center. There are also shallow areas where half of the year, things go under water. During that time, the mode of travel becomes boat. It's very difficult for pregnant mothers, who will travel when there is a complication or impending labor. People try all the modes of travel: Sometime they hang the mother over their shoulders, they carry the mothers in hammocks and they use pull carts.

What's it like when a baby is on the brink of death?

For a mother it's the most horrifying experience when her baby dies. Birth asphyxia is a very common cause, so when a child is born and people see that the baby is not breathing, [everyone] panics — from the birth attendant to the family members waiting anxiously to hear the first cry to the extended family. At one hand there is a feeling of sadness and frustration, but there's also the desperation of seeking care. What we are seeing is that people are very fast to seek out health care providers — who are sometimes simple health care community members or paramedics, and who try desperately to apply what they can, like rubbing the back of the newborn.

In those situations, what's made the difference?

The belief in the community that things can change. There are moments, year after year, when people have felt helpless, like they [can do] nothing but wait, and then see the children and mothers dying. But through our work and other organizations, and the government, people now have a strong belief that there is a way out, if you act quickly. We have seen that even a poor family can organize [its neighbors] to transport a child to the health care center.

As a doctor who sees so many deaths, do you stay optimistic?

We believe that things can change. And the community that we work with also believes that. People are finding innovations: small things that don't need high technology. Overall the last seven years, communication has improved a lot in Bangladesh, a country where cellphone coverage is so much. It's been used in so many aspect of life that it has become [a] tremendous technology blessing. Obstacles are being removed as people find out more information. Seeing small things work is keeping us optimistic.

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