More than one million babies die the day they are born every year, and the 14 countries with the highest rates of first-day deaths are all in Africa, according to a new report.
Somalia, Congo, Mali, Sierra Leone and Central African Republic are the five countries with the highest rates of such deaths, according to the report "Surviving the First Day" from the aid group Save the Children.
"Health care for mothers in sub-Saharan Africa is woefully insufficient. On average, only half the women in the region receive skilled care during birth," the report said.
"The region as a whole has only 11 doctors, nurses and midwives per 10,000 people, less than half the critical threshold of 23 generally considered necessary to deliver essential health services."
The numbers in Somalia - a country wracked by 20 years of violence with little established government and few health services - are particularly grim.
Eighteen out of 1,000 babies in Somalia die the day they are born, the report said. Five per cent of newborns die within the first month of life and one in six won't live to age 5, it said.
"What's worse, Somalia has seen absolutely no improvement in newborn or child survival in at least two decades," it said.
Somali women have on average more than six children, the second-highest fertility rate in the world.
Pre-birth care to expectant mothers is largely not available in Somalia, said Dr Omar Saleh, a World Health Organization official who frequently travels to health facilities in rural Somalia.
"And then the natal care itself, which is delivery, some of the obstructed labours are delayed due to the long distances to medical care or insecurity or high prices of transport," Saleh said.
"And then after delivery the main thing is the availability of incubators. And the whole science of neo-natal care is a huge science that is not well developed in Somalia."
The one positive: "Everybody is working on it," he said. "The good thing is that everybody is aware." In terms of absolute numbers, the most first-day deaths occur in India - more than 300,000 per year, the report said.
Nigeria has nearly 90,000 per year.