Each year, some 15 million babies in the world, more than one in 10 births, are born too early, according to Born Too Soon: The Global Action Report on Preterm Birth, released today by Save the Children, The March of Dimes Foundation, the Partnership for Maternal, Newborn & Child Health and The World Health Organization. Sadly the report points out that India has the maximum number of preterm births with 3,519,100 of them, almost 24% of the total number.
More than one million of the 15 million babies prematurely die shortly after birth; countless others suffer some type of lifelong physical, neurological, or educational disability, often at great cost to families and society.
“Being born too soon is an unrecognized killer,” says Joy Lawn, M.D., PhD, co-editor of the report and Director, Global Evidence and Policy for Save the Children’s Saving Newborn Lives program, and coordinator of the team that undertook the estimates. “Preterm births account for almost half of all newborn deaths worldwide and are now the second leading cause of death in children under 5, after pneumonia, and six times more than child deaths due to AIDS.”
New figures in the report show both the magnitude of the problem and the disparities between countries. Of the 11 countries with preterm birth rates over 15 percent, all but 2 are in sub-Saharan Africa. Sixty percent of preterm babies are born in South Asia and sub-Saharan Africa. Yet preterm birth is a truly global problem. The United States and Brazil both rank among the top 10 countries with the greatest number of preterm births. In the United States, for example, about 12 percent, or more than one in nine of all births, are born preterm, double the rate of China and most European countries.
The countries with the greatest numbers of preterm births are:
India - 3,519,100; China - 1,172,300; Nigeria - 773,600; Pakistan - 748,100; Indonesia - 675,700; United States - 517,400; Bangladesh - 424,100; Philippines - 348,900; Democratic Republic of the Congo - 341,400; and Brazil - 279,300.
The 10 countries with the highest rates of preterm births for every 100 births are:
Malawi-18.1 per 100; Comoros and Congo-16.7; Zimbabwe-16.6; Equatorial Guinea-16.5; Mozambique-16.4; Gabon-16.3; Pakistan-15.8; Indonesia-15.5; and Mauritania-15.4.
Those contrast with the 11 countries with the lowest rates of preterm births:
Belarus-4.1; Ecuador-5.1; Latvia-5.3; Finland, Croatia, and Samoa-5.5; Lithuania and Estonia-5.7; Antigua/Barbuda -5.8; Japan and Sweden-5.9.
“The numbers of preterm births are increasing. Of the 65 countries with reliable trend data for preterm birth rates, all but 3 countries have shown increases in the last 20 years,” says Dr. Lawn. “Worldwide, 50 million births still happen at home and many babies die without birth or death certificates. These first ever country estimates give us a clear picture of how many babies are born too soon and how many die.”
In high-income countries, the increases in the number of preterm births are linked to the number of older women having babies, increased use of fertility drugs and the resulting multiple pregnancies, and lifestyle challenges such as obesity, smoking and diabetes. Medically unnecessary inductions and Cesarean deliveries before full-term have also increased preterm births. In many low-income countries, the main causes of preterm births include infections, malaria, HIV, and high adolescent pregnancy rates. In rich and poor countries, many preterm births remain unexplained.
Wide differences within countries were found. For example, in the United States the preterm birth rate in 2009 for black Americans was as high as 17.5 percent, compared with 10.9 percent for white Americans. The age of the mother made a significant difference. In the U.S., the preterm birth rate for women aged 20 to 35 was between 11-12 percent; it was more than 15 percent for women under 17 and over 40.
But the most startling gap highlighted in the report is the survival gap for preterm babies depending on where they are born. In low-income countries, more than 90 percent of extremely preterm babies (younger than 28 weeks or more than 3 months early) die within the first few days of life, while less than 10 percent die in high-income countries.
“This 90: 10 survival gap means these babies are not just born too soon — they are born to die, with even their families not knowing there are highly effective solutions that could save their lives”, emphasizes Dr. Lawn, “A number of countries, for example, Ecuador, Turkey, Oman and Sri Lanka have halved their neonatal deaths from preterm birth through improving care of serious complications like infections and respiratory distress.”
Evidence-based solutions include:
- Antenatal steroid injections for mothers in premature labor, which cost $1 per injection. This helps develop immature fetal lungs and prevent respiratory problems; yet, in low-income countries, they are currently only given to 10 percent of those in need. This alone could save almost 400,000 lives of babies a year.
- “Kangaroo Mother Care” where the newborn is held skin-to-skin on the mother’s chest to keep warm, making frequent breastfeeding easy, preventing infections and provides constant maternal supervision. This could save 450,000 lives a year.
- Antiseptic cream, chlorhexidine, to prevent birth cord infection and antibiotics to fight infection.
An estimated three-quarters of those preterm babies who die could survive without expensive care if proven and inexpensive treatments and preventions were available for all babies wherever they are born. Skilled frontline workers, especially midwives and nurses with the right skills are the most critical needed.
Born Too Soon culminates with a new, globally agreed goal to half the number of babies dying from preterm birth by 2025. This can be achieved but requires preterm birth to receive attention around the world, policymakers to invest and implement and the voice of affected parents to be heard.
Content Courtesy: Save The Children