Over 60% of global premature births take place in Africa and South Asia. The majority of deaths in newborns, defined as babies under 4 weeks old, is attributable to prematurity. The number is so great that prematurity is the second leading cause of death for children under 5 years old. The good news is that the majority of the deaths caused by prematurity are avoidable.
An estimated 15 million babies are born early around the world every year. Of those babies, 1.1 million die. Three quarters of those deaths can be avoided, says a new report, Born Too Soon: The Global Action Report on Preterm Birth, by The March of Dimes Foundation, The Partnership for Maternal, Newborn & Child Health, Save the Children and The World Health Organization.
"These facts should be a call to action. Fortunately, solutions exist," says UN Secretary General Ban Ki-Moon in the report's introduction. "Ensuring the survival of preterm babies and their mothers requires sustained and significant financial and practical support."
Preterm births are on the rise. Of the 65 countries with reliable birth data, only three are not experiencing an increase in preterm birth rates. The difference between high and low income countries for preterm survival is stark. "Over 90% of extremely preterm babies of extremely preterm babies (<28 weeks) born in low-income countries die within the first few days of life; yet less than 10% of babies of this gestation die in high-income settings," says the report.
The 10 countries with the highest rates of preterm births for every 100 births are: Malawi 18.1; 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. To reduce the number of unnecessary preterm births and deaths, a twin-path approach of reducing the number of preterm births and improving the care of preterm babies is suggested.
The health of the mother plays a large role in whether she is likely to give a preterm birth. Factors include the age of the mother (too young or too old), if she has an chronic diseases and if she is either under or overweight. Educating women about these risks coupled with the availability of family planning options can empower the mothers to when and how to become pregnant. For those who do become pregnant, antenatal packages can help healthcare professionals identify and treat chronic diseases and vitamin deficiencies.
Prevention will be the key, says Elizabeth Mason, M.D., Director of Maternal, Newborn, Child and Adolescent Health at the World Health Organization and a major contributor to the report. “We are now looking closely at what can be done before a woman gets pregnant to help her have an optimal outcome," says Dr. Mason. “We know that poverty, women’s education, malaria and HIV all have an impact on the pregnancy and the health of the baby.”
The second focus is ensuring the survival of preterm babies. One recommendation is for the mothers to employ the "Kangaroo care" method. Mothers are told to hold the baby on their chest to encourage skin-to-skin contact. Doing so ensures that the baby stays warm and encourages breastfeeding, both important to a premature baby. The authors estimate Kangaroo care could save 450,000 lives a year.
Chlorhexidine cord care is suggested as a way to prevent infections. Earlier this year, a study in Nepal showed how washing the umbilical cord with a chlorhexidine solution is a cheap and easy way to save lives. "The advantage of the intervention is the ease of application. Community health workers, hospital staff, midwives and even mothers can be trained in applying the chlorhexidine solution," said Dr. Abel Irena, PSI Research Adviser on Child Survival.
Though the solutions are relatively simple in theory. The challenge will be implementation. Data for some countries is less than reliable which presents a challenge for addressing the needs of mothers and children and assessing the impact of the interventions employed.
Fortunately, the recommended interventions will support all women and children. Providing health information to mothers, teaching young girls about family planning, and reducing unattended births will all support the health and welfare of women and their children. As Dr Mason explains, "All women need access to antenatal care. In many of the low-income countries, a woman has her first antenatal care at the time of delivery. Having early antenatal care is critical for all women.”