The Global Toll of Preterm Births

By Roberta Attanasio

Too many babies are born too soon – not ready for life outside the womb – year after year.

In May 2012, the World Health Organization (WHO), the Partnership for Maternal, Newborn & Child Health, Save the Children and the March of Dimes, published a report (Born too soon: the global action report on preterm birth) that included the first-ever estimates of preterm birth by country.

At the time it was released, Dr. Joy Lawn, one of the report co-editors, said “Being born too soon is an unrecognized killer. 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.”

Globally, more than 15 million babies are born prematurely (before 37 completed weeks of gestation) each year, with over a million neonatal deaths from complications of preterm birth.

The ten countries with the highest 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 United States account for 42% of all preterm births in developed countries. A New York Times article explains why the “U.S. Lags in Global Measure of Premature Births.”

According to the Born Too Soon report, “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 resulting multiple pregnancies. In some developed countries, 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.”

“The report also focuses on the dramatic survival gap between low-income and high-income countries for babies born before 28 weeks,” said Dr. Christopher Howson, a co-editor. “In low-income countries, more than 90 percent of extremely preterm babies die within the first few days of life, while less than 10 percent die in high-income countries.”

However, the report also states that more than three-quarters of premature babies can be saved with feasible, cost-effective care, as for example antenatal steroid injections (given to pregnant women at risk of preterm labor to strengthen the babies’ lungs), kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding) and antibiotics to treat newborn infections – even without the availability of neonatal intensive care.

Strong research programs are needed to clearly identify and understand the large variety of risk factors associated with preterm births, so that appropriate action cane be taken to limit the number of  “born too soon” babies.