News release
WHO,2 May 2012
1.1 Million preterm babies die every year, but with inexpensive treatment 75% could survive
2 May 2012 | New York -
Each year, some 15 million babies in the world, more than one
in 10 births, are born too early, according to the just released report
Born too soon: the global action report on preterm birth.
More than one million of those babies die shortly after birth;
countless others suffer some type of lifelong physical, neurological,
or educational disability, often at great cost to families and society.
An estimated three-quarters of those preterm babies who die
could survive without expensive care if a few proven and inexpensive
treatments and preventions were available worldwide, according to more
than 100 experts who contributed to the report, representing almost 40
UN agencies, universities, and organizations. The report explains what
is known about preterm birth, its causes, and the kinds of care that are
needed.
The lead authors of the report from The March of Dimes
Foundation, The Partnership for Maternal, Newborn & Child Health,
Save the Children and The World Health Organization, offer a detailed
plan for the actions needed to reduce both the death toll and the
numbers of preterm births.
First-ever country figures for a large, but neglected problem
Preterm births have been an overlooked and neglected problem, world health leaders say.
“All newborns are vulnerable, but preterm babies are acutely
so,” says UN Secretary General Ban Ki-moon, who wrote the foreword to
the report and considers the effort to reduce preterm births and deaths
an integral part of his
Global strategy for women’s and children’s health.
“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. “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.”
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%, all but 2 are in sub-Saharan Africa.
Preterm births account for 11.1% of the world's live births, 60% of them
in South Asia and sub-Saharan Africa. In the poorest countries, on
average, 12% of babies are born too soon, compared to 9% in
higher-income countries.
The problem of preterm births is not confined to low-income
countries. The United States and Brazil both rank among the top 10
countries with the highest number of preterm births. In the United
States, for example, about 12%, or more than one in nine of all births,
are preterm.
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
- Brazil – 279 300
The 10 countries with the highest rates of preterm births for every 100 births are:
- Malawi – 18.1 per 100
- Comoros – 16.7
- Congo – 16.7
- Zimbabwe – 16.6
- Equatorial Guinea – 16.5
- Mozambique – 16.4
- Gabon – 16.3
- Pakistan – 15.8
- Indonesia – 15.5
- 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 – 5.5
- Croatia – 5.5
- Samoa – 5.5
- Lithuania – 5.7
- Estonia – 5.7
- Antigua/Barbuda – 5.8
- Japan – 5.9
- Sweden – 5.9
“The numbers of preterm births are increasing. In all but 3
countries, preterm birth rates increased 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,” says Dr. Lawn.
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,”
says Christopher Howson, PhD., co-editor of the report, an
epidemiologist and head of Global Programs for the March of Dimes. “In
low-income countries, more than 90% of extremely preterm babies die
within the first few days of life, while less than 10% die in
high-income countries.”
“However, this is a solvable problem,” says Dr. Howson. “A
number of countries, for example, Ecuador, Botswana, Turkey, Oman and
Sri Lanka have halved their neonatal deaths from preterm birth through
improving care of serious complications like infections and respiratory
distress. These interventions are particularly effective in preventing
death in moderately preterm babies, which account for more than 80% of
all preterm births.”
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%, compared with 10.9% 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%; it was more than 15%
for women under 17 and over 40.
Spotlighting preterm births may help many low-income
countries, mainly in sub-Saharan Africa, achieve UN Millennium
Development Goal 4, a two-thirds reduction in young child deaths, and
Goal 5, improved maternal health, by 2015. These goals were set by the
United Nations General Assembly in 2000. Nearly all high-income
developed countries have already met these goals.
All preterm births are not the same
For the report, preterm was defined as 37 weeks of completed
gestation or less, which is the standard WHO definition. Preterm babies
are defined in 3 categories:
- late preterm - those born between 32 and 37 weeks - account for
84% of total preterm births, or 12.5 million. Most survive with
supportive care;
- very preterm - those born between 28 and 32 weeks. These babies require extra supportive care. Most will survive; and
- extremely preterm - those born before 28 weeks. These babies
require the most intensive, expensive care to survive. In developed
countries, these babies have a 90% chance of survival, though they may
suffer lifelong physical, neurological, and learning disabilities. In
low-income countries, only 10% survive.
A recent March of Dimes analysis shows that, even though
numbers are low, the risk of death of babies born between 37 and 39
weeks of gestation is twice as high as full term babies, or 39 weeks.
“It is important to ensure that babies get at least 39 weeks
of gestation when medically possible, and to deliver this message to
both providers and mothers," says Dr. Howson. “A healthy baby is worth
the wait."
Inexpensive and simple techniques save lives
"People tend to associate preterm with high-cost intensive
care services which would be challenging to poor countries, but a whole
menu of effective, inexpensive services are available and work to save
most of these lives," says Carole Presern, PhD, a midwife who has
delivered babies in remote areas of Asia and is the Director of The
Partnership for Maternal, Newborn & Child Health.
Experts at the UN, medical institutions and field
organizations say that inexpensive, proven forms of care for premature
babies could save at least three quarters of these babies in the
developing world. These include:
- antenatal steroid injections for mothers in premature labor,
which cost US$ 1 an injection. This helps develop immature fetal lungs
and prevent respiratory problems; yet, in low-income countries, they are
only available and provided for 10% of those in need. This alone could
save almost 400 000 lives of babies a year;
- "Kangaroo care" where the infant is held skin-to-skin on the
mother's chest to keep warm. The warmth is very important for premature
infants. Kangaroo care makes frequent breastfeeding easy and provides
constant maternal supervision for the infant. This could save 450 000
lives a year;
- antiseptic cream to prevent birth cord infection; and
- antibiotics to prevent and fight infection, an important cause of neonatal death.
All health care providers, including physicians, nurses, and
midwives, need training in basic preterm care, notes Dr. Presern who
says she has seen too many situations where even the doctor doesn't seem
to know what to do with a tiny infant.
Two types of preterm birth
Preterm births are divided into two categories: Those that are
spontaneous from early onset of labor or premature rupture of the
membranes and those that are provider-induced.
Provider-induced early deliveries may occur when the health of
the mother or fetus is in jeopardy, such as in pre-eclampsia
(dangerously high blood pressure in pregnancy), for convenience of the
doctor, midwife or mother, or by an error in due dates. Even babies
born a few weeks too soon are more likely to be re-hospitalized or to
have breathing problems or other illnesses.
Prevention key to reducing premature births
A key way to reduce preterm numbers is to find ways to help
all pregnancies go to full term, or 39 weeks.
"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.”
A number of risk factors for preterm birth have been
identified, including a prior history of preterm birth, underweight,
obesity, diabetes, hypertension, smoking, infection, maternal age
(either under 17 or over 40), genetics, multi-fetal pregnancy (twins,
triplets, and higher), and pregnancies spaced too closely together.
However, little is known about the interplay of these and other environmental and social factors.
The report calls for a strong research program to identify
risk factors clearly and understand how their interactions may lead to
preterm birth so that more definitive ways can be found to screen and
treat women at risk to prevent the problem from occurring.
Until research provides better answers, though, the report
advises taking effective measures now, such as screening women for known
medical conditions that could put them at risk during pregnancy,
assuring good nutrition before and during pregnancy, and making sure
that all women have access to good preconception and prenatal health
care and receive the recommended number of visits during pregnancy.
An agenda for action
In addition to detailed recommendations about needed research,
the report offers an agenda and action plan for all groups concerned
with preterm birth and child health, ranging from the United Nations and
governments at all levels to donor countries to global philanthropic
institutions and civil society.
Some 30 groups have already committed to take part in the
overall effort to reduce both the absolute numbers of preterm births and
the mortality rate and to support the research agenda. These
commitments are posted on the Every Woman, Every Child web site,
supporting the Every Woman, Every Child effort to advance the Global
Strategy for Women’s and Children’s Health.
The extensive list of recommendations in the report includes
specific actions such as addressing the missing essential medicines and
equipment, training existing health staff in how to look after women in
preterm labor and these vulnerable babies, increased funding for
research to find new prevention solutions, and better data for accurate
future counts. Efforts to increase awareness of the preterm birth issue
are essential.
"This report is not the last word, but an important next
step," says Dr. Howson. "Both the report and the broad international
constituency behind it offer a framework and set of clear actions to
help accelerate global progress on preterm birth.”
Parliaments scale up efforts on maternal and child health
In the first week in April, leaders of nearly 120 national
parliaments attending a major meeting in Kampala, Uganda resolved to
prioritize action and resources for improving the health of women and
children.
Delegates to the Inter-Parliamentary Union (IPU) passed a
resolution calling for all member-parliaments to take all possible
measures to achieve Millennium Development Goals (MDGs) 4 and 5 by 2015.
MDG 4 aims to reduce child deaths around the world by two-thirds by
2015; MDG 5 aims to reduce the maternal mortality ratio by
three-quarters by the same year.
This is the first time that the world’s parliaments, acting
through the IPU, have passed a resolution on this issue. The debate on
the resolution featured interventions from more than 50
member-delegations, associate members and observers, including Nigeria,
Brazil, the UK, Sweden and Indonesia.
For more information, please contact:
Fadéla Chaib
WHO Communications Officer and Spokesperson
Telephone: +41 22 791 32 28
Mobile: +41 79 475 55 56
E-mail:
chaibf@who.int