Every 2 seconds, a baby is born too soon. Every 40 seconds, one of those babies dies, according to a report released by United Nations agencies and partners titled Born Too Soon: Decade of Action on Preterm Birth.
The report states that 152 million babies were born too soon in the last decade. Preterm birth is the leading cause of child mortality, accounting for nearly 1 in 5 of under-5 deaths. 3 in 4 of stillbirths are born preterm based on data from high and upper middle-income settings.
Over the past decade, there has been no measurable progress in reducing preterm birth rates in any region. An estimated 13.4 million babies were born preterm in 2020. Very few countries have made progress in reducing their preterm birth rates, and changes have been modest at 5% in 10 years. 9 in 10 extremely preterm babies (less than 28 weeks) survive in high-income countries while fewer than 1 in 10 survive in low-income countries. 1,2 million babies are born too soon in the 10 most fragile countries affected by humanitarian crises, where accessing care for women and babies is particularly challenging, the report further reveals.
Helga Fogstad, the executive director of Partnership for Maternal, Newborn and Child Health (PMNCH), the world's largest alliance advocating for women's, children's and adolescents' well-being and health and co-producer of the Born Too Soon report shared her insights with allAfrica's Sethi Ncube.
Are there specific countries in the continent where preterm births is more pronounced?
In preterm rates in Africa in 2020, Malawi, South Africa, Ethiopia and DR Congo were among the 10 countries globally with highest rates and in Sub-Saharan Africa, preterm rates were 10% and 11% of preterm births result in death. Numbers are very big in countries with big populations for example, Nigeria and Ethiopia are among the top five countries for numbers of preterm in 2020 with Nigeria sitting at approximately 775,000 and Ethiopia at nearly half a million preterm births.
Are there any known medical or environmental causes associated with preterm births?
Challenges such as conflict, disease outbreaks and climate crisis have unfortunately increased the problem. Access to high quality services are essential for preventing and managing preterm births, so both the environment as well as quality care has been missing ... in nine countries facing severe humanitarian crisis, maternal mortality ratios were more than double the world's average and of course covid-19 has not helped. We also have infection, poor nutrition and air pollution that have exacerbated the situation.
Are there any preventive measures or interventions being implemented to address the issue of preterm births?
In low and middle income countries and communities where this is a problem, 9 out of 10 preterm deaths will occur and so, we are very interested in really being explicit about what are the preventive measures and so most of the major causes of neonatal deaths can be prevented by adopting a health systems approach to scaling up of small and sick newborn care in countries. This requires a 10 core components political commitment, and leadership, financing, human resources, here midwives are very important and referral systems, so when something happens, the family and the mother and the newborn can get care immediately and then linkages with high quality maternal care, family and community involvement and post discharge follow-up systems. Preventing preterm birth is crucial, it could be accelerated by focusing on context specific risks and addressing spontaneous preterm births, such as non-medically indicated caesarian section and planning births and knowing who the midwife in case of emergencies and empowering the woman with understanding and understanding her body and feeling if the baby is kicking or not is very important and also, to prevent malaria and enhance micronutrients to improve nutrition, but also avoiding air pollution are important. We have success stories, like in Tanzania, so this is important to bear in mind.
What are the potential long-term consequences for children who are born preterm as a result of this trend?
Healthy beginnings result in healthy progress of the individual and it also ensures that the individual can live up to their potential. It is very important to ensure that millions of children with moderate and severe long term disabilities do not miss out on education and work opportunities and get propagated into generational cycle or poor health outcomes. We must take care of preterm babies, they have opportunities to explore and unleash their potential. Some babies born too soon go on to live healthy lives free of disabilities, but the risk of death and disabilities are higher for preterm babies than for those born full term. Other long term effects can also include higher non-communicable disease risks, stress, heartbreak and devastating practical consequences.
Are there any educational or support programs available for South African families with preterm babies that you have worked on or aware of?
Two or three key priority set out in the Born Too Soon report is ensuring that the rights related to preterm births are upheld, requiring action across the continuum of care across sectors and with strong partnerships between mother and baby diet and the healthcare provider as well as families, communities and systems that support them. To achieve these key areas that can be considered for improvement is; community level engagement and empowerment, education, mental health support and bereavement support which is critical and then also to look at the aspect of referral and quality care.
What are the recommendations for healthcare providers and policymakers to address the situation effectively?
I think what is important to do is to make this visible and to follow this up and to ensure that all of these interventions that we have highlighted, really get implemented and that we keep our eye on the ball and that we do not let it to continue. Quality care, midwives, referral system and community support and also empowerment of the woman and her family are really critical. There is also need for leadership commitments and better data.
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Are there any initiatives in place to raise awareness about the risks and challenges associated with preterm births and promote early interventions?
Yes, so all of this information now exists on websites and we are going into a partnership for maternal, newborn and child health. We're going to use all our constituencies, so the academic which is the teaching institutions, the UN agencies, the NGOs, all of them to understand that this information, data and also evidence has been updated in order for them to use. We are also working with parliamentarians to make sure that this gets followed up in parliaments and also be included explicitly in national health plans and budgets and monitoring systems. And then parent engagement is also very important.
We have started executing and partnering with parent associations, because this is not only about death, it's about quality of life. Also, there are many days in the year that can be celebrated, they are World Prematurity Day, which is November 17, World Birth Defects Day on March 3 and these are things to then recognize, to motivate, but very key, (this is what media is doing) bringing attention to a very, very urgent situation and the need for better action.
Last comment ...
It's not necessarily about more money, but it's better use of money in order to actually be explicit about taking care of preterm and newborn care and all of the surrounding elements that are needed. And so I think that this needs more attention because we need to do better with existing resources.
