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A New Global Focus on Preterm Births

World Prematurity Day highlights effective, low-cost care. New commitments to address the problem.


Preterm birth is the world’s largest killer of newborn babies, causing more than 1 million deaths each year, yet 75 percent could be saved without expensive, high technology care.

That’s the primary message and motivating theme of World Prematurity Day, November 17, a global effort to raise awareness of the deaths and disabilities due to prematurity and the simple, proven, cost-effective measures that could prevent them.

On World Prematurity Day, countries in nearly every part of the world will take action to raise awareness of what can be done to reduce preterm births and better care for babies born too soon.

Families affected by premature birth can share stories, photos, and videos, and identify their locations on an interactive world map on 
facebook.com/WorldPrematurityDay. More than 700,000 visited this website in 2011.

“People think that preterm babies need intensive, high-tech care, but we have simple methods that really work and would save hundreds of thousands of lives,” says Joy Lawn, M.D., Ph.D., of Save the Children, a neonatal physician.

12.6 million moderate to late preterm births

Babies born between 32 and less than 37 completed weeks of pregnancy make up 85 percent of the 15 million preterm babies born annually –12.6 million.

“These babies are born too soon, but they are not born to die,” says Dr. Lawn. “Their deaths are utterly preventable.”
“We know what it takes to address the challenge of prematurity and we are committed to bringing partners together behind proven, affordable solutions,” says UN Secretary-General Ban Ki-moon who launched The Global Strategy for Women’s and Children’s Health in 2010. The Global Strategy is supported by Every Woman Every Child, an umbrella movement that has already leveraged more than $20 billion in new money and aims to save the lives of 16 million by 2015.

The countries with the greatest numbers of moderate to late preterm births annually are:

India –2,959,300; China –981,050; Nigeria –665,080; Pakistan –633,640; Indonesia –564,350; United States –438,410; Bangladesh –355,030; Philippines –295,780; Democratic Republic of Congo –291,750; and Brazil –233,320.

Essential newborn care

“Essential newborn care is especially important for babies born preterm,” said Elizabeth Mason, M.D., Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health. “This means keeping them warm, clean, and well-fed, and ensuring that babies who have difficulty breathing get immediate attention.”

Three low-cost interventions that are very effective, but are not commonly used, are:

  • Steroid injections. When given to mothers in preterm labor, dexamethosone, a steroid used to treat asthma, helps speed up the development of the baby’s lungs. At a cost of about US$1, two shots can stop premature babies from going into respiratory distress when they are born. This can prevent 400,000 deaths annually.
  • Kangaroo Mother Care. Using this technique, the tiny infant is held skin-to-skin on the mother’s chest. This keeps the baby warm and facilitates breastfeeding. Keeping preterm babies warm is especially important because their tiny bodies lose heat rapidly, making them highly vulnerable to illness, infection and death. This could prevent 450,000 deaths annually.
  • In addition, basic antibiotics can save lives, such as amoxicillin to treat pneumonia and injection antibiotics to fight serious infections.
  • “Using an essential package of pregnancy, childbirth and postnatal care that includes these interventions will save more than three quarters of preterm babies without intensive care,” says Carole Presern, Ph.D., head of The Partnership for Maternal, Newborn & Child Health (PMNCH) and a midwife. “Most of these infants can grow up healthy and without lifelong disabilities.”

Prevention is the next frontier

A key way to reduce the burden of preterm birth is to find ways to help pregnancies go to full term, or at least 39 weeks.

“Prevention is the next frontier,” says Christopher Howson, Ph.D.,Vice President of Global Programs for the March of Dimes and an epidemiologist. “We are looking closely at what can be done before a woman gets pregnant to help her have an optimal outcome.”

A number of risk factors for mothers to deliver prematurely have been identified, including a prior history of preterm birth, underweight, obesity, diabetes, high blood pressure, smoking, infection, age (either under 17 or over 40), genetics, multiple pregnancy (twins, triplets, and more) and pregnancies spaced too closely together.

“We also know that poverty, lack of women’s education, malaria and HIV all have an impact on the pregnancy and the health of the baby,” says Dr. Howson. “However, little is known about the interplay of these and other environmental and social factors in increasing the risk of preterm birth. We need to know more and this knowledge could have a big impact in the lowest income countries.”

Documented success for steroid use and Kangaroo Mother Care

In high-income countries, steroids have been widely used for women in preterm labor since the 1990s and an estimated 95 percent of women in preterm labor before 34 weeks of pregnancy now receive steroid injections prior to delivery.

By comparison, in low- and middle-income countries, only an estimated 5 percent of women receive these steroid injections.

Dr. Lawn says that these medicines are rarely used in the developing world, despite the low cost and proven effectiveness, because health care professionals do not know about this life-saving use. In fact, antenatal steroids are now identified by a new UN-led Commission on Life-Saving Commodities for Women and Children as an essential medicine that should be available everywhere.

“The use of steroids should be part of the ‘to do’ list of everyone looking after women in pregnancy. It should be written on hospital walls,” says Dr. Lawn. “In America or Europe, if a woman in preterm labor were not given steroid injections, the doctor could be sued for malpractice, as this is the standard of care. Why should a woman in Africa or Asia not get the same care, especially given the low cost?”

Kangaroo Mother Care started as a solution for overcrowded nurseries in Colombia where tiny infants were forced to share what incubators were available. The technique works well for both mothers and babies. Studies show that the mortality rate for babies who benefit from Kangaroo Mother Care can be the same or better than that for babies in incubators.

Though Kangaroo Mother Care was developed in 1967, the spread has been slow despite the well-documented effectiveness and its benefits for child development.

“One reason for the slow spread in some areas could simply be a lack of information about what works,” says Dr. Presern. “Another may be that many obstetricians, midwives and nurses find it hard to accept that such a natural approach could be superior to expensive high technology equipment.”

Countries make new commitments

On World Prematurity Day, a number of countries will announce major commitments to reduce preterm mortality. These countries have each adopted packages of interventions to care for premature babies and are championing initiatives in their countries and others. For example:
  • Malawi has the world’s highest preterm birth rate, a statistic that led the Vice President Khumbo Kachali and the country’s health leaders to prioritize care for preterm babies, instituting Kangaroo Mother Care and providing steroid injections in almost all hospitals.
  • India—with nearly 3 million moderate to late preterm births, the largest number in the world, and 304,050 preterm deaths per year—has been working with support from UNICEF to outfit 100 district hospitals to care for preterm babies.
  • Uganda has committed to speeding access to steroid injections for all women in preterm labor.

Born Too Soon report stimulates activity

Publication of the Born Too Soon report in May 2012 by the March of Dimes, PMNCH, the World Health Organization and Save the Children drew global attention to what many consider one of the world’s most overlooked public health problems. The report included the first country-by-country statistics for both absolute numbers and rates of preterm birth, documenting the extent and severity of the problem, also published in The Lancet.

The report showed that preterm births are not solely a problem of the developing world, but that wealthy countries, including the United States and Brazil, were also in the top 10, in terms of absolute numbers. To mark the publication of the report, more than 30 organizations made new or enhanced commitments in support of the Every Woman Every Child effort launched by the United Nations Secretary General Ban Ki-moon.

About World Prematurity Day

Started last year by the March of Dimes and founding parent groups –European Foundation for the Care of Newborn Infants (EFCNI), Africa-based Little Big Souls International Foundation and the National Premmie Foundation of Australia— World Prematurity Day will this year spread throughout the world, now involving more than 50 countries and groups globally.

Events are planned in many countries, including the United States, China, Indonesia, Malaysia, Malawi, Uganda and Argentina, to draw public attention to the problem of preterm birth and the simple care that can save many of these babies.

* * *

Born Too Soon Supporters: Governments, United Nations agencies, development partners, foundations, civil society, parents’ organizations, health professional associations, academia, and the private sector.

The Aga Khan University, American Academy of Pediatrics, American University of Beirut Medical Center, Association of Women’s Health, Obstetric and Neonatal Nurses, Australian Aid, Bliss UK, Bill & Melinda Gates Foundation, Canadian International Development Agency, Centers for Disease Control and Prevention, Countdown to 2015, European Foundation for Care of Newborn Infants, Family Care International, Flour Fortification Initiative, GAVI Alliance, General Electric, Global Alliance to Prevent Prematurity and Stillbirth, Home for Premature Babies (China), Institute for Clinical Effectiveness for Health Policy, International Federation of Gynecology and Obstetrics, International Confederation of Midwives, International Pediatric Association, International Preterm Birth Collaborative, Japan International Cooperation Agency, Johns Hopkins Bloomberg School of Public Health, Ecole de Santé Publique, Université de Kinshasa, Little Big Souls International Foundation Africa and UK, London School of Hygiene & Tropical Medicine, National Premmie Foundation Australia, Nationwide Children’s, National Collaborative Perinatal Neonatal Network, Norwegian Agency for International Development, Peking University Center of Medical Genetics, Swedish International Development Cooperation Agency, Tommy’s, UK Department for International Development, UNICEF, United Nations Foundation, United Nations Population Fund, United States Agency for International Development, University College London, University of Malawi, University of Texas Medical Branch, Institute of Human Genetics (University of the Philippines), Women Deliver.




Countries and territories
Number of moderate to late preterm births (32 to <37 completed weeks) (2011)
Number of deaths due to preterm birth complications (2011)
India
2,959,300
304,050
China
981,050
34,560
Nigeria
665,080
83,510
Pakistan
633,640
62,800
Indonesia
564,350
29,220
United States
438,410
6,400
Bangladesh
355,030
35,490
Philippines
295,780
11,290
Democratic Republic of the Congo
291,750
43,600
Brazil
233,320
9,480
Ethiopia
222,110
29,100
United Republic of Tanzania
184,560
16,930
Uganda
176,770
16,090
Kenya
161,690
14,320
Afghanistan
137,010
17,520
Iran (Islamic Republic of)
136,950
7,740
Mexico
135,820
5,280
Turkey
130,000
4,470
Sudan
123,760
12,310
Mozambique
123,000
9,790
Viet Nam
115,870
5,660
Egypt
115,700
6,300
Malawi
104,450
6,680
Yemen
104,390
10,270
Russian Federation
99,730
4,150
Ghana
94,780
8,270
Madagascar
89,460
6,080
Myanmar
85,990
11,550
Nepal
85,460
10,140
Angola
84,320
11,380
Thailand
83,470
2,340
Côte d’Ivoire
80,230
9,250
Cameroon
75,800
8,120
South Africa
71,000
8,320
Mali
70,980
11,800
Zambia
67,930
6,320
Colombia
67,820
3,290
Burkina Faso
66,980
8,280
Iraq
63,100
7,140
Niger
61,680
9,770
Malaysia
60,080
740
Chad
56,210
7,440
Germany
54,510
630
Japan
53,370
210
Zimbabwe
52,560
4,110
United Kingdom
50,280
1,200
Argentina
46,680
2,180
Guinea
46,310
5,120
France
44,750
300
Algeria
44,370
4,940
Uzbekistan
43,080
3,390
Syrian Arab Republic
42,630
1,880
Somalia
41,880
6,490
Venezuela (Bolivarian Republic of)
41,010
2,020
Senegal
38,650
4,250
Republic of Korea
37,140
500
Peru
36,560
2,170
Rwanda
36,040
3,270
Morocco
34,850
5,230
Sri Lanka
33,760
470
Benin
31,650
3,690
Haiti
31,630
2,550
Democratic People’s Republic of Korea
31,470
2,700
Spain
31,340
310
Guatemala
30,740
2,430
Saudi Arabia
30,590
1,630
Italy
30,540
420
Cambodia
28,210
2,680
Burundi
27,600
4,270
Ukraine
27,240
750
Kazakhstan
25,680
1,810
Canada
25,440
510
Poland
23,250
700
Togo
21,790
2,490
Honduras
20,950
920
Congo
20,380
1,570
Bolivia (Plurinational State of)
20,080
2,210
Eritrea
19,880
1,520
Australia
19,800
260
Dominican Republic
19,570
1,110
Sierra Leone
19,130
3,540
Jordan
18,660
940
Liberia
18,340
1,450
Tajikistan
17,510
1,650
Central African Republic
16,560
2,340
Mauritania
15,340
1,570
Chile
14,710
420
El Salvador
13,600
290
Romania
13,540
420
Tunisia
13,430
700
Azerbaijan
13,130
1,460
Lao People’s Democratic Republic
12,750
890
Ecuador
12,750
1,070
Netherlands
12,250
100
Kyrgyzstan
11,540
730
Papua New Guinea
11,500
1,740
Nicaragua
10,850
690
Israel
10,570
110
Paraguay
10,330
870
Libyan Arab Jamahiriya
10,070
630
Turkmenistan
9,080
910
Costa Rica
8,440
130
Belgium
8,190
70
Gambia
7,880
790
Mongolia
7,400
300
Namibia
7,310
410
Hungary
7,210
140
Czech Republic
7,110
60
Austria
6,740
70
Greece
6,520
210
Portugal
6,240
50
Serbia
6,160
270
Lesotho
6,070
860
United Arab Emirates
6,010
170
Botswana
6,000
210
Oman
5,960
110
Cuba
5,870
50
Gabon
5,720
380
Sweden
5,660
30
Guinea-Bissau
5,560
850
Switzerland
4,800
80
Panama
4,790
190
Bulgaria
4,730
190
Singapore
4,570
20
Timor-Leste
4,520
370
Kuwait
4,480
90
Republic of Moldova
4,380
50
Armenia
4,360
200
Jamaica
4,320
230
Lebanon
4,290
140
Uruguay
4,230
80
New Zealand
4,100
60
Swaziland
4,080
460
Comoros
3,900
290
Ireland
3,870
50
Georgia
3,780
270
Belarus
3,730
90
Equatorial Guinea
3,650
310
Denmark
3,590
70
Albania
3,120
110
Norway
3,080
20
Slovakia
3,070
110
Finland
2,850
30
Bahrain
2,770
30
Djibouti
2,620
300
Bosnia and Herzegovina
2,110
50
Croatia
2,000
20
Qatar
1,890
40
Solomon Islands
1,810
60
Mauritius
1,740
60
Lithuania
1,680
20
Cyprus
1,600
10
Fiji
1,530
60
Guyana
1,500
90
Trinidad and Tobago
1,350
90
Slovenia
1,280
10
Bhutan
1,270
150
Former Yugoslav Republic of Macedonia
1,250
80
Latvia
1,090
10
Cape Verde
960
40
Estonia
790
-
Brunei Darussalam
780
10
Vanuatu
780
10
Suriname
710
70
Belize
680
-
Montenegro
590
10
Sao Tome and Principe
460
50
Bahamas
430
10
Luxembourg
410
-
Other
2,920
110
World12,592,0501,032,710
Born Too Soon: The Global Action Report on Preterm Birth – Updated for 2011with live births and neonatal mortality estimates for 2011 from The UN Interagency Group for Child Mortality Estimation.

Data sources: Numbers of babies with moderate to late preterm birth: Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler A, Garcia CV, Rohde S, Say L, Lawn JE. National, regional and worldwide estimates of preterm birth, The Lancet, June 2012.

Deaths due to preterm birth complications data: Liu L, Johnson HL, Cousens S, Lawn JE et al. 2012. Global, regional, and national causes of child mortality in 2000–2010: an updated systematic analysis. The Lancet, June 2012. doi:10.1016/S0140-6736(12)60560-1.

Preterm birth prevention analysis: Hannah H. Chang, Jim Larson, Hannah Blencowe, Catherine Y. Spong, Christopher P. Howson, Sarah Cairns-Smith, Eve M. Lackritz, Shoo K. Lee, Elizabeth Mason, Andrew C. Serazin, Salimah Walani, Joe Leigh Simpson, Joy E. Lawn. Preventing preterm births: trends and potential reductions with current interventions in 39 very high human development index countries. 
The Lancet in press.

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Interviews with experts are available by phone and in person in New York City, London and Geneva

For TV Producers: B-roll on the Hoffman & Hoffman website: 
http://www.hoffmanpr.com/world/preterm/B-roll

Facebook for parent stories and an interactive map of preterm birthshttp://www.facebook.com/WorldPrematurityDay

Background materials on preterm birthhttp://www.who.int/pmnch/media/news/2012/20121117_world_prematurity_day

Every Woman Every Child commitments to preterm birthhttp://www.everywomaneverychild.org

Contacts: Marshall Hoffman, H&H, +1 703 533-3535, +1 703 801-8602 (mob); marshall@hoffmanpr.com
Nils Hoffman, H&H Video, +1 703 967-1490; nils@hoffmanpr.com
Michele Kling, MoD, +1 914 997-4613, +1 914 843-9487 (mob); mkling@marchofdimes.com
Fadéla Chaib, WHO, +41 22 791 32 28, +41 79 475 55 56 (mob); chaibf@who.int
Mike Kiernan, Save The Children, +1 202 640 6664 , +1 202 412 7579 (mob); mkiernan@savechildren.org

For TV producers: B-roll is available here: http://www.hoffmanpr.com/world/PMNCH/UNGA2012/
Category: Press Release Client: March of Dimes