The Department of Reproductive Health and Research of
the WHO (RHR/WHO) and March of Dimes came together to publish new data on
the global and regional toll of preterm birth in form of a White Paper as
a first step in measuring the extent of preterm birth worldwide(1). The
data will serve as a catalyst for policy makers, researchers, donors,
clinicians and the general public to address this major public health
problem. A future report will provide country-specific rates and suggest
strategies to reduce mortality and disability from preterm birth.
Commentary
Until recently, there was little recognition of preterm
birth as a worldwide problem, and this has impeded the development of
policies and programs appropriate for implementation in low- and middle-
income countries (LMIC). The relative neglect of preterm birth is linked
to data gaps on the global toll of prematurity, including the extent of
associated death and disability. The new estimates shown in this report
make a substantial contribution to addressing this deficiency. Widely held
perceptions that effective care of the preterm baby requires costly
interventions well beyond the health budgets of most LMICs, coupled with
concerns that greater attention to preterm birth will draw needed funding
away from other devastating maternal and perinatal health problems, have
also contributed to the reluctance of policy makers to make the problem of
preterm delivery a global priority(1).
There is a paucity of data on preterm birth prevalence
and mortality and almost complete absence of data on acute morbidity and
long-term impairment associated with prematurity in LMICs and many
high-income countries. Similarly, there is scarcity of data on preterm
birth in India despite having highest number of births and neonatal deaths
in the world. The available data indicate that 15% of all neonatal deaths
are caused by prematurity and its complication(2). There are many reasons
for poor state of preterm birth-related epidemiology in LMICs that include
poor infrastructure of primary health care services, poor health-related
statistics and information systems, lack of preterm birth surveillance
registries or poor coordination among existing registries and reliance on
hospital based rather than population-based studies.
Need of the Hour
Data in the White Paper paint a grim picture. The high
numbers of preterm birth worldwide, the disproportionate toll of preterm
births in developing countries, the high rates of preterm birth in Africa
and North America, the increasing rates of preterm birth observed wherever
data are available and the major data gaps on preterm birth prevalence,
mortality, acute morbidity and long-term impairment worldwide are all
indications that preterm birth is a global problem that needs greater
attention by policy makers, researchers, health care providers, the media,
donor organizations and other stakeholders.
Our understanding of the exact causal pathways
resulting in preterm labor still remains obscure and more research is
needed to find the interventions that are effective at preventing preterm
births. However, there is a lot that can be done now. For example, in
high-income countries there needs to be more focus on preconception
health. Women planning a pregnancy should be encouraged to adopt a healthy
lifestyle. In developing countries, there are several simple low-cost
interventions that can help promote a healthy pregnancy outcome, such as
treating malnutrition in women before and during pregnancy, treating high
blood pressure and diabetes, and monitoring pregnancies for problems. Care
for preterm babies can also be low cost and effective, such as keeping the
baby warm, treating infections, and providing adequate nutrition.
Governments need to pay more attention to preterm birth as a serious
health issue.
Funding research to find the causes of premature birth,
encouraging investment of public and private research institutions to
identify causes and to identify and test promising interventions, helping
health care providers to improve risk detection and address risk factors,
education of women about risk-reduction strategies and the signs and
symptoms of premature labor, providing information and emotional support
to families affected by prematurity are the few key strategies that can be
adopted at the regional and national level to combat high burden of
prematurity at the global level.
Conclusion
Addressing preterm birth is essential for reducing the
pronounced inequities in neonatal health and for the world to achieve
MDG-4. A greater focus on preterm birth will also benefit maternal health,
contributing to global efforts to accelerate progress towards MDG-5. Given
the proximity of 2015 and the evidence that MDG-4 and MDG-5 are off track,
the time is now for the international community to step up and dedicate
greater resources to preterm birth.
