The first-ever country-by-country estimate of premature births finds that 15 million babies a year are born preterm — more than one in 10 live births.
About 1 million of those babies die shortly after birth, and countless others suffer a significant, life-long physical, neurological or educational disability, says a report, Born Too Soon: The Global Action Report on Preterm Birth, released today.
The findings "dispel the notion that this is a rare problem" and "leave no excuse for preterm births to remain a neglected problem," says Joy Lawn, director of global evidence and policy for Save the Children and co-editor of the report.
Although more than 60% of preterm births are in sub-Saharan Africa and south Asia, they are also a problem for some high-income countries, including the USA and Brazil. Both rank among the 10 countries with the highest number of preterm births.
In the USA, about 12% of all births are preterm, a percentage far higher than in Europe or other developed countries.
Factors driving up the rate in the USA include the number of older women having babies; increased use of fertility drugs, which increase the risk of multiple births; and increased rates of medically unnecessary Cesarean deliveries and inductions "done at the convenience of the doctor or mother," says Christopher Howson, another co-editor of the report and head of Global Programs for the March of Dimes. Other organizations involved in producing the report were the World Health Organization and the Partnership for Maternal, Newborn and Child Health, a global alliance of more than 400 health organizations.
In addition to a notable age gap (the rate for women ages 20-35 was 11% to 12% vs. 15% for women under 17 and over 40), a considerable racial gap also exists in the USA, Howson says.
The preterm birth rate for black Americans in 2009 was as high as 17.5%, compared with 10.9% for white Americans. "In the United States, our preemies have among the highest survival rates in the world," Howson says. "Where we fall flat is on the prevention side. We need to do a lot more to prevent preterm births, such as improving health care access for all, bringing down rates of smoking and issues of unnecessary C-sections and inductions." Globally, preterm births are the second leading killer of children younger than 5, and "the numbers haven't come down very much, especially when you compare it to things like pneumonia, diarrhea — where we've really made progress — malaria and HIV, where we've also made significant progress," Lawn says. "In fact, the numbers have been increasing," she says, adding that "out of 65 countries where reliable trend data is available, only three (Croatia, Euador and Estonia) show a significant reduction" from 1990 to 2010.
For the report, preterm was defined as 37 weeks of completed gestation or less, the standard World Health Organization definition.
A recent March of Dimes analysis shows that, even though numbers are low, the risk of death of babies born at 37 to 39 weeks of gestation is twice as high as full-term babies, or 39 weeks, Howson says: "Only one week increases the risk of adverse outcomes."
An estimated 75% of the world's 1 million preterm deaths could be avoided if a few "proven and inexpensive treatments and preventions" were widely available in low-income countries, according to the report, including teaching "kangaroo care," in which tiny babies are held skin-to-skin on their mother's bare chests for warmth when there are no incubators.
Also, steroid injections for mothers in premature labor, which cost $1 an injection, help develop immature fetal lungs and prevent respiratory problems.
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