152 million babies were born preterm in the last decade according to a new report, Born Too Soon: Decade of Action on Preterm Birth.

An estimated 13.4 million babies were born too soon in 2020, with nearly one million babies born too soon directly from preterm complications. Of every 10 births globally, one is preterm. Every two seconds, a baby is born too soon – and every 40 seconds, one of those babies dies. Preterm birth rates have not changed in any region of the world in the past decade.

The Born Too Soon: Decade of Action on Preterm Birth report was led by the World Health Organization (WHO), UNICEF, the UNFPA and the London School of Hygiene & Tropical Medicine (LSHTM), with the Partnership for Maternal, Newborn & Child Health (PMNCH).

The report highlights that preterm birth is the leading cause of child deaths globally and accounts for more than one in five of all deaths of children before their 5^th birthday. As well as death, there are lifelong consequences, affecting individuals and their families, as well as wider society and national economies with loss of potential, as well as disability burden.

The Born Too Soon report provides a comprehensive overview of the state of preterm birth and its profound impact on women and families in every country, as well as on wider society and the economy. It sounds an alarm for the “silent emergency” of preterm birth, long under-recognised in its scale and severity, which is impeding progress towards maternal and child health targets.

The new Born Too Soon “decade” report builds on the landmark 2012 report and shows how, where and why change is now occurring – and where it is not – underlining crucial actions required to reduce preterm births in the next decade.

Joy Lawn, Professor of Maternal, Reproductive & Child Health at LSHTM and co-lead of the Born Too Soon decade report and the original 2012 report, said: “Born Too Soon shows that the cost of inaction over the last decade was 152 million babies born too soon. More than 10 million deaths due to preterm birth were primarily in sub–Saharan Africa and Southern Asia, but preterm birth threatens health progress in every country. Greater investment in care of vulnerable newborns can save millions of families from heartbreak now. More work is also needed to prevent preterm birth, also impacting stillbirths and maternal health. Together these twin tracks of preterm prevention and care will produce healthier individuals and societies to deliver on economic and social development.  Our next generation depends on us all acting now - the investment may not be small but the returns on this investment will be major for every country.”

Too often, the location where babies are born determines if they survive. The Born Too Soon report documents how inequalities shape outcomes: nine out of 10 extremely preterm babies (<28 weeks) survive in high-income countries, yet only one in 10 survive in low-income countries. Gaping inequalities related to race, ethnicity, income and access to quality care determine the likelihood of preterm birth, death and disability -- including within high-income countries, such as the US. There, rates have risen and are now more than double those in Northern Europe. In many countries, having a preterm baby is a cause of bankruptcy.

Eric Ohuma, Associate Professor of Medical Statistics at LSHTM, who contributed to the report said: “To reduce neonatal mortality, we must guarantee early access to accurate gestational age assessments during pregnancy. By integrating this vital information into routine systems, we can effectively monitor global preterm birth rates. Alongside low birth weight, is crucial that we establish targets to drive reduction of preterm births.”  

Preterm births are closely linked to maternal health risks, such as adolescent pregnancy and pre-eclampsia, underlining the need for supporting women with sexual and reproductive health services, including effective family planning, as well as quality care in pregnancy and around the time of birth.

There is also increasing evidence of the direct and indirect effects of climate change on pregnant women, stillbirths, and preterm births. Air pollution is estimated to contribute to six million preterm births and almost three million low birthweight babies each year. The rising number of conflicts in the world affect women and children disproportionately, while the impact of COVID-19 continues. Nearly one in 10 preterm babies are born in the 10 most fragile countries affected by humanitarian crises where accessing care for women and babies is particularly challenging.

Action is urgently needed to improve prevention of preterm birth, as well as better care for those affected. Opportunities and innovations over the last decade enable rapid progress, but require investment in every country, and more ambitious partnerships, with parent power at the centre.

Read the Born Too Soon report.