On 17 November, the world marks World Prematurity Day. Started in 2008 as ‘International Prematurity Awareness Day’ in Rome, organised by the European Foundation for the Care of Newborn Infants, it was renamed as ‘World Prematurity Day’ in 2011, and has been commemorated as such ever since. This day is dedicated to advocating for preterm infants and raising awareness about the impacts of preterm birth on children, their families, and society. It offers an opportunity to reflect on progress, ongoing challenges, as well as future directions. 

Born too soon

Last year, the London School of Hygiene & Tropical Medicine, together with the World Health Organization (WHO), UNICEF, the UNFPA, and the Partnership for Maternal, Newborn & Child Health published the report ‘Born Too Soon: Decade of Action on Preterm Birth.’ The report provides an overview on the global burden, its impact, as well as progress that has been made. Specifically, it stated that one in every ten births is preterm (<37 weeks gestation), accounting for around 150 million preterm babies born within the last decade. Meanwhile, rates have remained static in recent past and complications from preterm birth represent the leading cause of death for newborns and children under the age of five, while those that survive are at risk of lifelong disabilities.

Unequal shots at life

Evidence before the report showed that while prematurity remains a global problem, its prevalence and outcomes vary highly between regions and countries. In 2020, the highest preterm rates occurred in the South Asian region (13.2%), while the highest country-level rate was recorded in Bangladesh (16.2%) and the lowest in Serbia (4.1%). Of note, more than half of preterm births in 2020 occurred in 8 countries only: India, China, Pakistan, Nigeria, Ethiopia, Bangladesh, Democratic Republic of Congo, and the United States of America. The figures have remained largely unchanged since 2010, with an estimated global annual reduction of 0.14% between 2010 and 2020.

The majority (85%) of preterm births occur between 32 and 37 weeks of gestation, a period where likelihood of survival is highest, and care can often be provided without a Neonatal Intensive Care Unit through low tech/low-cost alternatives, such as Kangaroo Mother Care. Large disparities in survival for preterm babies persist between countries, reflecting inequalities in availability and access to care. While most babies (>28 weeks) in high-income settings survive, those born in low-income countries often die within the first days of life.

The need for better data

High-quality data is vital for monitoring progress and guiding action. Yet, in many low- and middle-income countries (LMICs), there is limited information on preterm births, including their gestational age and birth weight. Most countries provide only high-level grouped data however, this might change with the increasing coverage of electronic data systems that can provide individual-level data. In 2020, around 60% of United Nations member countries reported data on low birthweight, while 40% reported preterm birth data. The WHO now recommends that all countries include gestational age and birthweight in their routine health data. Even when preterm deliveries are reported, the data often lack the detail necessary to inform the most suitable programmatic response. In Southern Asia and sub-Saharan Africa, less than 20% of the preterm births contain information on birthweight and less than 10% are reported with detailed information on their gestational age. This data would have important implications, as gestation week and birthweight are both closely related to chance of survival and interventions required.

Urgent action to achieve SDGs

Being born premature is linked to neonatal conditions, such as infections and gastrointestinal and respiratory diseases, which continue to be the primary contributor to the global burden of disease unchanged from 1990. Preventing and caring for preterm infants will be an important step towards achieving Sustainable Development Goal 3.2 of reducing neonatal mortality (Target: 12 deaths per 1,000 livebirths) and Under-5-Mortality (Target: 25 deaths per 1,000 livebirths). If current trends continue, approximately 60 countries – many of them in the sub-Saharan African region – are unlikely to meet these targets by 2030. This highlights an urgent need to prioritise preterm births on the global agenda and ensure every baby, regardless of where and when they are born, has the chance to survive and thrive.