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May 12, 2023 05:24 pm | Updated 05:24 pm IST
The story so far: At 3.2 million, India recorded the highest number of preterm births in 2020, according to the World Health Organisation’s Born Too Soon: decade of action on preterm birth report. Released on May 9, 2023, the report analyses preterm births across the world and suggests changes to healthcare systems and societies to avoid them.
Babies born alive before 37 weeks of pregnancy are complete are called preterm babies. Based on gestational age, there are three categories of preterm births, as defined by the WHO:
Preterm births can happen both spontaneously or for several medical reasons, including infection, or other pregnancy complications that require early induction of labour or caesarean birth.
According to the WHO report, rates of preterm birth have barely changed between 2010 and 2020. In fact, it is even rising in some parts of the world. In 2020, an estimated 13.4 million babies were born preterm.
Preterm birth is the single largest killer of children under five years of age. According to estimates, around one million newborns died due to preterm birth-related complications in 2020.
Preterm birth rates were 9.9% in 2020, compared to 9.8% in 2010. In high-burden regions, change in preterm births was barely measurable – in South Asia, it stood at 13.3% in 2010 and 13.2% in 2020, while in Sub-Saharan Africa it was 10.1% in both 2010 and 2020.
Ten countries which reduced their preterm birth rates by more than 5% between 2010 and 2020 were the Czech Republic, Austria, Brunei, Singapore, Spain, the Netherlands, Denmark, Hungary, Brazil and Sweden, although this amounts to an annual average reduction of only about 0.5% per year. Preterm birth rates increased by more than 5% in 13 countries – Poland, Iceland, Croatia, the U.K., Bulgaria, Armenia, Bahrain, Ireland, Chile, Georgia, Colombia, the Republic of Korea, and North Macedonia – in the same period.
In 2020, around 1.2 million preterm newborns were estimated to be born in the ten countries most affected by humanitarian crises – Afghanistan, Chad, Central African Republic, Democratic Republic of the Congo, Myanmar, Somalia, South Sudan, Sudan, Syria, and Yemen.
The Covid-19 pandemic had both direct and indirect effects on preterm births. However, the full impact of Covid-19 on preterm births remains unclear.
The WHO report quotes evidence that maternal Covid-19 infection may directly affect the foetus through pathways of viral transmission from mother to baby, poorer placental functioning and reduced maternal capacity due to systemic disease. It is suspected that these transmission pathways could have contributed to an increased risk of preterm birth as well as a greater need for neonatal intensive care.
In high-income countries, studies have shown that the Covid-19 pandemic did not affect preterm birth rates. However, in both low and high-income countries, mothers infected with Covid-19 had a higher rate of giving birth preterm.
Covid-19 is one of the “four Cs”, alongside conflict, climate change, and the cost-of-living crisis, that the WHO report identifies as new and intensified challenges. Further, Covid-19 also destabilised healthcare services for women and newborns.
Preterm birth is the fourth leading cause of loss of human capital worldwide, at all ages, behind ischaemic heart disease, pneumonia and diarrhoeal disease. Between 1990 and 2019, neonatal conditions were the leading cause of disability-adjusted life years (DALYs) in most regions. These included neonatal encephalopathy and infections as well as congenital conditions.
Preterm birth is associated with long-term damage to respiratory and cardiac systems for many survivors and can also have a neurodevelopmental impact. Disabilities can range from less severe outcomes to major disabilities like diplegia.
The report says that most preterm babies are born between 32 and 36.9 weeks and that being born even a few weeks preterm can cause learning and behavioural disorders. Babies born between 37 and 39.9 weeks are at a slightly higher risk of adverse neurodevelopmental outcomes.
The United Nations aims to end preventable deaths of newborns and children under five years of age by 2030 as part of its Sustainable Development Goals (SDGs), with all countries aiming to reduce both neonatal and under‑five mortality. According to WHO, 54 countries will fall short of meeting the SDG target for under-5 mortality and 63 countries will not achieve the SDG target for neonatal mortality, unless quality of care for newborns and young children is improved.
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