Myth 1: Preterm birth is not a significant public health problem in low- and middle-income countries.
Fact. Until recently, higher-level health policy-makers in many low- and middle-income countries have not prioritized preterm birth as a health problem partly despite neonatal mortality data being available since 2005 showing it as a leading cause of death. One challenge has been the lack of data showing the national toll of prematurity and associated disabilities. It was not until 2009 that the first global and regional rates of preterm birth were published by the World Health Organization (WHO) and the March of Dimes. Born Too Soon: The Global Action Report on Preterm Birth, published in May 2012, presented the first-ever country estimates of preterm birth rates and showed that the global total of preterm birth is even higher than reported in 2009. Born Too Soon also identified solutions for both prevention and care of the preterm newborn and proposed actions forward (see figure below). With more data and evidenced-based solutions, there has been wider engagement of global partners and greater action in countries. World Prematurity Day 2012 is an opportunity to continue the momentum for change and raise awareness about this issue.
Figure: Approaches to prevent preterm birth and reduce deaths among premature babies
Myth 2: Effective care of the high-risk mother and premature newborn requires the same costly, high-technology interventions that are common in high-income countries, but is beyond the national health budgets of low- and middle-income countries.
Fact. A range of proven, low-cost, low-tech interventions exist, such as Kangaroo Mother Care and antenatal corticosteroids, that if fully implemented, could immediately and substantially reduce prematurity-related death and disability in high-burden countries. High-income countries such as the United States and the United Kingdom experienced significant reductions in neonatal mortality before the introduction of neonatal intensive care units, through a combination of public health campaigns, dissemination of antimicrobials, and basic thermal care and respiratory support. In low-resource settings, therefore, immediate and significant progress can be made in preventing deaths related to complications from preterm birth with similar cost-effective interventions and improved public health services.
Myth 3: The solutions to prevent preterm birth are known; all that is needed is the scale up of these solutions to reach all mothers.
Fact. Very little is known about the causes and mechanisms of preterm birth, and without this knowledge, preterm birth will continue. Before pregnancy, some solutions are known to prevent preterm birth such as family planning, especially for girls in regions with high rates of adolescent pregnancy; yet there are few other effective prevention strategies available for clinicians, policy-makers and program managers. Once a woman is pregnant, most of the interventions to prevent preterm birth only delay onset, turning an early preterm birth into a late preterm birth. Much more knowledge is needed to address the solution and reach a point where preterm birth is prevented.
Myth 4: Programs’ attention to care and, where possible, prevention of prematurity will draw funding away from other high-priority RMNCH interventions.
Fact. The actions outlined in Born Too Soon are both feasible and affordable in financially-constrained environments and have a cascade of beneficial effects on the health of women, mothers and newborns, in addition to reducing the rate of preterm birth and the mortality and disability associated with prematurity.
This blog is part of a series on HNN that will lead to World Prematuriy Day, November 17, discussing preterm birth and highlighting the actions needed to prevent and reduce preterm birth, the leading cause of newborn deaths. Join us as we discover that everyone has a role to play. To get involved and learn more, please visit www.facebook.com/WorldPrematurityDay. This blog was written by Mary Kinney, Joy Lawn and Chris Howson.
Additional blogs related to preterm birth:
- Why Preterm Births Matter, by Gary Darmstadt, Amie Newman and Wendy Prosser
- Kylie’s story: Joseph’s birth, by Kylie Hodges
- Born Too Soon: 5 points for action on preterm birth, by Joy Lawn, Mary Kinney and Christopher Howson
- The Partnership for Maternal, Newborn & Child Health: Taking Action for Preterm Birth, by Carole Presern and Lori McDougall
- Join the Global Movement to Tackle Preterm Birth, by JoAnn Paradis