In a powerful statement of support for a new push to prevent preterm birth, more than 50 organizations came together in New York City on February 18th, 2015, to discuss the first public-private partnership to prevent preterm birth, with an initial focus on the three countries where one third of all preterm births and an astounding half of all newborn deaths from preterm complications occur – India, Nigeria and Pakistan.
Co-hosted by the March of Dimes, Every Preemie—SCALE and the MDG Health Alliance, the meeting attracted wide representation from the reproductive, maternal, newborn and child health and development sectors and fields of infectious and chronic diseases, disability and nutrition. The United Nations, non-government sector, private foundations, academic institutions and corporations were all represented at the table.
Participants were welcomed by Dr. Chris Howson from the March of Dimes, a longtime advocate for a greater focus on prevention in maternal and child health, Judith Robb-McCord, who leads the new USAID funded initiative, Every Preemie—SCALE, to expand uptake of interventions that can reduce the burden of preterm birth and low birth weight in 24 USAID priority countries, and Leith Greenslade, a Vice Chair at the MDG Health Alliance, which catalyzes new initiatives with the potential to dramatically accelerate achievement of global health goals.
Chris Howson outlined how a greater focus on preventing preterm birth was critical to the achievement of the new global goal of “ending preventable newborn deaths” by 2030, and would also contribute reductions in rates of maternal death, stillbirth and other causes of mortality and disability such as congenital disorders, as many adverse maternal and birth outcomes share risk factors including early or advanced maternal age, certain infections, non- communicable diseases, and nutritional insults.
Judith Robb-McCord emphasized that as preterm birth is now the #1 cause of death for children under five, new approaches and much greater collaboration within the reproductive, maternal, child and adolescent health community and beyond is needed to achieve results. Drawing parallels to the successful prevention agendas in the areas that have achieved the strongest results under the MDGs (i.e. malaria, diarrhea, pneumonia and HIV/AIDS), Leith Greenslade called for a robust preterm birth prevention agenda prioritizing the populations of women where preterm deaths cluster.
Speaking on behalf of the UN Secretary-General’s Every Woman, Every Child movement, Natalie Africa welcomed a public-private partnership to prevent preterm birth as advancing the aims of the movement as it transitions to the post-2015 environment. Mary Kinney from Save the Children and Lori McDougall from the Partnership for Maternal, Newborn and Child Health, representing the Every Newborn movement, both acknowledged the need for a greater focus on prevention and welcomed the new partnership as part of the global efforts underway to implement the Every Newborn Action Plan.
Presenting the current state of the evidence for prevention, Dr. Jim Litch, from the Global Alliance to Prevent Prematurity and Stillbirth and Every Preemie—SCALE, cited a wide range of factors that increase the risk of preterm birth including sexually transmitted infections, tobacco use, depression, intimate partner violence, anemia, diabetes and hypertension, malnutrition and micronutrient deficiencies, and adolescent pregnancy and short birth intervals. He concluded that targeted investments in these areas would not only reduce preterm birth rates but also reduce stillbirths, newborn deaths and low birth weight babies and have a sizable impact on reducing the many costs associated with the delivery of care for premature babies. Dr. Litch emphasized that preterm birth is a complex challenge that requires increased investment to better understand what works and could be scaled-up in low resource settings to prevent preterm birth, manage preterm labor, care for preterm babies and nurture wellness through early childhood.
The Public-Private Partnership to Prevent Preterm Birth aims to halve the rates of preterm births among specific sub-populations of women and girls in India, Nigeria and Pakistan by targeting the leading risk factors for spontaneous preterm birth identified in the landmark 2012 Born Too Soon report. These factors, include (1) Lifestyle+, (2) Infection, (3) Nutrition and (4) Contraception. See the chart below for a more detailed explanation of each of the “LINC” factors. Acknowledging that we need to know much more about the specific causes of preterm birth among specific populations of women, the Partnership will proceed with the evidence that we have and act as a platform to try new approaches and test innovation all the while contributing to the development of more robust evidence base.
The partnership will undertake three major activities:
(1) Population-specific roadmaps outlining five year strategies to achieve target reductions in preterm birth rates based on local assessments of preterm birth prevalence, mortality and disability, prevalence of LINC factors and coverage of interventions; with performance milestones and target outcome indicators.
(2) Premature Birth Report Cards, modeled on those issued annually in the United States by the March of Dimes, to measure progress in reducing the preterm birth rate and newborn deaths from preterm complications in each target region; rating local performance on the priority LINC factors for wide media and public circulation.
(3) Targeted, high saturation, mass media, interpersonal and mobile communication campaigns to educate women, their families and health professionals about the dangers of preterm birth and how to reduce risk by intervening on the LINC factors and increasing healthy and care-seeking behaviors for specific pre-pregnancy and prenatal services.
Locally-led multi-stakeholder teams with representation from governments, civil society, professional associations and corporations would lead each of the three efforts, and advocate for their endorsement and implementation by governments and other key stakeholders, supported by a Global Steering Committee.
The partnership was welcomed by leading representatives from existing multi-country maternal and newborn initiatives, including the Global Preterm Birth Initiative, Survive & Thrive, Saving Newborn Lives, the Maternal Health Task Force, the Newborn Foundation and Women Deliver, and by a number of professional associations including the International Federation of Gynecology and Obstetrics, the International Confederation of Midwives, the International Pediatric Association, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics. Importantly, representatives from the nutrition, contraception, chronic disease and disability sectors expressed their support (1000 Days, Family Care International, Guttmacher Institute, World Diabetes Foundation, Handicap International). Leading corporations in attendance, including Johnson & Johnson, Becton Dickinson, GlaxoSmithKline, DSM, Hygeia, Medtronic and Novo Nordisk embraced the opportunity to join forces with a broader group of actors to prevent preterm births.
All participants acknowledged the fast pace of change since the Global Report on Preterm Birth and Stillbirth in 2010, the landmark Born Too Soon Report in 2012 and the Every Newborn Action Plan in 2014, but agreed that the pace of change needed to be even faster with preterm birth rates rising in most countries. All agreed that with a new Sustainable Development Goal of ending preventable deaths just around the corner, efforts to prevent preterm birth and its associated mortality and disability need to accelerate now…
A Global Steering Committee is now in formation, chaired by the March of Dimes, to develop the proposal and launch the partnership later this year.
If you would like to be involved in the partnership, please contact Chris Howson at the March of Dimes on CHowson@marchofdimes.org
Presentations from the meeting, the concept note describing the Partnership and the presentations by Jim, Leith and Chris can be found here.