The WHO sounds the alarm for a "silent emergency": 13.4 million babies were premature in 2020 worldwide

Around 13.4 million babies were born prematurely in 2020, that is, around 1 in 10 babies were born before 37 weeks of pregnancy worldwide in that year; and nearly a million have died from related complications, according to a new report released by United Nations agencies and partners.

The document, called 'Born Too Soon: Decade of Action on Preterm Birth', prepared by the World Health Organization (WHO) and the United Nations Children's Fund (Unicef) together with PMNCH -the the world's largest alliance for women, children and adolescents – raises the alarm about the “silent emergency” of preterm birth, the magnitude and severity of which have not been recognized for a long time, and which is impeding progress in the improved health and survival of children.

The report includes updated estimates from WHO and UNICEF, prepared with the London School of Hygiene and Tropical Medicine, on the prevalence of preterm births.. Overall, it finds that preterm birth rates have not changed in any region of the world in the last decade, with 152 million vulnerable babies born “too early” between 2010 and 2020.

“This new report shows that the cost of inaction over the last decade was 152 million babies born too soon.. Although some regions are more affected, preterm birth threatens health progress in all countries,” said Joy Lawn, director of the Center for Maternal, Adolescent, Reproductive and Child Health at the London School of Hygiene and Tropical Medicine.

Premature births are currently the leading cause of infant mortality, accounting for more than 1 in 5 of all child deaths that occur before the age of 5.. Survivors of preterm birth can suffer lifelong health consequences, with an increased likelihood of disability and developmental delays.

“Behind every untimely death there is a trail of loss and anguish. Despite the many advances that the world has made in the last decade, we have made no progress in reducing the number of small babies born too soon or in avoiding the risk of their death,” said UNICEF's Director of Health, Steven Lauwerier, who has described the balance as “devastating”.

SURVIVAL DIFFERENCES BY REGION, INCOME, AND RACE

Building on a landmark report on the subject published in 2012, this new study offers a comprehensive overview of the prevalence of preterm birth and its profound impact on women, families, societies and economies.

Too often, where babies are born determines whether they survive. The report notes that only 1 in 10 extremely premature babies (<28 weeks) survive in low-income countries, compared with more than 9 in 10 in high-income countries.

“The enormous inequalities related to race, ethnicity, income and access to quality care determine the probability of premature birth, death and disability, even in high-income countries”, point out the signatory entities of the document.

South Asia and sub-Saharan Africa have the highest rates of preterm birth, and premature babies in these regions face the highest risk of mortality. Together, these two regions account for more than 65% of the world's preterm births.

The report also highlights that the effects of conflict, climate change and environmental damage, Covid-19 and the rising cost of living are increasing the risks for women and babies everywhere.

For example, it is estimated that air pollution contributes to 6 million premature births per year. Nearly 1 in 10 babies are born prematurely in the 10 most fragile countries affected by humanitarian crises, according to a new analysis of the report.

Maternal health risks, such as teenage pregnancy and preeclampsia, are also closely related to preterm births.. This underscores the need to ensure access to sexual and reproductive health services, including effective family planning, with high-quality care during pregnancy and at the time of delivery.

MORE INVESTMENT NEEDED

In the last decade, community activism around the prevention of preterm birth and stillbirth has also grown, promoted by networks of parents, health professionals, academia and civil society, among others.. Around the world, groups of families affected by preterm birth have been at the forefront of advocating for access to better care and policy change, as well as supporting other families.

On the eve of the International Conference on Maternal and Newborn Health, to be held in Cape Town (South Africa) from May 8 to 11, the WHO, UNICEF, UNFPA and PMNCH call for some measures to improve care for women and newborns and mitigate the risks of preterm birth.

First, they call for increased investment, both international and national, to optimize maternal and newborn health, ensuring high-quality care is delivered when and where it is needed.

“Our next generation depends on all of us acting now: the investment may not be small, but the benefits of this investment will be important for all countries,” said the director of the Center for Maternal, Adolescent, Reproductive and Child Health at the School of Hygiene and Tropical Medicine of London.

There is also a need for accelerated implementation of established national policies for maternal and neonatal care; as well as intersectoral integration. With the latter, they refer to promoting education throughout the life cycle; support smarter economic investments, with co-financing between sectors; strengthen climate adaptation responses throughout the life cycle; and advance in the coordination and resilience of emergency systems.

Lastly, they are committed to locally driven innovation; that is, invest in innovation and research at the local level to improve the quality of care and equity in access.

“Ensuring quality care for these smallest and most vulnerable babies and their families is absolutely essential to improve child health and survival.. Progress is also needed to help prevent preterm birth, which means all women must be able to access quality health services before and during pregnancy to identify and manage risks,” said Dr Anshu Banerjee, Director of Health of the Mother, the Newborn, the Child and the Adolescent and Aging of the WHO.