A Tale of Two Halves

It always strikes me as shocking that in this day and age, 2012, there is still such a split in the world and such a marked difference in high-income and low-income countries. There are many complexities to this and the stark difference means there are often two very different sets of statistics.

Each year, some 15 million babies in the world, more than one in 10 births, are born too early. Of these, 1.1 million babies will sadly die. The tragedy is that of this number, 75% could be saved in developing countries with inexpensive care. For the smallest and sickest babies, intensive care is often unavoidable but it is not necessary for all preterm babies and there are many options that could be explored to save lives.

The figures from the report show the split between between countries. Of the 11 countries with preterm birth rates over 15 %, all but 2 are in sub-Saharan Africa. Preterm births account for 11.1 % of the world's live births, and 60% of them in South Asia and sub-Saharan Africa. 

In the poorest countries, on average, 12 % of babies are born too soon, compared to 9 % in higher-income countries. The problem of preterm births is not confined to low-income countries-the United States and Brazil both rank among the top 10 countries with the highest number of preterm births. The UK surprisingly also comes in only at 46th (7.8%)  in a poll of 184 countries premature birth rates per 100 live births.

In wealthy and developed countries, the increase in the number of preterm births are linked to the number of older women having babies, increased use of fertility drugs and resulting multiple pregnancies. In some developed countries, medically unnecessary inductions and Caesarean deliveries before full-term have also increased preterm births. In the developing world, the main causes of preterm births include infections, malaria, HIV, and high teenage pregnancy rates as the body is not yet fully ready to carry children of their own. Infections and malaria could be managed and prevented with better available healthcare and more frequent antenatal monitoring and education to both take care of expectant mothers and warning signs of preterm birth to watch out for. For any woman, it is all too easy to brush things off and think "Oh, it's nothing. There are more important things to worry about today" and we can all but imagine when these important things are pressures such as keeping a roof over your head.

In low-income countries, more than 90 % of extremely preterm (born before 28 weeks) babies die within the first few days of life, while less than 10 % die in high-income countries. That is such a huge difference. Having spent two months in a neonatal unit, it is heartbreaking when a child looses their fight. To think that in another country, to expect the majority not to pull through is a sobering thought. Too often we think of these premature babies as figures, as tiny helpless beings that are just not strong enough, not well enough, not grown enough. But each baby, around the world is that: a baby. A baby, a new life, a sign of potential. A loved child, a child with a family who care and will grieve. A person that will be remembered forever. This is not the same as debates about the ethics of termination when the foetus is barely more than cells, this is a baby born alive with the chance of making it.

Experts say that inexpensive, proven forms of care for premature babies could save at least three quarters of these babies in the developing world. These include:

• Antenatal steroid injections for mothers in premature labour, which cost $1 an injection. This helps develop immature foetal lungs and prevent respiratory problems; yet, in low-income countries, they are only available and provided for 10 % of those in need. This alone could save almost 400,000 lives of babies a year. They are given far more frequently in high-income countries and many parents put the survival and health of their premature baby down to receive either one or both of these corticosteroid injections.
  
• "Kangaroo care" where the infant is held skin-to-skin on the mother's chest to keep warm. The warmth is very important for premature infants. This could save 450,000 lives a year.
  
•  Antiseptic cream to prevent birth cord infection.
  
•  Antibiotics to prevent and fight infection, an important cause of neonatal death.
  

Ecuador, Botswana, Turkey, Oman and Sri Lanka have halved their neonatal deaths from preterm birth through improving care of serious complications like infections and respiratory distress. These interventions are particularly effective in preventing death in moderately premature (32-37 weeks) babies, which account for 80% of all premature births.

 "This report is not the last word, but an important next step," says Dr. Howson, who helped compile the report. "Both the report and the broad international constituency behind it offer a framework and set of clear actions to help accelerate global progress on preterm birth.”

The goal is to halve neonatal mortality rates by 2025, and commit to furthering research and promoting better care pre-conception and in the antenatal period. As the saying goes, knowledge is power and the more tools we have to empower women and the health professionals caring for them, the more we can put premature birth and mortality back into the past where it belongs.