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Journalism of Courage
Every two seconds, a baby is born too soon. Every 40 seconds, one of those babies dies.
Almost half of all pre-term births (babies born before the 37th week of pregnancy) in 2020 happened in five countries — India, Pakistan, Nigeria, China and Ethiopia — according to a new report released by the United Nations (UN) agencies and partners on Tuesday. Together they accounted for 45 per cent of babies born too soon around the world, exposing them to a high mortality risk. This indicates a “silent emergency” for children’s survival and health.
An estimated 13.4 million babies were born pre-term in 2020 with nearly one million dying from complications. This is equivalent to around one in 10 babies as per the report titled ‘Born too Soon: Decade of Action on Pre-term Birth”, put together by WHO, United Nations Children’s Fund and Partnership for Maternal, Newborn and Child Health (PMNCH) – the world’s largest alliance for women, children and adolescents.
In 2020, Bangladesh had the highest estimated pre-term birth rate (16.2 per cent), followed by Malawi (14.5 per cent) and Pakistan (14.4 per cent). India and South Africa, at an estimated 13 per cent each, were among the top five countries with high pre-term birth rates. The total pre-term birth numbers for the five countries are alarming indeed as India tops the list with 30.16 lakh births, Pakistan is at 9.14 lakh, Nigeria at 7.74 lakh and China at 7.52 lakh. The report includes updated estimates from WHO and UNICEF.
What’s causing pre-term births in India? Clearly the infrastructure for neonatal care needs to be more expansive and last-mile. Explaining the findings, Dr Surender Singh Bisht, secretary general of the National Neonatology Forum (NNF), said, “In rural areas, there used to be a common complaint of lack of access to health care but initiatives like special newborn care units, improved labour rooms and efficient deliveries have helped save many pre-term babies. But they are still not as expansive.”
The government has launched many programmes such as the India Newborn Action Plan and Rashtriya Bal Suraksha Karyakram and has set up many Speciality Newborn Care Units (SNCUs) across the country.
Dr V C Manoj, president-elect of NNF, said, “Several factors like lifestyle changes, chronic diseases and IVF pregnancies are associated with increased pre-term births in urban centres.” Dr Bisht concurred. “Reduced fertility levels and assisted pregnancies are also not without the risk of pre-term births.”
As for the region-wise break-up of pre-term births in India, a report published on June 28 last year in PloS-Global Public Health showed that West Bengal reported 16 per cent of such births, Tamil Nadu 14 per cent and Gujarat 9 per cent.
Overall, the report finds that pre-term birth rates have not changed in any region in the world in the past decades. The global pre-term birth rate was 9.9 per cent in 2020, compared to 9.8 per cent in 2010.
There was also no change in pre-term birth rates in any region, including the highest-burden regions (southern Asia logging in 13.3 per cent in 2010 and 13.2 per cent in 2020, and sub-Saharan Africa at 10.1 per cent in both 2010 and 2020). In fact, these two regions collectively account for over 65 per cent of pre-term births globally.
At a webinar, Dr Anshu Banerjee, director for Maternal, Newborn, Child and Adolescent Health and Ageing at WHO, said every woman must be able to access quality health services before and during pregnancy to identify and manage risks and avoid a pre-term birth.
According to Dr Sachin Shah, president, Indian Academy of Paediatrics – Intensive Care (Pune chapter), it is important to encourage quality care at special newborn care units and train mothers in practising kangaroo care for low birth weight infants. This essentially means prolonged skin-to-skin contact with the mother and frequent breastfeeding.
Pre-term birth is the leading cause of child mortality, accounting for nearly one in five of deaths of children under five years. Three of four pre-term babies are still born. According to the report, only a few countries have made progress in reducing their pre-term birth rates, though changes have been modest at five per cent in 10 years, a mere 0.5 per cent per year. The “four Cs” – conflict, climate change, COVID-19 and the cost-of-living crisis – heighten threats for the most vulnerable women and babies in all countries. Helga Fogstad, Executive Director, PMNCH, said that climate change was a big factor in pre-term births and policy changes were needed to mitigate such risks.
