Prof. Priya Soma-Pillay
“Every two seconds, somewhere in the world, a baby is born preterm and every 40 seconds, a preterm baby dies.”
Preterm birth, defined as childbirth before 37 weeks of gestation continues to be a significant global health issue with serious short and long-term consequences for both infants and their families. An estimated 13.4 million babies were born preterm in 2020, with approximately one million infants dying from preterm complications.1 Preterm infants are particularly vulnerable to complications due to impaired respiration, difficulty in feeding, poor body temperature regulation and a high risk of infection. Often, where babies are born dictates if they will survive. One in 10 extremely preterm neonates (< 28 weeks) survive in low-income countries compared to more than 9 in 10 in high-income countries.1 Inequalities related to race, ethnicity, socioeconomic and educational status, and access to quality healthcare services determine the likelihood of death and disability.
Preterm birth is the leading cause of under-five deaths and accounts for 1 in 5 of all deaths of children under 5 years of age. One-third of newborn deaths are babies born preterm and three-quarters of all stillbirths (28 weeks or more) are preterm in high and middle-income countries.
Rates and causes of preterm birth
Thirteen percent (154 800) of babies born in South Africa in 2020 were born preterm and this rate has been a flat line (unchanged) over the last decade.2 The neonatal mortality rate from 2019 to 2020 was 12 per 1 000 live births. Preterm birth was the cause of almost 50% of all neonatal deaths, according to the South African Maternal, Perinatal and Neonatal Health Policy published in 2021.3
Preterm birth rates globally have remained unchanged over the last decade. The highest reported rates are in southern Asia and sub-Saharan Africa.1 In 2010 13.3% of babies in southern Asia were born premature; this figure was 13.2% in 2020. In sub-Saharan Africa 10.1% of babies in both 2010 and 2020 were premature. The Born Too Soon: 2023 Decade of Action on Preterm Birth Report has highlighted 4 global issues (the “four” Cs) that have affected efforts to improve preterm birth outcomes in the last decade1:
Conflict – By the end of 2022, over 100 million people were driven from their homes by war, violence, or human rights abuses. Worldwide, 61% of maternal deaths, 51% of stillbirths and 50% of newborn deaths occurred in countries that required UN humanitarian aid in 2023. Surviving newborns are particularly vulnerable to lifelong risks.
COVID-19 – The pandemic destabilized health services for women and newborns. Separation of newborns from caregivers threatened high-impact practices like kangaroo mother care (KMC) and exclusive breastfeeding. A recent study found that if universal coverage of KMC was achieved, more than 125 000 newborn lives could have been saved, with fewer than 2000 deaths from COVID-19.2