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India’s Premature Birth Problem – A Silent Emergency That Needs Urgent Action

With 13 million pre-term births, are we heading towards a silent medical emergency?

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A baby is 'born too soon' every two seconds, and every 40 seconds one of those babies die — according to a new report published by the World Health Organisation (WHO).

Pre-term births and fatal complications are the world's 'silent emergency' quotes the report called, Born too soon: Decade of Action on Preterm Birth.

Pre-term birth is defined as the birth of a baby born before completing 37 weeks of gestation.

Pre-term birth is a subject of silent medical emergency and requires urgent intervention at different levels of the health system.

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The report found that an estimated 13.4 million babies were born preterm in 2020, with 45 percent of them being born in just five countries, including India, China and Pakistan.

India Had Highest Pre-term Births In 2020

India had the highest number of pre-term births in 2020, accounting to over 23 percent of all preterm births worldwide.

As per the findings, in 2020 alone, 1 million of these babies did not survive. Overall, it is estimated that one in five deaths before the age of five is associated with preterm birth.

Those who survived were found to be more prone to disabilities and developmental delays, such as diplegia, learning & behavioural spectrum disorders, and visual impairment occurring due to retinopathy of prematurity.

Pre-term birth remains the fourth leading cause of loss of human capital worldwide at all ages (after ischaemic heart disease, pneumonia & diarrhoeal disease).

These disabilities are preventable and are a sensitive marker of the quality of care & health index of a country.

The report, published by the World Health Organization and the United Nations Children’s Fund with Partnership for Maternal, Newborn and Child Health — involved more than 140 casestudies from 46 countries.

'A Decade of No Change': Other Key Findings of the Report

The data states almost 9,00,000 neonatal deaths were due to direct complications of pre-term birth.

The rate of pre-term births has remained unchanged during the past decade and in some places, they are on the rise.

In the highest-burden regions, for instance, there's been a negligible change.

South Asia - 13.3 percent in 2010 to 13.2 in 2020

Sub-Saharan Africa - 10.1 percent in both 2010 and 2020

At the regional level, the largest incidence of pre-term birth remains in Southern Asia, where 4.8 million babies were born preterm in 2020.

Prof. Madhu Agarwal, a practising Obstetrician in Lucknow says, "Pre-term deliveries pose significant challenges both to the patient, caregivers, communities, health systems, and society at large.

"It increases mental burden, financial stress, and increases hospitalization costs for the families, as well as cost to the public health exchequer ".
Prof. Madhu Agarwal, Obstetrician

The report points out four major contributing factors that pose distinct but overlapping challenges & compound existing inequalities, especially in places where health systems are already weak.

  • Climate change

  • COVID - 19

  • Cost of living crisis

These factors present life-or-death challenges to those already facing extreme vulnerability, including small & sick newborns.

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Preventive Strategies: Investment For Future

Mitigating these risk factors of pre-term delivery can go a long way in reducing pre-term births, saving newborn lives and reducing under-5 mortality.

The different approaches which can be implemented as per the report includes :-

Pre-conception care including access to family planning.

Sexual health programs aimed at the prevention and treatment of infections prior to, and during pregnancy.

Assessing and treating nutritional deficiencies early on

Promoting healthy nutrition including micronutrient fortification and addressing lifestyle risks such as smoking, and environmental risks, like indoor air pollution.

Reducing risks before, during, and between pregnancies through preconception and antenatal care packages may help preterm birth prevention.

Antenatal corticosteroids administered to a pregnant woman in preterm labour can prevent respiratory distress syndrome in premature babies, reducing newborn mortality and morbidity.

To conclude, the need of the hour is urgent inter-sectoral coordination & utilization of digital health technologies to provide quality ante-natal care services at village, tier-2,3,4 cities to provide health access to last miles.

The government’s ambitious National Digital Health Mission and various other incentives through the programs will, to some capacity, act as a catalyst in strengthening the system and reducing maternal mortality and infant mortality rates.

(Dr Faiz Abbas Abidi is a resident doctor at Lucknow's Dr Ram Manohar Lohia Institute of Medical Sciences. He is working on biomedical research, public health issues and digital health interventions. Dr Faiz is specifically working on Department of Biotechnology-supported project on developing cost-effective solutions to improve maternal & child health care in tier 2,3 ,4 cities & villages. He Tweets at @doc_faiz.)

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