Dr Mary Kinney Preterm birth is now the leading cause of child deaths worldwide. One out of 10 babies are born prematurely, and worldwide, the preterm birth rates have not changed in the past decade. But, according to University of the Western Cape (UWC) senior lecturer, Dr Mary Kinney at the School of Public Health, this can and must change.
“With World Birth Defects Day approaching on 3 March, it should be emphasised that more than 13 million babies are born too soon each year, increasing their risk of birth defects. Worldwide, every two seconds, a baby is born too soon, and every 40 seconds, one of these babies dies. “The state of affairs has a profound impact on women, families, societies and economies, and the public should not turn a blind eye. We have solutions to prevent preterm birth and also care for babies born too soon - saving both the mom and their baby. The cost of inaction at the 2030 horizon will be more than 30 million deaths of women and babies by 2030, more than half of them in Africa. Who you are and where you are born should not determine whether your baby survives, but that is, unfortunately, the sad reality.”
Worldwide, nine in 10 extremely preterm babies - less than 28 weeks - survive in high-income countries, while less than one in 10 survive in low-income countries. Within high-income countries, there is an “unacceptable gap” in outcomes by race and for the poorest or first nation people groups.
“The challenges disproportionately affect the most vulnerable and marginalised people - we need to anticipate and protect rather than be complacent,” she said.
Furthermore, conflict, climate change, COVID-19 and the cost-of-living crisis are increasing threats for the most vulnerable women and babies in all countries.
Local figures issued by Stats SA in 2023 show an average of 15%, or one in seven babies, are born prematurely every year.
Approximately 84 000 preterm infants are born annually, and 10% of them are at increased risk of death and various other complications, including respiratory, neurological and eye morbidities.
Little Zeek shortly after he was born. Rochelle Petersen, 35, from Heideveld in Cape Town, was one of the fortunate ones. She gave birth to two full-term babies, now six and 13, but her third child, Zeek, was born prematurely at 29 weeks.
Petersen experienced complications with high blood pressure, and the baby was in distress with an unhealthily high heart rate.
She was rushed to a clinic in Hanover Park and then to Mowbray Maternity Hospital, which accommodates premature births.
“He was delivered with a caesarian section and was taken up into ICU. I was in the high care unit to stabilise my blood pressure, and I was grateful that the care I got was amazing; doctors answered all my questions. Preemies tend to have weak lungs, so before I left the hospital, I was taught mouth-to-mouth resuscitation if ever he should develop breathing problems. His first winter he was in and out of hospital with viral infections. I’ve learned that preemies are still very susceptible to infections in their first year, because their immunity isn’t that well developed,” said Petersen.
“It meant we had to ask family members not to visit. Even my mother, who was of great help to me, being a smoker, had to change her clothing after smoking and clean herself up to protect our struggling baby from issues with breathing. As he went into his second year, Zeek’s immunity improved, and he is enjoying good health so far. I always had my faith in God that Zeek would get through this.”
Others are not as fortunate. Some families experience abuse of their rights, such as being separated from their babies, as it happened during the Covid pandemic.
Dr Kinney said: “Human rights law applies to everyone, including the vulnerable babies born too soon and their families. We must protect the right to access high-quality care, including developmental care, and fight for it, because some families go bankrupt due to high costs of care.”
There is, however, good news: the majority of related deaths and disabilities are preventable and the first global targets on newborn mortality (SDGs) and stillbirths (Global Strategy) have been set by the World Health Organisation.
According to Dr Kinney, renewed targets for maternal and child survival by 2030 are to be reaffirmed at the World Health Assembly in May this year.
Globally, the place where births happen and babies receive care has shifted, with over 80% of births now occurring in health facilities instead of at family homes.
The WHO developed new evidence and updated global guidelines on a plan to prevent and better manage preterm birth, which is encouraging, while some countries have proven to have impressive leadership for improved care for small and sick newborns that demonstrates what can be achieved with political commitment, investment, and focused implementation.
Dr Kinney said, “We need leadership at the highest level as well as a strong and empowered grass-roots movement, and everyone has a role to play. We can ensure that every baby born too soon - and other vulnerable newborns - survives and thrives. But this requires energy and action at levels that we’ve witnessed a generation ago on the prevention and care for HIV/AIDS. “We can and must do more to prevent preterm birth and to provide respectful care for women at risk, improving health and human capital around the world and achieving the SDG targets for maternal and newborn health. This investment is about saving millions of families from heartbreak, and healthier societies leading to major economic and social shifts,” Dr Kinney concluded.
Facts about Preterm Birth
- Inequalities result in unacceptable survival gaps for babies born preterm.
- Approximately 85% of preterm births occur between 32-37 weeks of gestation, where survival is usually possible without neonatal intensive care - but there are still far too many deaths in this age group in low-resource settings.
- A decade on, more than 70 organisations have come together to develop an updated report. This report, which has involved more than 140 individuals from 46 countries, takes stock of the journey of the past decade - the good and the bad, the challenges and the opportunities.
- The world's largest alliance for women, children, and adolescents, PMNCH, supports the 2012 Born Too Soon report, which ignited a movement for action on preterm birth.
- Only a handful of countries have made modest progress in reducing their preterm birth rates (changes of 0.5% per year); in 13 countries with reliable data, the rates of preterm birth are rising, and there has been no measurable change in 52 countries.
- Recent innovations make this care more doable for every district hospital as part of primary health care, and with a high return on investment.
- Clearer guidance and recognition for the human rights for women and preterm babies, parents and health-care providers which is essential for good health and well-being, stronger health systems and societal progress.
- More mobilization and demand for change exists, especially among parents and healthcare professionals.
- Air pollution linked to climate change contributes yearly to 6 million preterm births and almost 3 million low-birth-weight babies. More investment is needed to specifically mitigate risks and to increase focus on women and babies in policies and programmes addressing the climate emergency.
Listen to Dr Mary Kinney speak the challenges of about Preterm babies
Click here to read about the Born Too Soon report
