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Born Too Soon

A Global Action Report on Preterm Birth

New global report: 15 million babies born too soon, over 1 million die each year

Born Too Soon: The Global Action Report on Preterm Birth provides the first-ever national, regional and global estimates of preterm birth. The report shows the extent to which preterm birth is on the rise in most countries, and is now the second leading cause of death globally for children under five, after pneumonia.

Addressing preterm birth is now an urgent priority for reaching Millennium Development Goal 4, calling for the reduction of child deaths by two-thirds by 2015. This report shows that rapid change is possible and identifies priority actions for everyone.

This inspiring report is a joint effort of almost 50 international, regional and national organizations, led by the March of Dimes, The Partnership for Maternal, Newborn & Child Health, Save the Children and the World Health Organization in support of the Every Woman Every Child effort, led by UN Secretary-General Ban Ki-moon.

A list of preterm birth rates by country are available for download at

>>View the full report, executive summary, press release, and author-reviewer list 

>>View related materials and interactive map of preterm births 

Born Too Soon: Kangaroo Mother Care Saves Preterm Babies from Save the Children on Vimeo.


Born Too Soon proposes actions for policy, programs and research by all partners – from governments to NGOs to the business community -- that if acted upon, will substantially reduce the toll of preterm birth, especially in high-burden countries. The report contains a foreword by UN Secretary-General Ban Ki-moon and is accompanied by more than 30 new and expanded commitments to prevention and care of preterm birth, joining more than 200 existing commitments in support of Every Woman Every Child. Commitments on preterm birth in support of Every Woman Every Child are listed below.

* indicates a commitment by a new partner.

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)*
The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) is a leader among U.S. nursing associations, representing more than 350,000 nurses in our specialty. AWHONN achieves its mission to promote the health of women and newborns through its evidence-based practice resources, legislative programs, research, and collaboration with organizations.

AWHONN’s Late Preterm Infant (LPI) Research-Based Practice Project (RBP), supported by Johnson & Johnson confirms our commitment to raise awareness of risks associated with late preterm birth, reduce complications, and improve care provided to this vulnerable population. Project outcomes include expanding the body of knowledge about LPI morbidity and increasing nurses’ knowledge and ability to provide appropriate care.  A comprehensive Implementation Tool Kit is in development that includes strategies to ensure effective nursing care for key clinical processes identified through the RBP project as pivotal to eliminating preventable LPI complications.

Australia will spend $1.6 billion over five years to 2015 under the Global Strategy for Women’s and Children’s Health to help give poor women and their babies the best chance of survival. A strong health system, available 24 hours a day, 365 days a year is needed to ensure women have healthy pregnancies, safe deliveries and access to services for their newborn babies. Working in partnership with national governments, Australia helps to strengthen health systems by improving service delivery and access to health clinics, training skilled health workers and ensuring reliable supplies of essential medicines, educating women on nutrition, prenatal and postnatal care, and providing quality emergency care if a delivery becomes complicated. Australia also supports efforts to prevent preterm births and improve the health of preterm babies through substantial core contributions to WHO, UNFPA, UNICEF; global initiatives such as the GAVI Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria; and civil society organisations.

The Bill & Melinda Gates Foundation
The Bill & Melinda Gates Foundation commits to reducing the burden of preterm birth as part of its broader Family Health agenda, where we are in the process of granting $1.5 billion from 2010 to 2014. In order to reduce the burden associated with preterm birth, we are investing in three core areas: supporting coverage of interventions that work (e.g. Kangaroo Mother Care, antenatal corticosteroids); supporting research and development of new interventions (particularly related to prevention of preterm birth); and supporting tools to better understand the burden and what can be done to reduce the incidence of preterm birth (e.g. the Lives Saved Tool (LiST) and MANDATE Project).

Core Group*
CORE Group will increase awareness about practical steps to prevent and treat preterm complications to the CORE Group’s Community Health Network, a community of practice of over 70 member and associate organizations by disseminating this report and other state-of-the-art information through its working groups, listservs, and social media channels that reach 3,000 health practitioners around the world.

European Foundation for the Care of Newborn Infants (EFCNI)*
The European Foundation for the Care of Newborn Infants (EFCNI) as first pan-European organization and interactive network to represent the interests of preterm and newborn infants, and their families, welcomes the release of the collaborative global action report “Born Too Soon ”.  Well-organized, effective and targeted pre-conceptional, maternal and newborn care makes a lifelong difference to preterm infants and their families. A healthy start at birth lays the foundation for the good health throughout an individual’s life. In partnership with the Global Alliances, March of Dimes and other organizations worldwide, EFCNI looks forward to reducing the severe toll of prematurity in all countries. As prematurity poses a serious and growing threat to the health and well-being of the future European population, one of EFCNI’s major aims is to raise awareness for preterm birth in society. EFCNI commits itself to make maternal and newborn health a policy priority in Europe by the year 2020.

Flour Fortification Initiative*
Iron and folic acid are commonly added to wheat and maize flours in the milling process, and the foods subsequently made with fortified flour provide more of these nutrients to consumers. Several studies indicate an association between maternal iron deficiency anemia in early pregnancy and a greater risk of preterm delivery (1). Insufficient folic acid before conception and very early in a pregnancy can lead to neural tube defects, and such serious birth defects are one cause of preterm deliveries (2).

This March of Dimes report clearly states the health risks associated with preterm deliveries. The Flour Fortification Initiative joins the March of Dimes as partners to work together towards smarter, stronger, healthier babies delivered at full term.

The GAVI Alliance
GAVI commits to accelerating the reach of vaccines that directly benefit the health of mothers, newborns and children in the world’s poorest countries.

Building on the success of recent efforts to control measles, GAVI will help developing countries to advance the control and elimination of rubella and congenital rubella syndrome. By 2015, over 700 million children will be immunised through campaigns and routine immunisation with combined measles-rubella vaccine. Rubella vaccines alone will avert an estimated 140,000 deaths and will protect hundreds of thousands of babies against severe birth defects from congenital rubella syndrome, and help to prevent still births and miscarriages caused by rubella infection.

To accelerate the successes of maternal neonatal tetanus elimination, GAVI helped UNICEF support 33 countries in reaching more than 40 million women with two doses of MNT vaccines.

GAVI will continue to support countries to strengthen the delivery of quality immunisation services, bringing life-saving vaccines to mothers and children as part of integrated MNCH services.

The Global Alliance for Clean Cookstoves at the UN Foundation
While the link between exposure to cookstove smoke and a wide range of health problems such as pneumonia, chronic obstructive pulmonary disease, and lung cancer is well established – causing around 2 million deaths per year—the current body of evidence linking cookstoves with adverse pregnancy outcomes is compelling but somewhat limited.  As part of its commitment to Every Woman Every Child, the Global Alliance for Clean Cookstoves, hosted by the UN Foundation, will provide up to US$ 800,000 in funding over the next two years towards research that fills key gaps in the existing evidence on the link between the use of traditional cookstoves and child survival. These will specifically focus on adverse pregnancy outcomes, including low birth weight, pre-term birth, and birth defects; and/or severe respiratory illness, including pneumonia, in children under-five years of age.  Results will hopefully identify a new category of interventions aimed at reducing premature births worldwide.

Global Alliance to Prevent Prematurity and Stillbirth (GAPPS)*
Global Alliance to Prevent Prematurity and Stillbirth commits to leading global efforts to discover the causes and mechanisms of preterm birth and stillbirth. Research leadership includes stewardship of the Preventing Preterm Birth initiative, a Grand Challenges in Global Health from the Bill & Melinda Gates Foundation; operating the GAPPS Repository of maternal and newborn samples for researchers of pregnancy and newborn health; and guidance on research harmonization. Additionally, GAPPS commits to expanding collaborative efforts to demonstrate the critical need for strategic investments in pregnancy and post-birth scientific research where large health gains can be achieved through the development of new, low-cost, high-impact innovations and developing a global advocacy campaign to promote the need for research and catalyze funding for it. GAPPS will work to make every birth a healthy birth.

Home for Premature Babies (HPB)*
By uniting 400,000 families, the Home for Premature Babies (HPB)—China’s largest association of parents and families affected by a preterm birth and established in 2005—has entered a phase of rapid development. In addition to our current work on awareness raising and providing rehabilitation service for preterm infants, we are planning to achieve the following goals within 3 to 5 year’s time: 1) double our membership; 2) create and publish a monthly magazine on premature infants, 3) establish a medical tele-consultation system, 4) develop and implement a continuing education program for pediatricians, and 5) establish a branch of HPB in every province in China.

International Pediatric Association*
The 177 national and regional pediatric societies of the International Pediatric Association (IPA) are committed to help reduce the incidence of preterm delivery. We support healthiest possible neonatal, child and adolescent health for every future parent with every aspect of our practice and policy contributions. We support the healthiest possible motherhood through planning, available health services, pregnancies that are supported by the entire community and safe delivery for mother and baby.

We will feature the publication Born Too Soon: A Global Action Report on Preterm Birth on the IPA website and in the organizational newsletter, encouraging national pediatric societies to feature this topic in their educational meetings and policy discussions.

The Japan International Cooperation Agency (JICA)
The Japan International Cooperation Agency (JICA) commits to support the Global Strategy for Women’s and Children’s Health through the capacity development of partner countries in enhancing their health service delivery for maternal, newborn and child health care.
JICA will contribute to achieving the goals expressed in Japan's Global Health Policy 2011-2015, which commits to saving approximately 11.3 million children’s lives and 430,000 maternal lives in cooperation with other donors.  JICA will support partner countries in building and strengthening systems that provide a comprehensive “Continuum of Care for Maternal and Child Health”.

Every year, JICA implements technical cooperation and grant aid projects for MNCH at the level of 3 billion and 3-16 billion Japanese yen respectively, and will initiate concessional loans to help support partner countries to achieve MNCH-related MDGs. JICA will endeavor to make a change on MNCH through the integrated management of the three modalities of assistance.

The Johns Hopkins Bloomberg School of Public Health
The Johns Hopkins Bloomberg School of Public Health is committed to strengthening evidence on the extent and causes of preterm births globally and to developing culturally and economically appropriate interventions to reduce the burden of premature birth around the world. We also commit to working with governments and their partners on the translation of evidence into effective policies and programs. We aim to achieve measurable results of our efforts by 2015.

Kinshasa School of Public Health, DRC*
Preterm birth remains a major public health problem in the Democratic Republic of Congo as in other developing countries. According to a study conducted in the Maniema Province in 2006, the low birth rate was 164 per 1000 live births at Kipaka Area.

In the year 2011, the General Referral Hospital of Kinshasa had 314 pre-term deliveries out of 1,170.

It is not surprisingly then that the Kinshasa School of Public Health with its partner, the University of North Carolina, has joined the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and has submitted a proposal aimed to prevent preterm birth.

The goal of this initiative is to encourage scientific studies that eventually will lead to or refine preventive interventions for preterm birth and still birth related to preterm birth, primarily in developing world settings.

The March of Dimes
The March of Dimes commits to continuing its Prematurity Campaign through 2020, working to reduce the preterm birth rate in the United States to 9.6% or less, and helping to build a global constituency to reduce the toll of death and disability caused by preterm birth worldwide. The March of Dimes Prematurity Campaign devotes approximately $20 million annually to: 1) funding for biomedical research, and transdisciplinary research aimed at delineating the multi-factorial causes of premature birth; 2) collaboration with state governments, hospitals, and lower-income country partners to enhance the quality and accessibility of prenatal and newborn care; 3) provider education and consumer awareness campaigns to identify and reduce risk of prematurity, and provide guidance and comfort to parents of premature babies. The March of Dimes joined with parent groups to create and promote World Prematurity Day, November 17, to build a constituency for further action, including the recommendations in Born too Soon.

Paediatrics and Child Health, College of Medicine, University of Malawi
The College of Medicine in the paediatric department is committed to improving the care of newborns in Malawi. Specific efforts are being made to help premature babies with respiratory distress by introducing appropriate technologies, and enhancing the Kangaroo Mother Care through teaching and outreach.

Peking University Center of Medical Genetics (PUCMG)*
The mission of the Peking University Center of Medical Genetics (PUCMG) is to promote healthcare in order to improve the quality of life in China.  The Preterm Clinical Research Consortium of PUCMG estimated the rate of preterm birth in China to be 5.5% in 2011. PUCMG will continue to work closely with global, regional and Chinese national and local communities—including governmental agencies, medical professionals, academic investigators, industrial partners and parent groups—to raise public awareness of the toll of preterm birth in China. We will continue existing programs, including youth and preconceptional interventions, directed to reducing the rate or preterm birth and associated mortality and disability in China.  PUCMG will also conduct studies to explore the etiology and pathogenesis of preterm birth in China in order to provide evidence-based, novel strategies for prevention, intervention and care. Within 3 years, PUCMG will have completed a prospective cohort study identifying major risk factors for preterm birth in the Chinese populations.

The Partnership for Maternal, Newborn & Child Health
 The Partnership for Maternal, Newborn & Child Health (PMNCH) commits to raising greater attention for the significant contribution of preterm birth to neonatal and child mortality, creating greater visibility, resources and partner engagement in this important aspect of reaching Millennium Development Goal 4, which calls for reducing under-five child mortality by two-thirds by 2015.

Specifically, PMNCH commits to:

  • Develop a knowledge summary on preterm birth to accompany the May 2012 launch and dissemination of Born Too Soon: The Global Action Report, with wide distribution to PMNCH members and through other advocacy channels, including web and listserv publication;
  • Through the Innovation Working Group of the Every Woman Every Child Effort and its private sector constituency , support the development of preterm private sector commitments linked to the publication of the final report of the Commission on Life-Saving Commodities for Women and Children, due in September 2012;
  • Promote widespread engagement of its membership in World Prematurity Day, November 17, to further increase popular and political attention to this important issue;
  • From 2013, track progress on the implementation of the preterm commitments published in Born Too Soon. Findings will be communicated in an annual report by PMNCH every year through 2015. This PMCH report will be submitted to the independent Expert Review Group for its own annual progress report on the results and resources related to the Global Strategy and on progress in the implementation of the recommendations of the final report of the Commission on Information and Accountability for Women’s and Children’s Health (2011).
Preterm Birth International Collaborative (PREBIC)*
Preterm Birth International Collaborative (PREBIC) supports prematurity prevention programs by organizing workshops for scientists, clinicians and other health care professionals around the globe aimed to build consortiums of investigators. These consortiums identify knowledge gaps in various areas of preterm birth research and develop protocols and scientific studies to fill the knowledge gaps. PREBIC organizes satellite scientific symposiums in association with major Obstetrics and Perinatal Congresses to educate professionals in the field on various aspects of preterm birth research. PREBIC has also set up facilities to conduct high throughout “OMICS’ research and build network of investigators to conduct organized research to better understand preterm birth and for global prevention of preterm birth.

Save the Children
As a technical leader for newborn health, Save the Children commits to working with the poorest families in the highest burden countries to increase access to proven newborn care interventions critical to achieving MDG-4 since over 40% of under-5 child deaths occur in the first month of life. Basic newborn care, especially for those “born too soon”, makes the difference between life and death. Yet societal norms often accept newborn death as inevitable. We commit to working with partners to make preventable newborn deaths unacceptable. Through partnerships with governments, civil society, professional organizations, corporations and the UN system, Save the Children will continue to advance implementation of maternal and newborn services, enabling frontline health workers and empowering families to provide the care that every newborn needs. We will promote increased and equitable access for high-impact interventions for preterm babies including antenatal corticosteroids to strengthen premature babies’ lungs, Kangaroo Mother Care, neonatal resuscitation, improved cord care using chlorhexidine, breastfeeding support and effective treatment of neonatal infections.

The Government of Sweden/Sida
This report puts important attention to an area within the continuum of maternal and newborn health care. Knowledge and interventions to prevent prematurity is a neglected area in many countries of the world; especially in low income countries. For Sweden and Sida the reduction of newborn morbidity and mortality remains a high priority. We are committed to reducing the incidence of prematurity and to do so mainly through support to capacity building of a competent midwifery workforce. An educated and professional midwife provides a number of important prerequisites for preventing pre-term births as well as identifying and caring for the pre-term baby. As part of the global movement to reduce MNC mortality Sida will work to increase awareness of the role midwives can play and improve education and working conditions to allow midwives to play a significant role in the prevention of  premature birth and competent care for the pre-term baby.

Government of the U.K./DFID
The UK welcomes the publication of “Born Too Soon: The Global Action Report for Preterm Birth”, highlighting the impact of pre-term birth on newborn and under five mortality. We agree there is an urgent need for more action to prevent and manage pre-term births. We urge all our partners to increase their efforts to achieve the aims of the UN Secretary-General’s Global Strategy for Women’s and Children’s Health.

The UK has set out clear plans to help improve the health of women and young children in many of the poorest countries. We will help save the lives of at least 250,000 newborn babies and 50,000 women during pregnancy and childbirth by 2015. All the UK’s commitments to improve the lives of women and children can be found in “UK AID: Changing lives, delivering results”, at

UNICEF is committed to ensuring the healthy survival and development of all children, particularly the most vulnerable and disadvantaged. Specifically UNICEF commits to:

  • support global advocacy efforts to increase awareness and action to prevent and care for preterm births.
  • Support governments to implement and scale up preterm and newborn care interventions especially for the poorest families.
  • Strengthen community programs for the prevention of preterm births and care of new borns to improve equitable access to services for the most disadvantaged mothers and babies.
  • Work with WHO to support [Member States] to strengthen the availability and quality of data on preterm births and provide updated analyses of global preterm birth levels and trends every three to five years.
  • Advance the procurement and supply of essential medicines and commodities that relate to preterm births, neonatal illnesses and deaths.

University of the Philippines Manila*
Born too Soon is a timely reminder to all stakeholders that prematurity must be the concern of all. We stand committed to continue our research and advocacy work on models for preconception care. The current project will produce counseling modules for different settings - counseling at the workplace, peer counseling (targeting high school and college students) and counseling at the community (urban and rural). The project is being piloted city-wide in Lipa City, Batangas, Philippines in cooperation with the Local Government of Lipa City.

The modules will be turned over to the Department of Health for replication in other parts of the country.

This project is funded by the Department of Health Philippines, Institute of Human Genetics- National institutes of Health and the March of Dimes Foundation, USA.

The University of Texas Medical Branch*
UTMB and the Department of Obstetrics & Gynecology, Maternal-Fetal Medicine Division, is one of the premier educational institutions in the United States serving a high-risk pregnancy population. The institution is committed to research and educational programs that for decades have been in the forefront of prematurity-prevention initiatives. The Obstetrics & Gynecology Department's Perinatal Research Division studies preterm-birth risk factors, pathophysiology, pathways, and designs prevention strategies. In addition, the division is dedicated to understanding causes and consequences of fetal programming due to preterm birth.

Government of the U.S.A/USAID
The United Stated Agency for International Development (USAID) is fully committed to saving newborn lives as part of a comprehensive maternal, newborn, and child health program through its investments in the U.S. Global Health Initiative. USAID has worked closely with Governments, UN Agencies, civil society organizations, professional associations, and the private sector to support efforts to generate evidence on high-impact newborn interventions and service delivery approaches, sparked the development of game-changing innovations to reduce maternal and neonatal mortality, supported the update of global guidelines and policies, worked with Governments to introduce them at the country level, increasingly engaged the private sector to be part of the solution, and built global public-private alliances to harness the resources and creativity of diverse organizations. USAID will continue to use these effective and inclusive approaches to support selected high-impact and affordable interventions that can prevent and manage complications associated with preterm birth as part of an integrated newborn and child health program with the aim of ending preventable child death.

Women Deliver
Women Deliver commits to making family planning one of three themes of its international conference, Women Deliver 2013, May 28-30, 2013 in Kuala Lumpur, Malaysia. Spacing births through voluntary family planning is a key intervention to reduce the risk of preterm births. The global conference will explore solutions on how to reduce unmet need for family planning by 100 million women by 2015 and 215 million women, by 2020. To encourage sharing of lessons learned and successes, Women Deliver commits to developing a track for its global conference on newborn health.

The World Health Organization
The World Health Organization is committed to reducing the health problems and lives lost as a result of preterm birth. Specifically, we will work with Member States to strengthen the availability and quality of data on preterm births. We will provide updated analyses of global preterm birth levels and trends every three to five years. We will work with partners around the world to conduct research into the causes of preterm birth, and test effectiveness and delivery approaches for interventions to prevent preterm birth and treat babies that are born preterm. We will regularly update clinical guidelines for the care of preterm babies, including “kangaroo mother care” (the baby is carried by the mother, with skin-to-skin contact), feeding babies with low birth weight, treating infections and respiratory problems, and home-based follow-up care. And we will develop tools to improve health workers’ skills and assess the quality of care provided to preterm babies.