A New Global Focus on Preterm Births
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Additional Background and Resources:
Background materials on Born Too Soon report and preterm birth: http://everywomaneverychild.org/borntoosoon
Every Woman Every Child commitments to preterm birth: http://everywomaneverychild.org/commitments (search by “issue area”)
For TV Producers: B-roll on the Hoffman & Hoffman website: www.hoffmanpr.com/world/preterm/B-roll
Facebook for parent stories and an interactive map of preterm births: www.facebook.com/WorldPrematurityDay
Preterm birth is the world’s largest killer of newborn babies, causing more than 1 million deaths each year, yet 75 percent could be saved without expensive, high technology care.
That’s the primary message and motivating theme of World Prematurity Day, November 17, a global effort to raise awareness of the deaths and disabilities due to prematurity and the simple, proven, cost-effective measures that could prevent them.
On World Prematurity Day, countries in nearly every part of the world will take action to raise awareness of what can be done to reduce preterm births and better care for babies born too soon.
Families affected by premature birth can share stories, photos, and videos, and identify their locations on an interactive world map on facebook.com/WorldPrematurityDay. More than 700,000 visited this website in 2011.
“People think that preterm babies need intensive, high-tech care, but we have simple methods that really work and would save hundreds of thousands of lives,” says Joy Lawn, M.D., Ph.D., of Save the Children, a neonatal physician.
12.6 million moderate to late preterm births
Babies born between 32 and less than 37 completed weeks of pregnancy make up 85 percent of the 15 million preterm babies born annually –12.6 million.
“These babies are born too soon, but they are not born to die,” says Dr. Lawn. “Their deaths are utterly preventable.”
“We know what it takes to address the challenge of prematurity and we are committed to bringing partners together behind proven, affordable solutions,” says UN Secretary-General Ban Ki-moon who launched The Global Strategy for Women’s and Children’s Health in 2010. The Global Strategy is supported by Every Woman Every Child, an umbrella movement that has already leveraged more than $20 billion in new money and aims to save the lives of 16 million by 2015.
The countries with the greatest numbers of moderate to late preterm births annually are:
India –2,959,300; China –981,050; Nigeria –665,080; Pakistan –633,640; Indonesia –564,350; United States –438,410; Bangladesh –355,030; Philippines –295,780; Democratic Republic of Congo –291,750; and Brazil –233,320.
Essential newborn care
“Essential newborn care is especially important for babies born preterm,” said Elizabeth Mason, M.D., Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health. “This means keeping them warm, clean, and well-fed, and ensuring that babies who have difficulty breathing get immediate attention.”
Three low-cost interventions that are very effective, but are not commonly used, are:
· Steroid injections. When given to mothers in preterm labor, dexamethosone, a steroid used to treat asthma, helps speed up the development of the baby’s lungs. At a cost of about US$1, two shots can stop premature babies from going into respiratory distress when they are born. This can prevent 400,000 deaths annually.
· Kangaroo Mother Care. Using this technique, the tiny infant is held skin-to-skin on the mother’s chest. This keeps the baby warm and facilitates breastfeeding. Keeping preterm babies warm is especially important because their tiny bodies lose heat rapidly, making them highly vulnerable to illness, infection and death. This could prevent 450,000 deaths annually.
· In addition, basic antibiotics can save lives, such as amoxicillin to treat pneumonia and injection antibiotics to fight serious infections.
“Using an essential package of pregnancy, childbirth and postnatal care that includes these interventions will save more than three quarters of preterm babies without intensive care,” says Carole Presern, Ph.D., head of The Partnership for Maternal, Newborn & Child Health (PMNCH) and a midwife. “Most of these infants can grow up healthy and without lifelong disabilities.”
Prevention is the next frontier
A key way to reduce the burden of preterm birth is to find ways to help pregnancies go to full term, or at least 39 weeks.
“Prevention is the next frontier,” says Christopher Howson, Ph.D.,Vice President of Global Programs for the March of Dimes and an epidemiologist. “We are looking closely at what can be done before a woman gets pregnant to help her have an optimal outcome.”
A number of risk factors for mothers to deliver prematurely have been identified, including a prior history of preterm birth, underweight, obesity, diabetes, high blood pressure, smoking, infection, age (either under 17 or over 40), genetics, multiple pregnancy (twins, triplets, and more) and pregnancies spaced too closely together.
“We also know that poverty, lack of women’s education, malaria and HIV all have an impact on the pregnancy and the health of the baby,” says Dr. Howson. “However, little is known about the interplay of these and other environmental and social factors in increasing the risk of preterm birth. We need to know more and this knowledge could have a big impact in the lowest income countries.”
Documented success for steroid use and Kangaroo Mother Care
In high-income countries, steroids have been widely used for women in preterm labor since the 1990s and an estimated 95 percent of women in preterm labor before 34 weeks of pregnancy now receive steroid injections prior to delivery.
By comparison, in low- and middle-income countries, only an estimated 5 percent of women receive these steroid injections.
Dr. Lawn says that these medicines are rarely used in the developing world, despite the low cost and proven effectiveness, because health care professionals do not know about this life-saving use. In fact, antenatal steroids are now identified by a new UN-led Commission on Life-Saving Commodities for Women and Children as an essential medicine that should be available everywhere.
“The use of steroids should be part of the ‘to do’ list of everyone looking after women in pregnancy. It should be written on hospital walls,” says Dr. Lawn. “In America or Europe, if a woman in preterm labor were not given steroid injections, the doctor could be sued for malpractice, as this is the standard of care. Why should a woman in Africa or Asia not get the same care, especially given the low cost?”
Kangaroo Mother Care started as a solution for overcrowded nurseries in Colombia where tiny infants were forced to share what incubators were available. The technique works well for both mothers and babies. Studies show that the mortality rate for babies who benefit from Kangaroo Mother Care can be the same or better than that for babies in incubators.
Though Kangaroo Mother Care was developed in 1967, the spread has been slow despite the well-documented effectiveness and its benefits for child development.
“One reason for the slow spread in some areas could simply be a lack of information about what works,” says Dr. Presern. “Another may be that many obstetricians, midwives and nurses find it hard to accept that such a natural approach could be superior to expensive high technology equipment.”
Countries make new commitments
On World Prematurity Day, a number of countries will announce major commitments to reduce preterm mortality. These countries have each adopted packages of interventions to care for premature babies and are championing initiatives in their countries and others. For example:
· Malawi has the world’s highest preterm birth rate, a statistic that led the Vice President Khumbo Kachali and the country’s health leaders to prioritize care for preterm babies, instituting Kangaroo Mother Care and providing steroid injections in almost all hospitals.
· India—with nearly 3 million moderate to late preterm births, the largest number in the world, and 304,000 preterm deaths per year—has been working with support from UNICEF to outfit 100 district hospitals to care for preterm babies.
· Uganda has committed to speeding access to steroid injections for all women in preterm labor.
Born Too Soon report stimulates activity
Publication of the Born Too Soon report in May 2012 by the March of Dimes, PMNCH, the World Health Organization and Save the Children drew global attention to what many consider one of the world’s most overlooked public health problems. The report included the first country-by-country statistics for both absolute numbers and rates of preterm birth, documenting the extent and severity of the problem, also published in The Lancet.
The report showed that preterm births are not solely a problem of the developing world, but that wealthy countries, including the United States and Brazil, were also in the top 10, in terms of absolute numbers. To mark the publication of the report, more than 30 organizations made new or enhanced commitments in support of the Every Woman Every Child effort launched by the United Nations Secretary General Ban Ki-moon.
About World Prematurity Day
Started last year by the March of Dimes and founding parent groups –European Foundation for the Care of Newborn Infants (EFCNI), Africa-based Little Big Souls International Foundation and the National Premmie Foundation of Australia— World Prematurity Day will this year spread throughout the world, now involving more than 50 countries and groups globally.
Events are planned in many countries, including the United States, China, Indonesia, Malaysia, Malawi, Uganda and Argentina, to draw public attention to the problem of preterm birth and the simple care that can save many of these babies.
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Born Too Soon Supporters: Governments, United Nations agencies, development partners, foundations, civil society, parents’ organizations, health professional associations, academia, and the private sector.
The Aga Khan University, American Academy of Pediatrics, American University of Beirut Medical Center, Association of Women’s Health, Obstetric and Neonatal Nurses, Australian Aid, Bliss UK, Bill & Melinda Gates Foundation, Canadian International Development Agency, Centers for Disease Control and Prevention, Countdown to 2015, European Foundation for Care of Newborn Infants, Family Care International, Flour Fortification Initiative, GAVI Alliance, General Electric, Global Alliance to Prevent Prematurity and Stillbirth, Home for Premature Babies (China), Institute for Clinical Effectiveness for Health Policy, International Federation of Gynecology and Obstetrics, International Confederation of Midwives, International Pediatric Association, International Preterm Birth Collaborative, Japan International Cooperation Agency, Johns Hopkins Bloomberg School of Public Health, Ecole de Santé Publique, Université de Kinshasa, Little Big Souls International Foundation Africa and UK, London School of Hygiene & Tropical Medicine, National Premmie Foundation Australia, Nationwide Children’s, National Collaborative Perinatal Neonatal Network, Norwegian Agency for International Development, Peking University Center of Medical Genetics, Swedish International Development Cooperation Agency, Tommy’s, UK Department for International Development, UNICEF, United Nations Foundation, United Nations Population Fund, United States Agency for International Development, University College London, University of Malawi, University of Texas Medical Branch, Institute of Human Genetics (University of the Philippines), Women Deliver.
Countries and territories
|Number of moderate to late preterm births
(32 to <37 completed weeks) (2011)
|Number of deaths due to preterm birth complications (2011)|
|Democratic Republic of the Congo||291,750||43,600|
|United Republic of Tanzania||184,560||16,930|
|Iran (Islamic Republic of)||136,950||7,740|
|Syrian Arab Republic||42,630||1,880|
|Venezuela (Bolivarian Republic of)||41,010||2,020|
|Republic of Korea||37,140||500|
|Democratic People’s Republic of Korea||31,470||2,700|
|Bolivia (Plurinational State of)||20,080||2,210|
|Central African Republic||16,560||2,340|
|Lao People’s Democratic Republic||12,750||890|
|Papua New Guinea||11,500||1,740|
|Libyan Arab Jamahiriya||10,070||630|
|United Arab Emirates||6,010||170|
|Republic of Moldova||4,380||50|
|Bosnia and Herzegovina||2,110||50|
|Trinidad and Tobago||1,350||90|
|Former Yugoslav Republic of Macedonia||1,250||80|
|Sao Tome and Principe||460||50|
Born Too Soon: The Global Action Report on Preterm Birth – Updated for 2011with live births and neonatal mortality estimates for 2011 from The UN Interagency Group for Child Mortality Estimation.
Numbers of babies with moderate to late preterm birth: Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler A, Garcia CV, Rohde S, Say L, Lawn JE. National, regional and worldwide estimates of preterm birth, The Lancet, June 2012.
Deaths due to preterm birth complications data: Liu L, Johnson HL, Cousens S, Lawn JE et al. 2012. Global, regional, and national causes of child mortality in 2000–2010: an updated systematic analysis. The Lancet, June 2012. doi:10.1016/S0140-6736(12)60560-1.
Preterm birth prevention analysis: Hannah H. Chang, Jim Larson, Hannah Blencowe, Catherine Y. Spong, Christopher P. Howson, Sarah Cairns-Smith, Eve M. Lackritz, Shoo K. Lee, Elizabeth Mason, Andrew C. Serazin, Salimah Walani, Joe Leigh Simpson, Joy E. Lawn. Preventing preterm births: trends and potential reductions with current interventions in 39 very high human development index countries. The Lancet in press.
UN Commission sets out plan to make life-saving health supplies more accessible
UNITED NATIONS, New York, 26 September2012 – A new plan and set of recommendations to improve the supply and access of life-saving health supplies was submitted today to the UN Secretary-General by the members of the United Nations Commission on Life-Saving Commodities for Women and Children.
The Commission is part of the Every Woman Every Child movement and was formed to support the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, with the aim of ending the suffering of women and children around the world caused by lack of access to life-saving commodities. The Secretary-General called on the global community to work together to save 16 million lives by 2015. The Commission seeks to meet this challenge by improving access and use of essential medicines, medical devices and health supplies that effectively address causes of death during pregnancy, childbirth and into childhood.
President Goodluck Jonathan of Nigeria and Prime Minister Jens Stoltenberg of Norway, who co-chair the Commission, expressed their continued commitment to improving access to these supplies. Other commissioners, as well as UNICEF Executive Director Anthony Lake and UNFPA Executive Director Babatunde Osotimehin, who serve as Commission vice-chairs, echoed the call to action.
“I am pleased to see the Commission’s work presented here today and am committed to seeing these important recommendations implemented at country level, where they will impact millions of lives,” said President Goodluck Jonathan of Nigeria. “As co-chair of this important Commission, I will be hosting a meeting in Abuja later this year to discuss with ministers from other countries how we will rapidly translate this work into tangible action for women and children.”
“In spite of promising decline in maternal and child mortality with around 40 percent since 1990, the fact that the day a woman gives birth is still the most dangerous day in her and her child’s life is unacceptable,” said Prime Minister Jens Stoltenberg of Norway. “The Commission’s recommendations are concrete and represent highly cost effective interventions.”
The recommended steps include bulk buying, local manufacturing and innovative marketing to help transform the supply, demand and use of quality life-saving products. It is estimated that hundreds of thousands of women and children’s lives could be saved each year with essential supplies, including for family planning. Medicines for the prevention of bleeding after childbirth and treatment of diarrhoea and pneumonia such as oral rehydration solution and zinc and amoxicillin – which cost less than 50 cents per treatment — can make the difference between life and death for mothers and their babies.
“It is simply wrong that millions of children and women still die every year when we have the products and the knowledge to save their lives,” said UNICEF Executive Director Anthony Lake. “With the Commission’s help, we have still more practical solutions. What is needed now is the political will to implement them.”
As a result of better planning, increased financial resources, bulk buying, and joint procurement, the availability of long-lasting insecticide-treated bed nets (LLINs) in sub-Saharan Africa has shot up from 5.6 million in 2004 to 145 million in 2010 and contributed to a substantial reduction in malarial deaths on the continent.
“We are committed to increasing support to the implementation of the recommendations of the Commission, especially regarding maternal health and family planning,” said UNFPA Executive Director, Dr. Babatunde Osotimehin. “Access to voluntary family planning saves lives. We have to make sure that all women and girls have access to the reproductive health services and supplies they want and need. This is not only a matter of human rights, but also a matter of life and death. Moreover, healthier women and girls have more chances of fulfilling their potential and becoming more productive citizens.”
The Commission examined 13 medicines and health supplies, focusing on 50 countries with high death rates among women, newborns, and children under five due to preventable causes.
During the event, President Bill Clinton, founder of the William J. Clinton Foundation and 42nd President of the United States, delivered remarks in support of the commission’s work.
1. Sir Andrew Witty, Chief Executive Officer, GlaxoSmithKline
2. Agnès Saint-Raymond, Head of Human Medicines Special Areas, European Medicines Agency
3. Bob Collymore, Chief Executive Officer, Safaricom
4. Christopher Elias, President for Global Development, Bill and Melinda Gates Foundation
5. Dan Brutto, President, UPS International
6. Gary Cohen, Executive Vice President, BD (Becton, Dickinson and Company)
7. Hassan Mshinda, Director General Tanzania Commission for Science and Technology
8. Heather Bresch, CEO , MylanInc
9. Jamie Cooper-Hohn, President and CEO, Children’s Investment Fund Foundation
10. Jasmine Whitbread, Chief Executive Officer, Save the Children International
11. Julio Frenk, Chair, Partnership for Maternal, Newborn and Child Health
12. Kenneth C. Frazier, President and CEO, Merck
13. Rajiv Shah, Administrator, United States Agency for International Development
14. Ray Chambers, UN Secretary-General’s Special Envoy for Malaria
15. Li Dongjiu (Robert Lee), President, Shanghai Fosun Pharmaceutical Development Co., Ltd.
16. M.K. Bhan, Secretary to the Government of India Department of Biotechnology
17. Michael Anderson, Director-General for Policy and Global Programmes, UK Department for International Development
18. Per Heggenes, CEO, IKEA Foundation
19. TeguestGuerma, Director General, AMREF
20. ZainabHawaBangura, UN Special Representative on Sexual Violence in Conflict
About the UN Commission on Life-saving Commodities for Women and Children
The Commission was created by the UN Secretary-General, Ban Ki-moon, under the auspices of the Every Woman Every Child initiative.The Commission aims to increase access to life-saving medicines and health supplies for the world’s most vulnerable people.The Commission is co-chaired by President Goodluck Jonathan of Nigeria and Prime Minister Jens Stoltenberg of Norway and UNICEF and UNFPA serve as vice-chairs.www.everywomaneverychild.org/resources/un-commission-on-life-saving-commodities
About Every Woman Every Child
Every Woman Every Child is an unprecedented global movement, spearheaded by UN Secretary-General Ban Ki-moon, to mobilize and intensify global action to improve the health of women and children around the world. In the two years since its launch, the Every Woman Every Child movement has seen remarkable progress, bringing new attention and investment to some of the most neglected causes of women’s and children’s mortality, including preterm birth and contraceptive access most recently. A number of key advocacy moments and events served as catalysts for change in 2012 in support of Every Woman Every Child: April saw the launch of the UN Commission on Life-Saving Commodities for Women and Children, which aims to increase access to life-saving medicines and health supplies for the world’s most vulnerable women and children; 30 new and expanded commitments proposing actions towards the prevention and care of preterm birth were announced in May around the launch of the Born Too Soon report on preterm birth; in June, over 80 governments and a multitude of partners gathered at the Child Survival Call to Action to launch a sustained, global effort to save children’s lives; and at the London Family Planning Summit in July more than 150 partners announced commitments to ensure that an additional 120 million women and girls can access voluntary family planning by 2020. Further detailing the movement’s progress and implementation of commitments, the first annual review of the independent Expert Review Group will be presented to Secretary-General Ban Ki-moon during the week of the 2012 United Nations General Assembly meeting in New York. This report will reinforce the movement’s remarkable progress, while also emphasizing that momentum needs to be sustained. This remarkable progress needs to be sustained to achieve the health MDGs and reach our global target to prevent the deaths of 16 million women and children, and improve the lives of millions more by 2015.
UNICEF works in 190 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments. For more information about UNICEF and its work visit: www.unicef.org
UNFPA, the United Nations Population Fund, is an international development agency that delivers a world where every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled. UNFPA works in partnership with more than 150 countries, especially in the area of reproductive health, including maternal health and family planning. For more than 30 years, UNFPA has been procuring contraceptives and life-saving commodities and medicines for developing countries and is today one of the largest public sector procurers of these items.
For further information, please contact:
Kathryn Donovan, UNICEF New York, Tel + 1 212 326 7452, email@example.com
Christian Moen, UNICEF New York, Tel + 212 326 7516, firstname.lastname@example.org
Mandy Kibel, UNFPA New York, Tel + 1 212 297 5293, email@example.com
Etienne Franca, UNFPA, New York, Tel + 1 917 310 8957, firstname.lastname@example.org