India had the highest number of pre-term births in 2020 (3.02 million) accounting for over 20 per cent of all pre-term births worldwide followed by Pakistan, Nigeria, China, Ethiopia, Bangladesh, Democratic Republic of the Congo and the USA. The findings are part of a new study that finds a prominent mention in the special issue of Lancet which celebrates 200 years on October 5.
Pre-term birth means delivery of the foetus in less than 37 weeks of gestation and is considered to be one of the main risk factors for neonatal mortality (aged under five years). In 2010, there were 3.49 million pre-term births in India. In ten years, that number has declined to 3.02 million preterm births, hardly a measurable change.
At the global level too, there has not been any change in pre-term birth rate between 2010 (9.8 per cent of live births) and 2020 (9.9 per cent of live births). Approximately 15 per cent of all pre-term births between 2010 and 2020 occurred at less than 32 weeks of gestation, highlighting the need for better prenatal and neonatal care.
Dr Umesh Vaidya, chief neonatologist, KEM and Ankura Hospital, Pune, says that premature births are not completely preventable, considering that reasons vary on a case-specific basis. “However, the common reasons include acute or long-standing sickness in the mother, twins or triplet pregnancy and cervical problems,” he says.
Dr Aarti Kinikar, Prof and Head, Department of Pediatrics and Vice Dean of B J Government Medical College, Pune, says there is a need for improving data collection and analysis so that targetted interventions can be taken for a reduction in pre-term births.
Many survivors of pre-term birth face lifetime disabilities, including learning difficulties, behavioural disorders, visual and hearing impairments. The true global burden of pre-term birth is unknown due to a shortage of data in many countries, especially in low-income and middle-income countries (LMICs). According to the report, this situation is a result of inadequate record keeping, poor measurement of gestational age, and the absence of systems in countries for routinely collecting and reporting pre-term birth data.
“Gaps in national routine data for preterm birth are most marked in regions of southern Asia and sub-Saharan Africa, which also have the highest estimated burden of pre-term births. Countries need to prioritise programmatic investments to prevent pre-term birth and to ensure evidence-based quality care when pre-term birth occurs. Investments in improving data quality are crucial so that pre-term birth data can be improved and used for action and accountability processes,” the study authors wrote.
Meanwhile, there is a silver lining too. Overall, 13 countries experienced a decline in pre-term births by 0.5 per cent or more (Austria, Brazil, Brunei, Czechia, Denmark, Germany, Hungary, Latvia, the Netherlands, Singapore, Spain, Sweden, and Switzerland).