Around the world, 15 million babies are born prematurely each year, and 1 million of them die. It would be a mistake to brush it off as something that happens far away in poor African counties without access to quality medical care.
Out of 184 countries assessed, the U.S. ranks 131st in premature birth prevention, according to a new report released Wednesday that represents nearly 50 organizations and was published by the March of Dimes, the World Health Organization, the Partnership for Maternal, Newborn and Child Health and Save the Children. It’s a worrisome distinction the U.S. shares with Somalia, Turkey and Thailand. Of every 100 babies born in the U.S., 12 arrive preterm, accounting for about half a million births each year. And that’s even after preterm birth rates in the U.S. have declined for four consecutive years.
Contrast that with Belarus, which performs best at 4.1 premature births per 100 deliveries, and Malawi, which has the worst track record at 18.1 premature births per 100 live births.
For Jen Sinconis, the title of the new report — Born Too Soon — is an understatement. Sinconis’ twin boys were born at 24 weeks in Oct. 2006. Sinconis’ placenta detached, and she had to deliver her sons via emergency C-section. Ethan weighed 1 lb., 6 oz.; Aidan weighed half a pound more. “My pregnancy was completely normal and healthy up until five hours before they were born,” says Sinconis, who manages a Starbucks in Seattle. “I had no idea anything would go wrong.”
Prematurity just doesn’t have the same public-relations cachet as other diseases — breast cancer, for example, or AIDS. Yet it’s the biggest reason that babies in the U.S. die before their first birthday. Worldwide, more than 40% of deaths of children under 5 are associated with preterm birth. But why it happens remains a mystery in many cases.
“We’ve been at this same point in history for other diseases,” says Eve Lackritz, a senior program officer with the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s Hospital. “Twenty-five years ago, we didn’t have a good understanding of AIDS and what caused it. We need to make that same commitment to research and prevention of preterm birth. Prevention is always less expensive than treatment.”
The U.S. Institute of Medicine has calculated the annual costs associated with preterm birth at more than $26 billion. Ethan and Aidan Sinconis racked up $2.2 million in medical bills in the first 18 months after they were born. Insurance covered most of the costs, but their parents’ portion approached $450,000. “It destroyed us,” says Sinconis, 35, who has written about her family’s experience in A Pound of Hope.
She and her husband, Justin, were forced to file for bankruptcy and sold their possessions on Craigslist to generate cash. Meanwhile, the boys struggled through heart surgery and eye surgery, sepsis, rickets and brain hemorrhages. When they left the hospital after six months, they were ordered to avoid contact with the outside world. Attached to oxygen, heart monitors and feeding tubes, they remained at home in isolation for three years.
Now 5½ years old, they’re smaller than other kids their age and struggle socially because they had no playmates for their first three years. They have speech delays, but amazingly, they’re both reading and writing on a second-grade level and will start kindergarten this fall.
Theirs is ultimately a story of success, but it’s not without its glaring caveats. Ethan still has heart and lung problems, and doctor and therapist visits are still a part of the brothers’ regular routine.
Another caveat, as far as the report is concerned, is the definition of preterm birth. For the purposes of the report, preterm birth is considered as occurring before 37 weeks. But there is a movement underfoot, at least in the U.S., to nudge up the benchmark to 39 weeks as research continues to show that babies undergo lots of critical development in the final weeks of a conventional 40-week pregnancy.
But even with the less stringent standard of 37 weeks, the report still finds that 11 countries have preterm birth rates over 15%. The majority are in sub-Saharan Africa; 60% of the world’s preterm babies are born there and in South Asia.
“This report tells two stories,” says Chris Howson, a co-author of the report and vice president for global programs for the March of Dimes. “One story is grim and should be a wake-up call to the international community that preterm birth is real and common and it kills. But it is also a story of hope and promise because it offers actions to accelerate prevention and reduce mortality.”
Some of the report’s recommendations to prevent preterm birth better include:
- Offer family planning to all women universally because teen pregnancy and improper birth spacing are risk factors for preterm birth
- Strengthen health services before and between pregnancies so mothers enter pregnancy as healthy as possible
- Improve basic care for pregnant women worldwide, with better-trained birth attendants and access to antibiotics and emergency obstetric care
- Invest in research into the causes of preterm birth
Some recommendations to reduce mortality from preterm birth include:
- Implement skin-to-skin kangaroo care, which helps newborns stay warm and promotes breast-feeding
- Make corticosteroids universally available to women in preterm labor to help their babies’ lungs mature. The report calculates that if the drugs were on hand for every woman in need, 400,000 babies could be saved by 2015. And it’s cheap — just $1 a dose, with two to four doses needed.