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HEALTH: Addressing Preterm Births Crucial to Anti-Poverty Goals

Eli Clifton

WASHINGTON, Feb 23 2010 (IPS) - Reducing the annual 13 million preterm births and 3.2 million stillbirths should be a global public health priority, says a report released Monday which asserts that significant reductions in these numbers could be achieved by improving access to low-cost interventions in both low and high-income countries.

The Global Report on Preterm Birth & Stillbirth highlights statistics which show that newborn deaths account for 42 percent of deaths in children under the age of five and that many cases of stillborns are linked to maternal deaths.

“If you tally this up you have close to six million infant deaths from either being stillborn or complications from being premature. That’s worse than HIV and TB [tuberculosis] combined,” Dr. Craig E. Rubens, executive director of the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), told IPS.

“We’ve seen a lot more advocacy around HIV and we’re seeing lots of advocacy around malaria and TB. I don’t want to minimise those things but there are these two other entities out there and if we don’t tackle them we will fail to meet the Millennium Development Goals by 2015,” Rubens continued.

The report, which was published by BioMed Central, identifies the known causes and proven interventions that could be widely used to combat stillbirths and deaths relating to complications from preterm births as well as calling for increased research to understand the causes and consequences of preterm and stillbirth.

Research for the report was conducted by GAPPS, supported by the Bill & Melinda Gates Foundation and Seattle Children’s Hospital, and incorporated the research of experts from around the world.

While the effects of preterm and stillbirth are most widely felt in low and middle income countries, the report emphasises that preterm birth rates are rising in high-income countries and preterm birth is the most common cause of newborn death worldwide.

Significant disparities exist between the number of preterm and stillbirths in the developing and developed worlds but large disparities are also present between ethnic groups in the U.S.

U.S. preterm birth rates in 2005 varied from 18.4 percent among African American women to 11.7 percent among non-Hispanic white women and 10 percent among Asian and Pacific Islander women.

Experts at the report’s launch Tuesday said that little explanation has been found for the ethnic disparities in the U.S.

The report’s authors emphasised the huge disparity between costs and research funding.

In the U.S., preterm births are the seventh leading health care expenditure – 26 billion dollars – yet research on the period shortly before and after childbirth ranks 63rd in National Institute of Health (NIH) funding.

“Preterm births and stillbirths are major health issues in rich and poor countries alike, a private loss to many families that should be on the public’s priority list,” said Dr. Joy Lawn of Save the Children’s Saving Newborn Lives program and a co-author of the report. “With greater understanding of the causes of preterm birth and stillbirth, we can prevent many losses, and make every birth count.”

The report includes a “Global Action Agenda” which was developed by 200 stakeholders at the 2009 International Conference on Prematurity and Stillbirth and summarised in four goals.

These included: increasing awareness and understanding of the magnitude of the problem; improving research standards and practices; supporting discovery, development and delivery of intervention, particularly in the developing world; and increasing resources for research and implementation of effective interventions.

One of the most important tools for researchers seeking reductions in preterm and stillbirths is the lack of quality tissue specimens from pregnant women and newborns.

GAPPS, in conjunction with the release of the report, announced that it is establishing the GAPPS Repository which will hold a large collection of prospective data and specimens from diverse populations of pregnant women and newborns.

The repository will permit the study of the multiple risk factors at different points throughout pregnancy and will bring together a global network of data in a more scientifically standardised manner than available in the past.

Low cost solutions – some as simple as early breastfeeding, vitamin K supplementation at delivery, screening and treatment of syphilis and malaria prevention and treatment – have proven effective in reducing the numbers of preterm and stillbirths but a lack of political will, lack of awareness and cultural barriers have limited the delivery of proven solutions.

Experts emphasise the biggest problem facing policymakers and healthcare professionals who seek to reduce preterm and stillbirths is the difficulty in getting low-cost, proven, healthcare solutions to pregnant women.

Dr. Eve Lackritz, chief of the Maternal and Infant Health Branch at the Centres for Disease Control, defined one of the key questions as, “What are the cultural situations which are not allowing women to access healthcare?” at the report’s release Tuesday.

Experts at the event were in agreement that calling attention to the extremely high infant and maternal deaths associated with preterm and stillbirths is crucial for mobilising public health resources to address the problem.

“We’re calling for more awareness and attention to this both internationally and domestically but we also need more science and attention to how we create preventive strategies and how we create collaborative partnerships,” said Rubens.