1 out of 10 babies born early globally; India had highest numbers in 2020

New Delhi: In 2020, around 13.4 million babies were born early (before 37 weeks of pregnancy) worldwide, indicating one out of 10 babies was born premature, which adversely impacts their health and survival.

India had the highest number of preterm babies in 2020 (3.02 million or 20 per cent of all global preterm births). These findings are from a detailed study published in the Lancet medical journal.

Titled ‘National, Regional, and Global Estimates of Preterm Birth in 2020, with Trends from 2010: A Systematic Analysis’, the study was authored by experts from the World Health Organisation (WHO), United Nations Children’s Fund (UNICEF) and the London School of Hygiene and Tropical Medicine.

The study provides global, regional and country estimates and trends for preterm births between 2010 and 2020, highlighting significant disparities between regions and countries. The paper derives estimates from population-based, nationally representative data, using a Bayesian modelling system. Data on preterm birth from January 1, 2010, to December 31, 2020, from 103 countries and areas was taken.

Who is a preterm baby?

As per the WHO, preterm birth is defined as a live birth with a gestational age of less than 37 weeks, that is a baby born before full 37 weeks of pregnancy. Normal births take place between 37 and 40 weeks of gestational period.

Globally, the viability of a live birth starts from 22 weeks of pregnancy. In India, it is usually from 24 weeks. The chance of survival of the foetus prior to 22 weeks is almost negligible. The more the prematurity, the more associated risks of health complications and survival.

Findings from the study

An estimated 13.4 million newborn babies were born preterm (less than 37 weeks) in 2020, which is 9.9 per cent of all births compared with 13.8 million in 2010 (9.8 per cent of all births worldwide. The annual global rate of reduction in preterm births between 2010 and 2020 was just 0.14 per cent.

Globally in 2020, approximately 15 per cent (two million of 13.4 million) of all preterm births were before 32 weeks requiring more neonatal care.

Minimal progress has been made in the reduction of preterm births in the last decade. Despite substantial investment in routine health information systems over the last decade and increasing facility birth rates, many missed opportunities to improve preterm birth data collection and reporting. Only 33 per cent of countries and areas (64 of 195 countries and areas) had national routine preterm birth data of sufficient quality to be included in these estimates. Gaps in routine data for preterm birth are most marked in southern Asia and sub-Saharan Africa.

Over 50 per cent preterm births occurred in 8 countries

Over 50 per cent of all preterm births in 2020 occurred in just eight countries and areas. India had the highest number of preterm births in 2020 (3.02 million, accounting for over 20 per cent of all preterm births worldwide) followed by Pakistan, Nigeria, China, Ethiopia, Bangladesh, the Democratic Republic of the Congo, and the USA.

Regions of southern Asia and sub-Saharan Africa have the highest estimated burden of preterm births. In total, 55.6 per cent of total live births are in southern Asia and sub-Saharan Africa. These two regions accounted for approximately 65 per cent of all preterm births globally in 2020.

Although most of the high preterm birth rates occur in low-income and middle-income countries and areas, rates of 10 per cent or higher were also observed in high-income countries such as Greece (11.6 per cent) and the USA (10 per cent).

Health implications

Preterm birth is the leading cause of neonatal mortality and is associated with long-term physical, neuro-developmental, and socio-economic effects. Since prematurity is the leading cause of death in children’s early years, there is an urgent need to strengthen both care for preterm babies as well as prevention efforts – particularly maternal health and nutrition – so as to improve childhood survival.

For those who live, preterm birth also significantly increases the likelihood of suffering major illnesses, disability and developmental delays, and even chronic diseases as adults like diabetes and heart conditions, according to experts.

“Preterm babies are especially vulnerable to life-threatening health complications and they need special care and attention. These numbers show an urgent need for serious investment in services available to support them and their families as well as a greater focus on prevention – in particular, ensuring access to quality health care before and during every pregnancy,” said Dr Anshu Banerjee, Director of Maternal, Newborn, Child and Adolescent Health and Ageing at WHO.

Why are some babies born premature?

Elaborating on the causes, Dr Nitasha Bagga, consultant neonatologist at Rainbow Children’s Hospital said, “The causes are multifactorial. Preterm babies can be due to some medical issues either with the mother or with the child. Chances of preterm births are high if the woman is pregnant with twins or triplets, or in cases of artificial methods of pregnancy like IVF and IUI, or if she suffers from some infection or has health issues such as high blood pressure or pre-eclampsia, diabetes, thyroid, heart diseases, malnutrition if her placenta is not healthy if there is a leakage in the water surrounding the baby (amniotic fluid) or internal bleeding. In the case of the baby, the risk of preterm birth is high if there are some chromosomal abnormalities or genetic problems and if the organs are not developed properly. In such cases to save the life of the baby, delivery has to be done pre-term, either through C-section or normally, whichever is viable.”

“If the babies are delivered in a well-conditioned environment and receive good neonatal care, they will be perfectly normal. But sometimes, when they are born in houses and rural areas without access to proper institutionalised care, they may be underweight, may develop growth problems, brain developmental delays and various other chronic health issues,” added Dr Nitasha.