Born Too Soon: learning from the past to accelerate action in the next decade

Abstract

Progress: This paper is a narrative review that takes stock of the progress in addressing preterm birth over the past decade - notably on policies, national plans, innovation, evidence, social mobilisation, and community engagement - to inform future progress on preterm birth. At the global policy level, many countries have strongly supported collective initiatives and resolutions on maternal and newborn health relevant to preterm birth in multilateral fora, most recently through a World Health Assembly resolution calling for a revival amongst the global community on stalled progress for maternal, newborn and child health. Following the adoption of other global plans, like the Every Newborn Action Plan and Strategies for Ending Preventable Maternal Mortality, most countries set corresponding national mortality and coverage targets, and many have national and subnational policies and plans for integrated maternal and newborn health. Adequate financing remains a challenge, and sexual and reproductive health and rights of women and girls are being challenged globally. There have been significant advances in evidence-based interventions for preterm birth prevention and care, reflected in updated World Health Organization guidelines on antenatal, intrapartum and postpartum care, and care for small and sick newborns. The past decade has also seen progress in social mobilisation and community engagement, particularly parent groups and healthcare professional organisations advocating on issues surrounding preterm birth.

Polycrisis and vulnerability: There are, however, significant challenges that continue to hamper progress on preterm birth. Polycrisis - the interplay of overlapping economic, geopolitical, and environmental crises - compounds existing inequities, especially in places where health systems are already weak. Distinct and overlapping threats from conflict, climate change and the cost-of-living crisis present life-or-death challenges to those already facing extreme vulnerability, particularly women and girls, and small and sick newborns.

Preterm birth: A MARKER OF MATERNAL AND NEONATAL HEALTH PROGRESS IN THE COMING DECADE: The detrimental impacts of preterm birth are felt along the life course and across generations. The success of countries and the global community in preventing preterm births and ensuring high-quality care for mothers and preterm babies serves as a critical measure of progress - or failure - in advancing global efforts to improve maternal and newborn health.

Keywords: Climate change; Community engagement; Conflict; Continuum of care; Cost-of-living; Evidence; Innovation; Neonatal; Newborn; Pandemic; Policy; Polycrisis; Preterm birth; Social mobilisation.

Fig. 1

Neonatal disorders: the leading condition of global burden of disease, 2000 and 2020

Fig. 2

Preterm birth-related vulnerabilities along the life-course, across generations, and impacted by other sectors

Fig. 3

Timeline of progress from the past decade and vision for the next decade

Fig. 4

EWENE targets and milestones – 90/90/80/80

Fig. 5

Impacts of polycrisis on preterm birth

Fig. 6

Definitions of preterm birth and related pregnancy outcomes

Fig. 7

Addressing preterm birth along the continuum of care [86]