On November 17, the global health community will commemorate World Prematurity Day, which reminds me of my experience giving birth to my son. Three years ago, my son was delivered by emergency Cesarean-section six weeks before his due date. I knew that because of the sophisticated intensive care available at the U.S. hospital where I planned to give birth, the chances that my baby would survive were high. Indeed, in the United States and other developed nations, the majority of preterm babies and even the extremely premature ones survive using expensive neonatal intensive care available in these countries.
Sixty percent of the world’s premature babies are born in Asia and Africa, where sophisticated and expensive neonatal intensive care is not available or easily accessible. How will these babies survive?
Fortunately, a variety of simple, effective interventions can be used in lower income countries to improve the survival of preterm babies. Like my son, over 80% of preterm births are moderate to late preterm, between 32 and 37 weeks. According to the “Global Action Report on Pre-Term Birth: Born Too Soon,” the majority of babies born during this period can survive just through these simple, low-cost evidence-based interventions.
One intervention offered to mothers in preterm labor is antenatal corticosteroid injections, used to boost the development of immature fetal lungs and reduce the risk of respiratory problems in preemies. Providing steroid injections is standard practice in developed countries and something I benefited from when I gave birth to my son. Yet, this evidence-based treatment, which costs just $1 per injection in low-income countries, is available to only 10 percent of those mothers in need of it. JSI is improving the use of this evidence-based intervention in several countries across Eastern Europe and Asia.
At the community and facility levels, from Africa to Asia, JSI promotes “Kangaroo Mother Care” to keep the baby warm, antiseptic cream to prevent umbilical cord infection, and antibiotics to treat infections Despite the low-cost and proven efficacy, these interventions are not widely available and are highly underutilized. In Kangaroo Mother Care, the mother holds the infant close to her breast, which provides thermal protection, makes frequent breastfeeding easy, and ensures constant maternal supervision for the infant. Evidence shows that the babies gain more weight and feed better as a result of Kangaroo Mother Care.
In addition to these low- and no-cost interventions, the survival of very preterm and extremely preterm babies born younger than 32 weeks and sick newborns requires investment in strengthening facility-based neonatal intensive care. Apart from strengthening the neonatal intensive care, it is also critical to establish linkages with the lower and higher level health centers. This system-wide approach will further decrease neonatal mortality rates.
JSI has helped to strengthen neonatal intensive care units and re-organize perinatal care services by regionalizing care for very preterm births in Russia through the Institutionalizing Best Practices in Maternal and Child Health (IBP-MCH) project, and in Ukraine through the Mother and Infant Health Project. Through regionalization, JSI helps country health systems to achieve a fully integrated system of consultation, referral, and transport and strengthens the linkages between different levels of care. Initial results of these projects are promising: these countries have seen significant reductions in perinatal mortality.
My wish for mothers around the world, no matter where they live or what resources they have, is to have access to the range of these and other preterm birth interventions and strategies, proven to be effective and feasible, so that they can enjoy their motherhood, as I have mine.