There are stark differences between preterm births in low and high income countries. Although preterm birth happens worldwide, more than 90% of babies born before 28 weeks gestation in low-income countries die shortly after birth. In high-income countries, less than 10% of these babies die. South Asia and sub-Saharan Africa have the highest preterm birth rates.

Globally, preterm birth kills more children under 5 years old than any other cause. Disability is an additional outcome of preterm birth with grave consequences for families and communities. Preterm birth has multiple interconnected risk factors and initiatives to address preterm birth in low-income countries are underway.

Risk Factors for Preterm Birth

Humanitarian settings often expose expectant mothers to risk factors for early birth. These risk factors include infection, such as HIV and malaria, gender-based violence and unclean living conditions. Undernutrition, excess physical work, air pollution exposure, adolescent pregnancy and reduced time between pregnancies also contribute to preterm birth incidence.

In low-resource conditions, health care is often disrupted or inaccessible for mothers and preterm infants. Displacement can also create formidable language and monetary barriers to health care. Conflict also contributes to limited health care for women and newborns. About 90% of countries with the highest neonatal death rates are in high-conflict locations.

Initiatives To Improve Preterm Birth in Low-Income Countries

Many programs aim to reduce the incidence of preterm birth and improve outcomes in low-income countries. Since 2007, the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) has partnered with several organizations to improve birth outcomes. In 2011, the Bill and Melinda Gates Foundation funded a $20 million GAPPS program called the “Preventing Preterm Birth Initiative.”

The program develops ways to prevent preterm birth and gives priority to low-resource settings. The funded research projects include a study on the connection between infections and preterm birth and a search for biomarkers to predict preterm birth. Additionally, the program runs research sites in Bangladesh and Zambia, enrolling pregnant women in studies to gain insights into the causes of preterm birth in these nations.

In 2014 GAPPS initiated the Scaling, Catalyzing, Advocating, Learning and Evidence-driven (Every Preemie-SCALE) project with a $9 million U.S. Agency for International Development (USAID) Cooperative Agreement. From 2014 to 2019, this program widened the use of preterm birth interventions in two dozen Asian and African countries. In 2016, Every Preemie published an analysis to promote the global utilization of antenatal corticosteroids in cases of impending early birth to boost the survival of newborns. In Malawi, Every Preemie evaluated the Family-Led Care Model, a strategy designed to improve facility and home care for preterm infants.

Since 2017, Birth With Dignity has provided education and training to health care providers in Uganda, a low-income country with high preterm birth rates. The organization provides education on postpartum hemorrhage, preeclampsia and emergency communication. The nonprofit’s work at Mbale Regional Referral Hospital and St. Francis Nsambya Hospital enhances high-risk care for mothers and babies.

Going Forward

Preterm birth in low-income countries is a critical issue. There are multiple approaches to improving its incidence and outcomes. In a 2023 global report, the World Health Organization (WHO) detailed strategies to prevent early birth, including quality care during pregnancy, sufficient nutrition and effective education. The report also recommended quality neonatal care for infections and breathing and feeding difficulties to reduce newborn mortality and disability. These strategies provide a path forward to improve global preterm birth.

– Kelly Carroll
Photo: Flickr