Health Care

U.S. Tops Thailand in Premature Births


U.S. Tops Thailand in Premature Births

Photograph by Luis Davilla/Getty Images

In the U.S., they’re often known as “miracle” babies, children born several weeks—even months—before they’re due to enter the world. With modern medicine, the assumption is that most of those newborns will survive and thrive if they are lucky enough to receive expensive neonatal treatment. But a vast global study released on May 2 looks at the devastating breadth of the problem—with 15 million babies born preterm each year around the world, leading to 1.1 million deaths—and the low-cost solutions that could prevent it.

The ambitious report, led by the March of Dimes, Save the Children, and the World Health Organization-backed Partnership for Maternal, Newborn & Child Health, includes the first-ever comparison of national premature birth rates in 184 countries. It’s a ranking in which the U.S. does not fare well, falling between Thailand and Timor-Leste with a preterm birth rate of 12 per 100 live births. That puts the U.S. in 54th place, with 130 countries faring better. As with many other issues in the U.S., there is a racial divide: The rate for black Americans is about 17.5 percent while white Americans had a 10.9 percent chance of delivering preterm. (Not surprisingly, there’s an age divide, too, with mothers over the age of 40 and under 17 most at risk of having premature babies.)

But the true value of the report may lie less in its description of the problem than in its analysis of possible solutions. While preterm babies may evoke images of incubators and months of intensive care in the U.S., the authors suggest that some three-quarters of the deaths worldwide could be averted with a few simple steps. They include such basics as warmth, breastfeeding support, simple infection treatment, and frequent skin-to-skin contact with the mother—otherwise known as “kangaroo care.” Steroid injections for mothers in premature labor, an intervention that costs roughly $1, could save some 400,000 lives a year. (Steroids spur lung development.) Such factors help explain why more than 90 percent of babies born before 28 weeks in developing countries die, while only 10 percent of those born in developed countries do.

That doesn’t mean there aren’t tough ethical questions around what happens when some of those preterm infants do survive. The May 2 press briefing featured a Connecticut couple whose daughter was born at 29 weeks. Kendall has undergone 10 brain surgeries in her first two years of life, while her family has racked up more than $1.2 million in health-care costs. While Adam Pallone said his daughter “lights up a room with her smile,” he didn’t hide his pain in noting that her cerebral palsy and other health issues mean she’ll “likely require lifelong care.” Such care is beyond the reach of parents in many poor countries; in wealthy nations, the expense has prompted debate about the limits of medical intervention.

The report doesn’t delve into such ethical issues, though it does put the societal costs of preterm birth in the U.S. alone at more than $26.2 billion a year. It also notes that the rising rate of preterm births is as much a symptom of modern health care as a result of a lack of it. Rising rates of in vitro fertilization, which raises the odds of multiple births, along with the increase in older mothers and scheduled delivery times have all played a role in increasing the likelihood that babies won’t reach full term.

The biggest focus, of course, is on trying to help mothers achieve full-term pregnancies. That ultimately comes down to more education in family planning, improved nutrition, and more programs that address risk factors from diabetes to smoking. Such basic care not only reduces the rate of preterm births, it increases the odds that those children will survive and grow up to help build their societies. It’s a powerful call to action that one hopes policy makers will take the time to heed.

Brady_190
Brady is a senior editor for Bloomberg Businessweek in New York.

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