Preterm birth

Fact sheet N363

November 2012

Key facts

Every year, an estimated 15 million babies are born preterm (before 37 completed
weeks of gestation), and this number is rising.
An estimated 1 million babies die annually from preterm birth complications.

Preterm birth is the leading cause of newborn deaths (babies in the first four weeks of
life) and the second leading cause of death after pneumonia in children under five
years.

Three-quarters of them could be saved with current, cost-effective interventions, even

without intensive care facilities.

Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born.

Overview
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There
are sub-categories of preterm birth, based on gestational age:

extremely preterm (<28 weeks)

very preterm (28 to <32 weeks)

moderate to late preterm (32 to <37 weeks).

Induction or caesarean birth should not be planned before 39 completed weeks unless
medically indicated.

The problem
An estimated 15 million babies are born too soon every year. That is more than one in 10
babies. Around one million children die each year due to complications of preterm birth.
Many survivors face a lifetime of disability, including learning disabilities and visual and
hearing problems.
In almost all countries with reliable data, preterm birth rates are increasing. Globally,
prematurity is the leading cause of newborn deaths (babies in the first four weeks of life) and
now the second leading cause of death after pneumonia in children under the age of five.

Inequalities in survival rates around the world are stark. In low-income settings, half of the
babies born at 32 weeks (two months early) die due to a lack of feasible, cost-effective care,
such as warmth, breastfeeding support, and basic care for infections and breathing difficulties.
In high-income countries, almost all of these babies survive.

The solution
More than three-quarters of premature babies can be saved with feasible, cost-effective care
e.g. antenatal steroid injections (given to pregnant women at risk of preterm labour to
strengthen the babies lungs), kangaroo mother care (the baby is carried by the mother with
skin-to-skin contact and frequent breastfeeding), antiseptic cream for the umbilical cord, and
antibiotics to treat newborn infections even without the availability of neonatal intensive
care.
Over the past decade, some countries have halved deaths due to preterm birth by ensuring that
health workers are skilled in the care of premature babies and by improving supplies of lifesaving commodities and equipment. These include Ecuador, Oman, Sri Lanka and Turkey.
To reduce preterm birth rates, women especially adolescents need better access to family
planning and increased empowerment, as well as improved care before, between and during
pregnancies.

Why does preterm birth happen?

Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but
some are due to early induction of labour or caesarean birth, whether for medical or nonmedical reasons.
Common causes of preterm birth include multiple pregnancies, infections and chronic
conditions, such as diabetes and high blood pressure; however, often no cause is identified.
There is also a genetic influence. Better understanding of the causes and mechanisms will
advance the development of solutions to prevent preterm birth.

Where and when does preterm birth happen?

Over 60% of preterm births occur in Africa and south Asia, but preterm birth is truly a global
problem; countries with the highest numbers include Brazil, India, Nigeria and the United
States of America. Of the 11 countries with preterm birth rates over 15%, all but two are in
sub-Saharan Africa. In the poorest countries, on average, 12% of babies are born too soon
compared with 9% in higher-income countries. Within countries, poorer families are at higher
risk.
The 10 countries with the greatest number of preterm births1:

India: 3 519 100

China: 1 172 300

Nigeria: 773 600

Pakistan: 748 100

Indonesia: 675 700

The United States of America: 517 400

Bangladesh: 424 100

The Philippines: 348 900

The Democratic Republic of the Congo: 341 400

Brazil: 279 300

The 10 countries with the highest rates of preterm birth per 100 live births:

Malawi: 18.1 per 100

Comoros: 16.7

Congo: 16.7

Zimbabwe: 16.6

Equatorial Guinea: 16.5

Mozambique: 16.4

Gabon: 16.3

Pakistan: 15.8

Indonesia: 15.5

Mauritania: 15.4

Of 65 countries with reliable trend data, all but three show an increase in preterm birth rates
over the past 20 years. Possible reasons for this include better measurement, increases in
maternal age and underlying maternal health problems such as diabetes and high blood
pressure, greater use of infertility treatments leading to increased rates of multiple
pregnancies, and changes in obstetric practices such as more caesarean births before term.
There is a dramatic difference in survival of premature babies depending on where they are
born. For example, over 90% of extremely preterm babies (<28 weeks) born in low-income
countries die within the first few days of life; yet less than 10% of babies of this gestation die
in high-income settings.

WHO response
In May 2012, WHO and partners The Partnership for Maternal, Newborn & Child Health,
Save the Children and the March of Dimes published a report Born too soon: the global
action report on preterm birth that included the first-ever estimates of preterm birth by
country.
Born too soon is the latest contribution to the UN Secretary Generals Global Strategy for
Womens and Childrens Health, which aims to save 16 million lives by 2015.

WHO is committed to reducing the health problems and lives lost as a result of preterm birth
with the following specific actions:

to work with Member States to strengthen the availability and quality of data on
preterm births;
to provide updated analyses of global preterm birth levels and trends every three to
five years;

to work with partners around the world to conduct research into the causes of preterm
birth, and test effectiveness and delivery approaches for interventions to prevent
preterm birth and treat babies that are born preterm;

to regularly update clinical guidelines for the management of pregnancy and mothers
with preterm labour or at risk of preterm birth, and those on the care of preterm babies,
including kangaroo mother care, feeding babies with low birth weight, treating
infections and respiratory problems, and home-based follow-up care; and

to develop tools to improve health workers skills and assess the quality of care
provided to preterm babies.