Between the Lines Q&A

A weekly column featuring progressive viewpoints
on national and international issues
under-reported in mainstream media
for release Oct. 7, 2009

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Report Finds 13 Million Babies
are Born Prematurely Worldwide;
1 Million Die

 RealAudio  MP3

Interview with Chris Howson,
vice president for global programs
at the March of Dimes Foundation,
conducted by Melinda Tuhus


The first global study of pre-term births has just been completed. A collaboration between the March of Dimes Foundation and the United Nations World Health Organization found that 13 million babies are born prematurely every year, and one million of them die. Those who survive often face a lifetime of disabilities, including hearing loss, blindness, cerebral palsy and learning disabilities. Surprisingly, the rate -- though not the total numbers -- of pre-term births by continent is almost as high in North America, including Canada and the U.S., as it is in Africa. The UN plans to follow up this report with more detailed, country-by-country research.

According to the March of Dimes the rate of premature births in the United States has increased 36 percent in the past 25 years. The increase in the rate of late preterm births (between 34 and 36 weeks gestation) accounts for most of the increase. The group points out that the emotional costs for families can be devastating and life-changing and the financial costs affect society as a whole. Prematurity accounts for almost half of hospital charges for infants.

Between The Lines' Melinda Tuhus spoke with Chris Howson, vice president for global programs at the March of Dimes Foundation, just before he delivered a report on the study at an international conference on the prevention of birth defects and disabilities in Delhi, India. He discusses what the report revealed, what's still not understood about the problem, and possible remedies.

CHRIS HOWSON: We put out this report because we wanted to light a fire under policymakers because we feel the issue of preterm birth internationally is one that is under-recognized, under-counted, under-valued and under-funded.

BETWEEN THE LINES: Even though 85 percent of these 13 million pre-term babies are born in Africa and Asia, if you look at rates, North America is a close second to Africa. How do you explain that?

CHRIS HOWSON: Regarding the different reasons, that's a really interesting question. That's almost a 13 million baby question. With respect to Africa, we don't know for sure, but contributing factors include many of those associated clearly with poverty and weak health care systems, for example, the poor overall health and nutritional status of women, a high burden of infectious diseases, lack of provision of family planning allowing a woman to decide when to start and end having children, and how to space her children, and the lack of good prenatal programs that might identify problems early on in a pregnancy. Those are clearly contributing factors in Africa.

Certainly in the U.S., the three factors that seem to be prominently associated with the 36 percent increase is the number of women age 35 and older choosing to have babies; the increase in the use of assistive reproductive techniques that can result in the implantation of multiple embryos - the Octomom being an extreme example of that. And data show clearly that moms who are carrying multiples have six times the risk of having those children pre-term as a mom carrying a single child. And the third factor appears to be the rise in the numbers of late pre-term births, and these are babies born between 34 and 36 weeks.

BETWEEN THE LINES: You mean an increase in late pre-term from what used to be full-term births?


BETWEEN THE LINES: Chris Howson, your report lists mother's weight as a factor. Are women who are either underweight or overweight more likely to have pre-term babies?

CHRIS HOWSON: Well, to be honest, we don't know what causes pre-term births. We don't know how to prevent it, and we don't even know how to delay pre-term births. But there are a number of factors associated with pre-term birth, that if implemented right now -- that's why we put out this report, which could go a long way toward reducing mortality and disability from pre-term birth. Again, these interventions differ according to the regions you apply them to. For example, in wealthy countries with strong health care systems, the recommendations are that women of child-bearing age should be encouraged to see a doctor regularly, particularly if they are planning on getting pregnant, and they should adopt a health lifestyle, including if they smoke, quitting smoking, and if they are overweight, losing weight. It's not that being overweight necessarily causes pre-term birth, but it's a factor associated with it.

BETWEEN THE LINES: What can be done right away to reduce this toll, and what kind of cost are we talking about?

CHRIS HOWSON: A lot could be done at a very low cost, and this is why it makes this issue so poignant, and, I think, serious. For example, in developing countries like Africa or Asia with weak health care systems, there are a number of simple, low-cost interventions that can help promote a healthy pregnancy outcome. We should be treating malnutrition in women, both before and during pregnancy. We should be treating infections that increase risk. We should be monitoring pregnancies carefully for signs of trouble, and should that baby be born pre-term, we should care for that baby by providing a package of interventions that are also themselves low-cost and of proven efficacy, and these might include things like, if that newborn is struggling to breathe, providing assisted breathing; keeping the baby warm; for example, there's a lot of work being done in many parts of Africa: newborn babies are strapped to a woman's back. There are things you can do where mothers can be taught to strap the baby skin-to-skin to their chest - the so-called kangaroo care - and carry the baby around that way, which keeps the baby warm and also encourages breast-feeding, which is another thing providing adequate nutrition. And then simple things like treating infections, providing antibiotics. This is a whole package of interventions that is really very, very low cost, and could go a long way toward saving newborn lives and diminishing the disability associated with pre-term births.

Contact the March of Dimes Foundation by calling (914) 997-4488. Read the pre-term birth report online at

Melinda Tuhus is a producer of Between The Lines, which can be heard on more than 45 radio stations and in RealAudio and MP3 on our website at This interview excerpt was featured on the award-winning, syndicated weekly radio newsmagazine, Between The Lines for the week ending Oct. 16, 2009. This Between The Lines Q&A was compiled by Melinda Tuhus and Anna Manzo.

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