An estimated one million stillbirths and newborn baby deaths could be prevented each year by implementing low-cost pregnancy interventions in low-and-middle-income countries as revealed by the Lancet Series on Small Vulnerable Newborns.
The five-paper series was launched on May 9, 2023 at the International Maternal and Newborn Health Conference (IMNHC) in Cape Town. The series is funded by Children’s Investment Fund Foundation (CIFF) and Bill and Melinda Gates Foundation and involves experts from the Aga Khan University, Tampere University, Johns Hopkins University, London School of Hygiene & Tropical Medicine, University College London, University of Botswana and CIFF.
The Series presents a new conceptual framework that brings preterm birth, small for gestational age (SGA), and low birthweight (LBW) together under the term “small vulnerable newborns” (SVN). This approach contributes to healthier and thriving women, newborns, children, adults, and societies.
As established by the Series, one in four newborns globally are SVNs contributing to 35.3 million newborns worldwide. There are also 1.9 million stillbirths recorded every year with sub-Saharan Africa and Southern Asia bearing the largest burden. Moreover, SVN survivors are vulnerable to health problems throughout their life course, affecting human capital, economic productivity, and healthcare costs.
Whilst there is a huge prevalence, prevention has been slow with flat global and regional trends. The authors highlight that in every region, progress for reducing preterm birth and low birthweight is a flat line and off track of targets. However, prevention is possible. “Millions of lives are lost during pregnancy and childbirth, especially in vulnerable populations. Prevention is possible but requires global and local societal commitments, from a health, rights, equity, and women agency perspective,” says Prof Marleen Temmerman, Director of Aga Khan University’s Centre of Excellence in Women and Child Health, East Africa (CoEWCH EA).
The series provides eight low-cost, evidence-based pregnancy interventions to be implemented in low-and-middle-income countries for the prevention of SVNs and stillbirths. These interventions include multiple micronutrient supplements, treatment of syphilis, and treatment of asymptomatic bacteriuria (a bacterial infection of the urine) for all women. The targeted interventions provided include low-dose aspirin, balanced protein energy supplements, prevention of malaria in pregnancy, progesterone provided vaginally, and smoking cessation.
In a global call to action, the series argues for a higher quality of care for women during pregnancy and at birth, and specifically for the scale-up of pregnancy interventions, which it estimates could prevent 566,000 stillbirths and 5.2 million SVN babies every year in 81 low- and middle-income countries (LMICs).
“Despite several global commitments and targets aimed at reducing SVN outcomes since 1990, every fourth baby in the world is 'born too small' or 'born too soon'. Our Series suggests that we already have the knowledge to reverse the current trend and save the lives of 100,000s of babies a year at a cost of $1.1 billion, a fraction of what other health programmes receive. We need national actors, with global partners, to urgently prioritise action, advocate and invest,” said Prof Per Ashorn, Tampere University, Finland and a lead author on the series.
The series provides three pillars that countries and the international community can action to address this issue. To start with, SVN prevention should be prioritised by recognising it as a crucial problem. The suggested interventions should also be implemented alongside scaling up high-quality care for women, particularly during pregnancy and at birth. Lastly, there ought to be increased accountability by improving measurement and monitoring.
“The fact that every fourth baby in the world is born too soon or born too small is a concern for human rights, public health, the national economy, and development. By not addressing this priority, we are jeopardising our collective future,” said Dr Abdu Mohiddin, Physician Scientist and Assistant Professor at the Aga Khan University.
The Lancet Series on Small Vulnerable Newborns highlights the pressing need for global and local societal commitments to improve the health of women and newborns.