This year, more than 33 million women around the world will give birth to babies born too soon or too small.
When I was pregnant with my first son, I purchased a special outfit with a matching hat for him to wear home from the hospital. I tucked it away while my husband and I made other preparations, purchasing a crib and a car seat and relishing in the time we had left as a family of two. Then, at 33 weeks pregnant, I woke up in labor. Twelve hours later, my son was born. When he came home after a 16-day stay in the neonatal intensive care unit, he wore a new outfit—in a smaller size—shipped priority.
Two years later, I was pregnant again—and the doctors assured me it was unlikely that our second baby would come early. Sometimes, though, lightning does strike twice: My second son was born at 30 weeks.
The doctors warned that he was so premature he was unlikely to make a sound, so I was stunned when he cried after delivery. We held him for a minute before he was taken for tests. He needed breathing support and feeding support; he became jaundiced. We didn’t hold him again for several days. When we finally did, we embraced both him and the cords and contraptions that kept him alive.
My younger son was in the NICU on Mother’s Day. I refused to be celebrated until we were all at home together. When he came home, he was smaller than most full-term infants at birth. His six weeks in the hospital were harrowing, and yet our family was lucky: We had world-class medical care, comprehensive health insurance, and the resources to navigate a toddler at home and a fragile infant in the hospital.
Over the last 15 years, I have had the privilege of meeting mothers and their children around the world. The universal experiences of motherhood—from the challenges of pregnancy and birth, to cooing over a newborn child—can make it seem that pregnancy, childbirth and motherhood are a great equalizer. But my own experience and my work have reinforced that motherhood remains undeniably influenced by privilege and power.
This year, more than 33 million women around the world will give birth to babies born too soon or too small—which equates to 1 in 10 babies globally—and the burden has been unequally distributed. Here in the United States, for example, Black women have a 50 percent increased risk of premature delivery compared to white women—a disparity that has remained stubbornly persistent even as overall rates of premature births have gone down. Globally, South Asia and Sub-Saharan Africa have the highest rates of premature birth. Tragically, 90 percent of the babies born too soon in lower income countries will not survive.
While the causes of prematurity are multifaceted, malnutrition is a global problem that is particularly pervasive and dangerous for pregnant women. Not only does malnutrition increase the risk of giving birth prematurely, but it can also lead to life-threatening conditions for mothers, including preeclampsia and hemorrhage.
There is no single intervention that will stop complications in pregnancies, halt premature births and end neonatal deaths. But that shouldn’t stop us from making full use of what we know can make a difference for many.
Black women have a 50 percent increased risk of premature delivery compared to white women—a disparity that has remained stubbornly persistent even as overall rates of premature births have gone down.
Doctors in high-income countries routinely recommend that pregnant women take a high-quality prenatal multivitamin. A standard prenatal vitamin, developed in 1999, has 15 essential vitamins and minerals that support a woman and her baby in pregnancy. Despite this, most women in lower income countries receive a supplement with only two ingredients—if they receive anything at all. This inequity is primarily driven by cost concerns.
However, a little investment could go a long way. In lower income countries, where rates of malnutrition are highest, it’s estimated that up to 40 percent of women are anemic—compared to 9 percent in high-income countries. Anemia is a serious condition caused by undernutrition and malnutrition that can be life-threatening. Anemia during pregnancy can be particularly dangerous, but studies have shown that when anemic pregnant women take the more fulsome prenatal vitamin—as compared to the lesser two-ingredient formula—rates of infant mortality go down by 29 percent. These prenatal vitamins are also shown to reduce stillbirths for anemic moms by 21 percent and cut the rate of preterm births by 16 percent.
The cost difference standing in the way of these profound improved outcomes? Roughly $4 per pregnancy.
Today, a movement is growing around the world to bring the power of these prenatal vitamins to women who need them. In countries like Ethiopia, Pakistan, Nepal and Nigeria, governments are exploring ways to ensure affordable access to prenatal vitamins. We need partnerships to ensure these efforts are successful. We need governments like the United States, Canada, France and the United Kingdom, combined with philanthropies and the private sector, to further prioritize global maternal health and nutrition. We need to make bold commitments of support to ensure the interventions we know work will find their ways to the women who need them.
This month, my sons are 9 and 7. They are budding artists and pioneers in their own imaginary worlds. You would never know they were born premature. They are strong and healthy, but I still remember what it felt like to hold their tiny bodies in their earliest days. And while I now celebrate each moment wholeheartedly with my family, this year still makes me reflect. Today, and every day, I want us all to commit to a world where every woman is afforded the best possible care in pregnancy and childbirth.
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