Preterm birth (i.e. birth before 37 completed weeks of gestation) is the leading cause of both neonatal death during the first four weeks of life (days 0‑28), and death of children under 5 (see indicator “Under age 5 mortality” in Chapter 3). Survivors of preterm births may also face a lifetime of disability, including learning disabilities and visual and hearing as well as other long-term developmental problems. However, preterm birth can be largely prevented. Three‑quarters of deaths associated with preterm birth can be saved even without intensive care facilities. Current cost-effective interventions include antenatal corticosteroids injections for pregnant women at risk of preterm delivery, kangaroo mother care (continuous skin to skin contact), early initiation (initiated within the first hour of birth) and exclusive breastfeeding (initiated within the first hour of birth) and basic care for infections and breathing difficulties (WHO, 2023[1]); see indicator “Infant mortality rate” in Chapter 3). New evidence that simple interventions such as use of continuous positive airway pressure (CPAP) and medicines such as caffeine for breathing problems can substantially reduce mortality in preterm and low birthweight babies (Ledinger, Nußbaumer-Streit and Gartlehner, 2024[2]). Preterm birth rates can be also reduced if women, particularly adolescents, had better access to family planning services and increased empowerment, as well as improved care and nutrition during pregnancy (see indicator “Family planning” in Chapter 4).
An estimated 13.4 million babies are born preterm worldwide every year representing a global preterm prevalence of 9·9%, and around 900 000 babies died from preterm birth complications in 2019. Across countries, the rate of preterm birth ranges from 4‑16% of babies born in 2020 (Ohuma et al., 2023[3]). In the Asia-Pacific region, India, Bangladesh and Pakistan reported a particularly large number of preterm births (Ohuma et al., 2023[3]). Across lower-middle- and low-income Asia-Pacific countries and territories, almost 10 babies out of 100 were born preterm on average in 2020 while the rate was lower on average in high-income and upper-middle-income countries and territories (7.2 and 6.7 babies per 100 live births, respectively). The preterm birth rate was particularly high in Bangladesh at 16.2 per 100 live births, followed by Pakistan and India at over 13 per 100 live births (Figure 4.3, left panel). Since 2010, preterm birth rate increased by almost one‑third in Korea, reaching 8.4 per 100 live births in 2020.
Overall, it is estimated that about 14.7% of all births worldwide are low birth weight (<2500g), representing around 19.8 million births in 2020; and nearly half of them happened in South Asia. In 2000, the rate was about 16.6% representing an absolute reduction of 1·9 percentage points between 2000 and 2020. (Okwaraji et al., 2024[4]). Preterm birth stands as one of the main driver for low birth weight. Beside preterm birth, low birth weight is also an important determinant of child health as it is associated with greater risk of death, poor health, and disabilities. Low birth weight infants are about 20 times more likely to die than heavier infants. (WHO, 2024[5]). Low birth weight is the result of many factors but largely preventable. Mothers’ risk factors include poor nutritional status such as low body-mass index (BMI), being a young mother, smoking or exposure to second hand smoke, excessive alcohol consumption, and history of unnecessary c-section deliveries (UNICEF and WHO, 2019[6]; Blencowe et al., 2019[7]).
On average, about 13% of newborn had low weight at birth across Asia-Pacific countries and territories (Figure 4.3, right panel). There was a significant regional divide between countries and territories in eastern Asia (such as China and Mongolia) and southern Asia (such as Bangladesh, India and the Philippines). Mongolia and China had the lowest birth weight rates at 5% or less, while India reported the highest rate of 27.4%.
Since 2010, Cambodia, Mongolia and Viet Nam made the most progress in reducing low birth weight rates, and lower-middle- and low-income Asia-Pacific countries and territories achieved a larger decrease compared to upper-middle- and high-income countries and territories in the region (Figure 4.4, left panel). Recently, the reduction is slower in China but it achieved one of the lowest birth weight rates in the Asia-Pacific region through rapid and sustained economic growth and improved access to food in many provinces. Despite some relatively low levels, some high-income Asia Pacific countries and territories such as Korea and Hong Kong (China) have experienced increase in low-birth-weight rates since 2010 by 25% and almost 40% respectively. Globally insufficient progress has been made in LBW reduction in the past two decades and, if current trends continue, the Global Nutrition Target of a 30% reduction in LBW prevalence between 2012 and 2030 will not be achieved. (Okwaraji et al., 2024[4])
Antenatal care can also help women prepare for delivery and understand warning signs during pregnancy and childbirth to avoid low birth weight. Higher coverage of antenatal care was associated with lower share of infants with low birth weight (Figure 4.4, right panel), suggesting the significance of antenatal care over infant health status across Asia-Pacific countries and territories. For instance, Korea with one of the highest antenatal care coverage (97%) had less than 8 low birthweight infants per 100 live births while Bangladesh with one of the lowest antenatal care coverage (37%) had almost 23 low birthweight infants per 100 live births.
