A “silent emergency” that is claiming one million tiny lives born premature each year requires concerted action to swiftly improve children’s health and survival, according to a new report released by UN agencies and partners

Estimated 13.4 million babies were born premature in 2020, with nearly a million dying from pre-term complications, according to Born too soon: Decade of action on preterm birth.

Produced by a range of agencies, including the UN Children’s Fund (UNICEF) and the World Health Organization (WHO), with its Partnership for Maternal, Newborn and Child Health (PMNCH), the report outlines a strategy forward to address this phenomenon, which has been long under-recognized in its scale and severity.

Gains made are now being pushed back further through the devastating combination of COVID-19, climate change, expanding conflicts and rising living costs. Preterm birth rates have not changed in any region in the world in the past decade, with 152 million vulnerable babies born too soon from 2010 to 2020, the report showed.

Preterm births occur earlier than 37 weeks of an expected 40-week full-term pregnancy. Preterm birth is now the leading cause of child deaths, accounting for more than one in five of all deaths of children occurring before their fifth birthday, the report said. Preterm survivors can face lifelong health consequences, with an increased likelihood of disability and developmental delays.

Too often, where babies are born, determines if they survive, the report found, noting that only 1 in 10 extremely preterm babies survive in low-income countries, compared to more than nine in 10 in high-income nations.

The report showed gaping inequalities related to race, ethnicity, income, and access to quality care, determine the likelihood of preterm birth, death, and disability, even in high-income countries.

Southern Asia and sub-Saharan Africa have the highest rates of preterm birth, accounting for more than 65 per cent of global cases. Other factors are also making an impact, increasing risks for women and babies everywhere. For example, air pollution is estimated to contribute to six million preterm births each year, the report showed.

At the same time, nearly one in 10 preterm babies are born in the 10 most fragile countries affected by humanitarian crises, according to a new analysis in the report. Progress must also advance in prevention, which means every woman must be able to access quality health services before and during pregnancy to identify and manage risks, she said.