Over 60% of preterm births occur in Africa and South Asia (Figure 1). The 10 countries with the highest numbers include Brazil, the United States, India and Nigeria, demonstrating that preterm birth is truly a global problem. Of the 11 coun- tries with preterm birth rates of over 15%, all but two are in sub-Saharan Africa (Figure 2). In the poorest countries, on average, 12% of babies are born too soon compared with 9% in higher-income countries. Within countries, poorer families are at higher risk.
This, of course, is the problem. There is not a single set of biological causes of prematurity, so there isn't an easy fix. The basic solution is to improve the lives of pregnant women, making sure that risks are identified and monitored. Healthy, empowered women, who are neither too young nor too old when they get pregnant will be at the lowest risk of prematurity, so moving a greater fraction of women into those categories is the solution, but it is a societal-wide fix, not simply an individual-level treatment regime. Perhaps the only good news out of this is that the infant mortality rates have gone down so much over the years everywhere that we are now able to concentrate on the really hardest issues.