Think All Pregnancies Are Created Equal? Think Again
We’ve all heard about the importance of prenatal care, and it’s easier than ever to prevent everything from preterm birth to newborn death and birth defects. So why aren’t more women getting the care they need? Turns out that living in a developing or middle-income country means a very real chance of missing out on basic health care that can save babies and mothers — even when those treatments are cheaper and more advanced than ever before.
When The Lancet embarked on a massive study of more than 300,000 births around the world, it asked how often women receive antenatal corticosteroids (steroid injections used to prevent disability and death in babies still in utero). The findings are surprising:
- Only half of pregnant women likely to benefit most from these prenatal drugs get them. That’s despite the fact that drugs like dexamethasone and betamethasone are cheap and easy to administer. The Lancet found that only 16 percent of eligible women in Afghanistan, the Democratic Republic of Congo, Nepal and Niger receive the drugs.
- Nearly half of women with preterm labor aren’t treated with drugs that can help. In fact, many women who do receive treatments like steroid injections aren’t treated when it can be most effective.
- Ineffective treatments abound. Hydration and bed rest are the most commonly prescribed treatments for women in preterm labor, despite evidence that they help little or not at all. Even worse, many women in preterm labor were treated with beta-agonists, which can actually harm babies and mothers.
Antenatal corticosteroid therapy has been shown to help the developing lungs of infants who are at risk of preterm birth, but studies have also shown that they can reduce mortality in such cases as well. Drug costs vary from around $40 to as low as 51 cents per treatment. So why aren’t more women being given prenatal corticosteroids, especially in light of the fact that over 60 percent of preterm births occur in Asia and Africa? Unfortunately, cost is not the only factor — issues as diverse as physician training to traditional birthing and prenatal practices to issues of education and awareness are at play.
What can be done to ensure that all pregnancies are created equal, or at least given the best shot in both the developed and developing world? The authors of the study are calling for corticosteroids to be included on lists of essential medicines for offending countries. Recognizing that many low- and middle-income countries lack medical infrastructure, they also suggest that prescribing practices be changed to allow midwives to administer drugs instead of doctors.
But other doctors point out that until family planning and prenatal care become more widespread, it’s not reasonable to expect cheaper and more effective drugs to work at all. That’s sobering news, especially in light of the fact that reproductive health and health care continue to be such a contentious and divisive issues even in the U.S., a high-income country in which one of every eight children is born prematurely. Perhaps we’d all do well to listen to the words of scientists who filed their comments along with the study: “Let us not wait another 40 years to translate evidence into global practice.”
Photo Credit: flickr