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Think All Pregnancies Are Created Equal? Think Again

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.”

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81 comments

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2:39AM PDT on Aug 26, 2014

ty

9:46AM PDT on Aug 25, 2014

It is terrible that all women in danger of having a premature delivery cannot get steroids! I myself had to beg for them at my hospital at 23 weeks even though I was having my 4th hemorrhage. My daughter Joy was born at 23 weeks in 2012. Due to modern medicine and prayers she is doing great today. I hemorrhaged at 17 weeks for the first of 4 times because of 100% placenta previa, which turned into placenta accreta (which I believe was caused by 3 prior c-sections). After she came home from 121 days in the NICU, I wrote a memoir called "From Hope To Joy" about my life-threatening
 pregnancy and my daughter's 4 months in the NICU (with my 3 young sons at 
home), which is now available on both the Amazon and Barnes&Noble websites. It was quite a roller 
coaster that I am certain some of you have been on or are currently riding on. My mission is to provide hope to women struggling with
 high-risk pregnancies, encourage expectant mothers to educate themselves before 
electing cesarean deliveries, provide families of premature babies a realistic 
look at what lies ahead in their NICU journey, and show that miracles can 
happen, and hope can turn into joy.
 Please see my website http://www.micropreemie.net and www.facebook.com/jenniferdegl and watch our amazing video of my daughter’s miracle birth and life at: http://www.youtube.com/watch?v=V_hleySg-iU

Thank you.

11:59AM PDT on Aug 24, 2014

Thank you.

11:49AM PDT on Aug 24, 2014

Thanks for sharing.

3:40AM PDT on Aug 24, 2014

I stopped reading halfway through. The very last thing this world needs is more successful pregnancies in the Global South, and I say that as a labor and delivery nurse of many years. They've embraced vaccinations and antibiotics, but not birth control. Until they start limiting their own fertility, we would be insane to help them further.

11:05PM PDT on Aug 23, 2014

World Health Organization-
Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth.
99% of all maternal deaths occur in developing countries.
Maternal mortality is higher in women living in rural areas and among poorer communities.
Young adolescents face a higher risk of complications and death as a result of pregnancy than older women.
Women in developing countries have on average many more pregnancies than women in developed countries, and their lifetime risk of death due to pregnancy is higher. A woman’s lifetime risk of maternal death – the probability that a 15 year old woman will eventually die from a maternal cause – is 1 in 3700 in developed countries, versus 1 in 160 in developing countries.
The major complications that account for nearly 75% of all maternal deaths are:
severe bleeding (mostly bleeding after childbirth)
infections (usually after childbirth)
high blood pressure during pregnancy (pre-eclampsia and eclampsia)
complications from delivery
unsafe abortion.
Not to mention children are the path to poverty and a lifetime of misery in many countries.

10:32PM PDT on Aug 23, 2014

so, how wide spread do you believe that birthing-risk ever were in history, minus wars and famine or bad environment? answer- not very. Put into perspective. No scare mongering, now, lest you look to wars and famines.

4:35PM PDT on Aug 23, 2014

All wanted children should be given the proper support to develop as strong and healthy as they can be

3:31PM PDT on Aug 23, 2014

Thank you

10:03AM PDT on Aug 23, 2014

Thank you

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