This comprehensive research article presents a novel framework for addressing preterm birth through intersectoral interventions, emphasizing that health outcomes cannot be improved through health sector efforts alone. The study introduces the “five Es” framework – equity and rights, education, economy, environment (including nutrition and climate), and emergencies – as critical areas requiring coordinated intervention to reduce preterm births and improve outcomes for mothers and newborns.
The article demonstrates that remarkable progress in maternal and child survival between 1990 and 2010, including a 50% reduction in under-5 mortality, came from investments in economic growth and education alongside health sector developments. However, amid the emerging “polycrisis” of climate change, conflicts, rising living costs, and pandemic risks, intersectoral action has become essential to achieving health-related goals, particularly for preterm birth prevention and care of small and sick newborns.
Under the equity and rights pillar, the research shows that factors like gender-based violence, child marriage, and female genital mutilation significantly increase preterm birth risks. For education, reduced educational attainment is associated with 10-57% increases in preterm birth rates. The economic analysis reveals stark disparities, with over 90% of extremely preterm babies dying in low-income countries compared to less than 10% in high-income settings. Environmental factors including climate change, air pollution, and poor nutrition significantly influence preterm birth outcomes, with recent estimates suggesting household air pollution contributes to 35.7% of all preterm births. In emergency settings, 25 countries with UN Humanitarian Appeals account for 58% of global maternal deaths and 38% of newborn deaths.
The article presents five pivots for the coming decade: implementing equity-focused, gender-transformative, and rights-based policies across sectors; ensuring inclusive education throughout the life-course including comprehensive sexuality education; prioritizing co-financing across sectors with universal health coverage; taking environmental action with climate adaptation strategies; and strengthening emergency preparedness and response plans. The authors conclude that comprehensive intersectoral policies and financing can significantly improve maternal and newborn health outcomes and accelerate progress toward Sustainable Development Goals.
