Women’s health and maternal care services: seizing missed opportunities to prevent and manage preterm birth

Progress: The past ten years have seen uneven developments in women's and adolescents' health and reproductive rights. Globally, reductions of maternal and neonatal mortality rates and adolescent birth rates have been achieved along with improvements in coverage of key reproductive and maternal health services. However, preterm birth rates have not changed significantly. There is still large variation in these rates across the world, with the highest rates occurring in South Asia and sub-Saharan Africa. Programmatic priorities: Effective interventions based on current clinical guidelines are available that can prevent preterm birth or reduce its negative impacts on newborns. These recommended interventions can be delivered as part of essential health service packages during the preconception, antenatal, intrapartum, and postnatal phases. They encompass comprehensive family planning services that enable women and adolescent girls to determine the timing and number of children they have, and the provision of prevention and treatment-related interventions during pregnancy, childbirth, and the postnatal period that improve maternal and newborn health including reducing preterm births as well as stillbirths. Health system improvements are needed so that all women are reached with these services and that they are provided respectfully and according to standards. Pivots: To better prevent and manage preterm births as part of broader goals of improving maternal and newborn health, health systems need to be strengthened so that all women are reached with essential packages of care before, during, and after pregnancy and childbirth. Achieving this and integrating these service packages into universal health coverage strategies requires collaboration across government leaders, civil society members, private sector actors, and development partners. Increasing coverage of antenatal care, institutional delivery, and postnatal care represents an opportunity to improve the quality of care provided during those service contacts including through the provision of interventions that address modifiable risk factors for preterm birth such as prevention and treatment of infections, poor nutritional status, and substance use. Other pivots to enhance the quality of care include using existing tools to optimize the management of preterm birth, such as appropriate use of antenatal corticosteroids, and providing respectful person-centred care for women, adolescents, and families.