Friday 1 April 2011

Preventing Premature Birth - Tackling Poverty

This blog post is in response to the documentary 23 Week Babies - The Price of Life, and should be read in this context. Just to explain to those who may not have seen it, this documentary explored whether 23 weekers should be routinely resuscitated, it was not an exploration of premature birth on a whole, looking at causation. And some claims were made in this programme that I really want to explore.

Just to put my comments into context, its not sexy, its not current, but I am a socialist. Always have been, and always will be. I believe that to whom much has been given, much is to be expected. I believe in the redistribution of wealth through taxation, I believe that disadvantaged groups in society should be not only protected, but actively helped in order to escape their situation, and to have happy and meaningful lives. I think the fact we even have to talk about poverty in the UK is disgusting, we have the means to ensure no one is living in poverty.

In this documentary, when looking at Holland and its low rate of premature birth, Adam Wishart said, almost as a throwaway line, the Dutch have a lower rate of premature birth most likely due to lower poverty, and less teenage mums.

I don't think enough is known about 23 weekers, and where they come from, who their parents are in order for us to make such statements, and certainly to my understanding, there is no concrete data to suggest that the rate of 23 weekers specifically relates to socio-economic deprivation or indeed teenage mothers. I strongly suspect that many 23 weekers (and in fact this was the case in two of the pregnancies featured) are multiples, and no one is suggesting that we should do selective reduction of multiple pregnancies, or ban IVF treatments that put more than one embryo back.

The research that is out there in relation to poverty and childbirth focuses around low birth weight babies. Low birth weight is not the same as premature birth. Babies can be born at low birth weight if the pregnancy is shorter, this is true, but what the research is really talking about is low weight for gestational age. Whilst a number of factors outside a woman's control can cause this, such as pre eclampsia and other conditions affecting the performace of the placenta, low birth weight can be influenced by a range of maternal factors, and these are quite prevalent in lower socio-economic areas. Some of these factors include smoking, recreational drug use, poor diet, stress and depression and pre existing maternal illness.

It is most certain that if we address poverty, we can address low birth weight, and most likely, premature birth too, but I am not sure by how much, and I am sure even the most pre eminent sociologist or medical researcher couldn't quantify how many premature births this may prevent. So many women do not know why their babies came early, and would have done anything to prevent this.

And just how much addressing poverty will prevent 23 weekers, who knows whether it would make much impact at all, and if so, not for a long long time.

I think what is important is that we continue to research the specific causes of prematurity - pre eclampsia, incompetent cervix, infection, premature rupture of the membranes, carrying multiples, as well as addressing factors such as smoking and drug use.

I also think education, right from the beginning, is important. In school we teach contraception, we should aslo be teaching what parents need to do if they do fall pregnant, how to take care of themselves and their unborn babies. It's no use just hoping that teenage pregnancy will just go away, it won't.

I think more needs to be done in ensuring services are correctly placed.We are very fortunate in this country that we have universal healthcare. Ante natal care is provided to everyone, but we need to ensure that it is accessible to everyone, and that all mothers understand the importance of keeping up their appointments, and following the advice given, particularly in relation to lifestyle factors. My own hospital's maternity and special care unit is closing. This unit is in the heart of a socially deprived area, and in fact my town, Bury, has one of the highest uses of crack cocaine of any town in England. By removing services, and centralising them, we make it even harder for people living in poverty to access them. We also need to make services more relevant, more accessible, and to reach people where they are at, both physically and economically.

I feel strongly that we need a follow up programme on the BBC explaining the causes of premature birth, and addressing specifically how we can reduce the incidence of premature birth, and ensure that every child is given the chance to grow up healthy and happy, and to prevent the heartbreak of having a baby born too small, too soon, too sick.


  1. Hi Kylie,

    I am a Community Health Worker, and my focus is solely on pregnant women in the South Bronx, NY. It is an economically, environmentally depressed part of the country, where asthma, cancer, drug and alcohol use, lack of prenatal care, domestic violence, and depression all help to contribute to 23 weekers and similar low birth rate outcomes.

    I help these women everyday, providing the education that I hope will help them choose to make positive, healthy decisions, for themselves and for their families.

    Not all premies are born to "at-risk" women, this is just part of the story. It was part of mine though, and he is going to be 8 yrs old later this month. Life is full of challenges, but this guy is a survivor. We all are, of something.

  2. An excellent post. I only caught the last half of the show when I saw you mention it on Facebook but what I did see angered me. It did seem to suggest that babies are born to small or too soon due to maternal fault, and indeed there was a very suggestive cut to a picture of cigarette smoke outside the maternity hospital doors. You are perfectly right in saying that you can't generalise about the causes of 23 weekers, or indeed any prem/low weight birth. I have no idea why I gave birth early and I will likely never know.

    Anyway, well done on addressing the issue in a balanced and sensible way, unlike the BBC documentary.