Bill & Melinda Gates Foundation

3 Ways to Prevent Premature Birth in Africa

November 15, 2012

Africa is such a huge, diverse continent with different cultures, people, beliefs and health systems. Each community is unique with its own health problems and solutions.

The same is true for the prevention and management of preterm (premature) birth in Africa. We have to look at each specific setting to identify what works best in that particular community, province and country. For preterm babies, one aspect to look at is where a woman gives birth and if there is a skilled attendant to assist the delivery.

To help identify best approaches to preterm prevention and care, I categorize health systems into three groups.

The first group is countries where over 80 percent of women have access to skilled care during pregnancy, child birth and postpartum period. In these settings, other conditions are also typically well developed, such as high female literacy and basic infrastructure such as roads and communication. The majority of the effective interventions for preterm birth, then, can be organized through health facilities because that is where women are going to go for care during pregnancy and at birth, particularly in the case of preterm birth. For example, South Africa has an extensive reporting system that even analyzes the causes of maternal and newborn deaths; this information feeds back into programs to guide local actions and improve services. 

The success of the preterm prevention and management program in Africa will rely on ‘finding the best fit’ in the national effort for improving maternal and newborn health.


On the other extreme, in Ethiopia, only about 10 percent of women give birth in health facilities. What works in South Africa is not going to work here. Community-based interventions with referral linkage to health facilities is the only way to reach the majority of the mothers and newborns.

The Ethiopian government developed a program with an appropriate fit for this setting: an extensive network of community-based health extension workers (HEW) are trained and deployed in rural health posts to provide health, nutrition, and water and sanitation interventions. This program continues to expand with additional HEWs to provide more skilled care to mother, newborns and children. They have tailored the services to the communities’ needs and lifestyles.

In the third group of countries, where about half of women give birth in health facilities, the choice of program strategies and the right mix of interventions at community and facility level can be hard to identify as many other factors come into play – the policy environment, financial condition, provider and consumer preference, and balance between reaching the majority of the population and equity, among many other factors.

Malawi and Ghana have reached some balance by supporting both health facility and community-based interventions –while improving access and quality of health facility based interventions, community health workers are deployed in rural and under-served areas to scale up evidence-based care following the principle of continuum of care.

When looking at how to prevent premature birth, besides examining the three tiers of country health systems, we also must consider the needs of the fast-growing urban populations and the urban poor, a group that has its own health care concerns and is being reached more and more through the private sector, social media, and mobile phone technology.  At the same time, the pastoralist and mobile populations in Africa are hardly in contact with the modern health services, let alone the services that suit their lifestyle.

The success of the preterm prevention and management program in Africa will rely on ‘finding the best fit’ in the national effort for improving maternal and newborn health. Community and providers’ views should be collected and considered so that the intervention packages are acceptable and feasible.

Preterm birth is a universal problem but the solutions must be tailored, unique, and adapted to the local context.

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