Complications from preterm birth is the number one cause of death for children under age five around the world – a staggering statistic with one in ten babies born too soon.  India has more preterm births than any other country in the world – over 3.3 million per year – and over 300,000 deaths due to direct preterm complications[1]. The Government of India has taken action to prevent preterm birth and to improve the chances of survival for babies born too soon including publishing operational guidelines in 2014 to direct the use of antenatal corticosteroids (ACS) in health facilities. The World Health Organization (WHO) recommends ACS be administered to women who are at risk of early labor between 24-34 weeks of pregnancy to promote lung maturity in the unborn baby. However, ACS can also be harmful when used past 35 weeks of pregnancy – a date which can be difficult to estimate in low-resource settings. We know ACS has the potential to help preterm babies survive, but tailored and context-specific approaches are needed to ensure its safe and effective use.

Every Preemie is partnering with the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India, under the direction of the Government of India Ministry of Health and Family Welfare, the State of Haryana Department of Health, and the Indian National Health Mission for a two-year research project to examine the current practice of ACS administration under this policy. The study focuses on the state of Haryana in northern India. In this state, as across much of India, many women give birth at home or in lower-level facilities that are not equipped for advanced maternal care. Within these districts the study will collect qualitative and quantitative data to assess the current use of ACS and identify the essential conditions required to safely and effectively administer ACS particularly a pre-referral first dose at lower-levels of the health system.

Every Preemie and PGIMER will work with an advisory group made up of public and private partners including Government of India representatives, Indian professional associations, and Indian academic institutions to review the study findings and revise national guidelines on ACS use. Working with government departments and experts in the Indian health setting ensures that the guidelines will be well-informed, actionable, and will have immediate support for roll out in lower-level health facilities. As the final phase, Every Preemie and PGIMER will implement and evaluate the new guidelines in select facilities.

India’s commitment to saving preterm babies and refining their ACS policy guidelines provide an opportunity to identify the conditions needed for safe and effective use of ACS at different levels of the health system.  When used successfully ACS not only saves lives but may also lower the rate of admission of preterm babies to specialized care facilities, reduce the length of their hospital stays, and ultimately reduce the cost of care for these babies. The lessons learned from this study will be used to inform policies and practices in India and around the globe. The results have the potential for replication and adaptation in similar low-resource settings throughout the world. Working with the local government, this partnership between Every Preemie and PGIMER highlights the value and importance of working together to accomplish one shared goal: saving the lives of preterm babies.

For more information on Every Preemie’s implementation research activities or the project as whole, please visit our website at www.everypreemie.org.

Every Preemie—SCALE is a 5-year USAID-funded program designed to catalyze the global and national conversation around preterm birth and low birth weight in 25 priority maternal and child health countries, primarily in Africa and South Asia. The program is implemented by PCI, the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), and the American College of Nurse-Midwives (ACNM).

[1] India: Profile of Preterm Birth and Low Birth Weight Prevention and Care