KATHMANDU, Jan 10: Just as healthy seeds and soil are essential for a plant to grow well, the same principle applies to human life. In recent times, many couples in Nepali society have been marrying later and having children at an older age. Obstetric specialists have observed that children born to such couples are increasingly delivered before full term. Preterm babies are at a higher risk of death.
It is generally believed that children born to couples under the age of 30 are naturally healthier. By this standard, marriages after 30 are considered late. Even after marrying at 30 or older, many couples further delay having children to focus on building their careers. According to statistics from Paropakar Maternity and Women’s Hospital (PMWH), in the past fiscal year (FY), 1,519 preterm babies were born. Of these, 794 were preterm deliveries between 28 and 32 weeks. Last year, the total number of deliveries at PMWH was 20,908, meaning preterm births accounted for about 4 percent. However, this rate is estimated to be higher in other birthing centers. According to medical standards, a healthy baby should remain in the womb for 40 weeks. In the current FY, PMWH has already recorded 271 preterm deliveries at 32 weeks.
Experts and data indicate that preterm births are increasing. Senior gynecologist and obstetrician Dr. Jageshwor Gautam of OM Hospital noted that the number of preterm deliveries has risen in recent years. At OM Hospital alone, 8–10 percent of babies are born at 37 weeks, while over 15 percent are born at 38 weeks. Dr. Gautam attributes this increase to couples delaying childbirth for various reasons. “This trend has grown alongside modern medical treatments,” he said. Specialists note that in developed countries, late marriage and older maternal age are also linked to higher rates of preterm birth.
Causes of preterm births
Infant mortality rate rises in Baitadi
Dr. Gautam explains that trends such as couples living apart due to foreign employment, late marriage, and delayed motherhood have led to an increase in preterm births. Previously, naturally timed pregnancies usually resulted in a single full-term child. Today, practices such as test-tube babies, artificial insemination, and delayed pregnancies have contributed to a rise in preterm deliveries. According to Dr. Shree Prasad Adhikari, director of PMWH, late marriage and pregnancy at an older age are major factors.
As women age, the reproductive capacity of their bodies declines. Preterm births are more likely if the mother has uterine infections, tumors, thyroid issues, diabetes, or high blood pressure. Medical procedures such as artificial insemination and underlying health conditions in women can also result in early delivery. In Nepal, assisted reproduction has become increasingly common over the past few decades. Multiple embryos are often implanted, leading to twins or triplets. Since the uterus may not have enough space, babies are sometimes delivered early or surgically removed. Tumors in the uterus and maternal conditions such as hypertension, thyroid disease, or diabetes can also trigger preterm birth.
Newborns at high risk of death
Doctors note that preterm babies are difficult to save. According to PMWH Director Dr. Adhikari, babies born before 24 weeks generally cannot survive. Those born at 32 weeks are difficult to save, while babies born after 32 weeks face lower risks. However, all preterm babies face some risk of death. Last year, 134 newborns died at PMWH, most of whom were preterm, the director said.
Other causes of newborn death include conditions such as eclampsia, hemorrhage, or umbilical cord complications, but preterm birth remains the main factor. Preterm babies’ organs are not fully developed, making adaptation to the external environment difficult. They often lack subcutaneous fat, and their liver and lungs are underdeveloped. Babies born before 32 weeks may have low blood sugar, hypothermia, weak liver and lung function, and difficulty feeding immediately after birth. Their weak immune systems make them prone to infections, temperature instability, and hyperthermia. Such babies require special care for several days, often including ventilator support.
A challenge for sustainable development
According to the 2022 Nepal Demographic and Health Survey, the neonatal mortality rate in Nepal is 21 per 1,000 live births, which has remained steady since 2016. The government aims to reduce this to 10 per 1,000 births within the next four years. The rising rate of preterm births presents a new challenge to achieving this goal, according to PMWH neonatal specialist Dr. Shailendra Bir Karmacharya.
Specialized care for preterm babies, early diagnosis and treatment of metabolic disorders, and the expansion of neonatal units can help reduce neonatal mortality, according to PMWH neonatal specialist Dr. Prajwal Paudel. Primary hospitals need to manage warming rooms, while provincial and federal hospitals must expand neonatal care units to meet growing demand.
