Kassabian Sara, Fewer Sara, Yamey Gavin, Brindis Claire D
Institute of Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
Evidence to Policy Initiative, University of California San Francisco, San Francisco, CA, USA.
Gates Open Res. 2020 Jun 22;4:65. doi: 10.12688/gatesopenres.13098.1. eCollection 2020.
Preterm birth, defined as infants born before 37 weeks of gestation, is the largest contributor to child mortality. Despite new evidence highlighting the global burden of prematurity, policymakers have failed to adequately prioritize preterm birth despite the magnitude of its health impacts. Given current levels of political attention and investment, it is unlikely that the global community will be adequately mobilized to meet the 2012 report goal of reducing the preterm birth rate by 50% by 2025. : This study adapts the Shiffman and Smith framework for political priority to examine four components contributing to policy action in global health: actor power, ideas, political context, and issue characteristics. We conducted key informant interviews with 18 experts in prematurity and reproductive, maternal, newborn, and child health (RMNCH) and reviewed key literature on preterm birth. We aimed to identify the factors that shape the global political priority of preterm birth and to describe policy opportunities to increase its priority moving forward. : The global preterm birth community (academic researchers, multilateral organizations, government agencies, and civil society organizations) lacks evidence about the causes of and solutions to preterm birth; and country-level data quality is poor with gaps in the understanding required for implementing effective interventions. Limited funding compounds these challenges, creating divisions among experts on what policy actions to recommend. These factors contribute to the lack of priority and underrepresentation of preterm birth within the larger RMNCH agenda. : Increasing the political priority of prematurity is essential to reduce preventable newborn and child mortality, a key target of the 2030 Sustainable Development Goal for health (target 3.2). This study identifies three policy recommendations for the preterm birth community: address data and evidence gaps, clarify and invest in viable solutions, and bring visibility to prematurity within the larger RMNCH agendas.
早产定义为妊娠37周前出生的婴儿，是儿童死亡的最大原因。尽管有新证据凸显了早产的全球负担，但政策制定者未能充分重视早产问题，尽管其对健康的影响巨大。鉴于目前的政治关注度和投资水平，全球社会不太可能被充分动员起来，以实现2012年报告提出的到2025年将早产率降低50%的目标。本研究采用希夫曼和史密斯的政治优先框架，来审视促成全球卫生政策行动的四个要素：行为体权力、理念、政治背景和问题特征。我们对18位早产及生殖、孕产妇、新生儿和儿童健康（RMNCH）领域的专家进行了关键信息人访谈，并查阅了关于早产的关键文献。我们旨在确定影响早产全球政治优先性的因素，并描述未来提高其优先性的政策机遇。全球早产群体（学术研究人员、多边组织、政府机构和民间社会组织）缺乏关于早产原因及解决办法的证据；而且国家层面的数据质量很差，在实施有效干预所需的理解方面存在差距。资金有限使这些挑战更加复杂，导致专家们在推荐何种政策行动上存在分歧。这些因素导致早产在更大的RMNCH议程中缺乏优先性且代表性不足。提高早产问题的政治优先性对于降低可预防的新生儿和儿童死亡率至关重要，这是2030年健康可持续发展目标的一个关键指标（指标3.2）。本研究为早产群体提出了三项政策建议：解决数据和证据差距、明确并投资于可行的解决方案，以及在更大的RMNCH议程中提高早产问题的关注度。
