1. Callister, Lynn Clark PhD, RN, FAAN

Article Content

The March of Dimes, in conjunction with global partners including The Partnership for Maternal, Newborn and Child Health, Save the Children, and the World Health Organization, published a global action report on preterm birth (PTB) (2012). This landmark work provides estimates of the rates of PTB in 65 countries, and was supported by the Global Strategy for Women's and Children's Health and the United Nations initiative Every Woman, Every Child (


By regions, South-Eastern Asia and Oceania have the highest percent of PTB (13.5%) compared to 8.6% in the developed world. Globally, greater than 1 in 10 infants are born prematurely, and over a million children die yearly related to complications of PTB. Unfortunately, there is a significant survival gap between those born in high-income countries and those in low-income countries, with those born <28 weeks gestation dying in low-income countries at a rate of over 90% within the first days of life compared to less than 10% mortality in those born in high-income countries.


The global action plan includes strategies beginning with preconception care, prevention, and evidence-based interventions. Feasible, cost-effective care in low-resource countries can save lives and prevent the complications of prematurity (United States Agency for International Development [USAID], 2013). According to the March of Dimes (2012), mortality associated with PTB can be reduced by 75% even without the availability of neonatal intensive care.


One of the most significant threats to the health and well-being of vulnerable preterm infants is hypothermia. The lack of a continuous source of electricity, as well as the lack of radiant heaters and incubators (which cost $20,000 each and require continuous electricity) in low-income areas, exacerbates this problem. The Embrace Warmer is a small blue sleeping bag developed at Stanford University that can keep a newborn warm for up to 6 hours, with a renewal from a generator or grid for 30 minutes every 4 to 6 hours. Although cost may be prohibitively expensive for low-income countries, Embrace has partnered with nonprofit organizations to distribute the warmer free to clinics in 10 countries. Clinics provide feedback on the utility of the device as well as data on use. The devices are not sold to individuals but only to nonprofit healthcare facilities or orphanages that can provide a demonstrated need, an adequate supply of intermittent electricity, positive collaboration including willingness to collect data, and a focus on education to prevent neonatal hypothermia. This includes training on Kangaroo Mother Care (KMC) that occurs in conjunction with use of the Embrace bag.


An example of one Global Embrace partner is the Teso Safe Motherhood Project in Uganda, Africa, where one of the highest rates of malaria in sub-Saharan Africa is seen. Anecdotal evidence of a pregnant woman infected with malaria, and then used the Embrace warmer with KMC rather than the local practice of using hot water bottles or charcoal can be found at


The March of Dimes global program includes partnerships in 33 countries across Central and South America, Africa, the Middle East, Southeastern Europe, Asia, and the Western Pacific region. The focus of the March of Dimes global program is on collaborative projects that have measurable outcomes and are adaptable to local conditions and needs within healthcare systems and sociocultural context.




Born Too Soon Executive Summary Group. (2012). Born too soon: The global action report on preterm birth. White Plains, New York: March of Dimes.


United States Agency for International Development. (2013). Commitment to child survival: A promise renewed call to action ending preventable child deaths. Rockville, MA: Government Printing Office. [Context Link]