The ignominy of low birth weight in South Asia

The ignominy of low birth weight in South Asia

Although estimates vary, it is recognised that more than 20 million infants worldwide, representing 16% of all births in developing countries, are born with low birth weight (LBW). The vast majority, over 95%, of these births are in developing countries. More than two thirds (68%) of all LBW infants are born with evidence of intrauterine growth retardation (IUGR), the majority in South-Central Asia, where more than a quarter (27%) of all infants weigh less than 2500 g at birth. Such IUGR infants mostly include those born at term (about 9.6% of all newborns weigh between 2000 and 2499 g at birth). They may also include preterm infants (an estimated 1.3% infants born globally weighing between 1500-1999 g at birth) or those born with a combination of prematurity and IUGR.

Recognised major risk factors associated with term LBW include maternal under nutrition, frequently reflected with low maternal body-mass index, as well as placental insufficiency associated with severe morbidity such as pre-eclampsia. The potential role of multiple micronutrient deficiencies in affecting birth weight is underscored by several studies from South Asia attributing the IUGR to specific deficiencies and corroborated by the recognised effect of multiple micronutrient supplementation in pregnancy on increasing the birth weight. These distal determinants of LBW are manifestations of a number of proximal factors including poverty and marginalisation.

South Asia must stand out as one of the most unfortunate regions of the world. Despite enormous resources, steady economic growth and dividends of a young population, inequity remains a major issue and major pockets of poverty remain. While much progress has been made in initiating large scale public health programs aimed at service delivery through community health workers, unconditional poverty alleviation strategies and conditional cash transfers, the emphasis is still on quick fixes rather than fundamental societal change. In contrast to Latin America and much of Southeast Asia, progress in key interventions such as female education and empowerment, enhancement of age at marriage and first pregnancy and access to family planning remain painfully slow. If South Asia is to make progress in human development, addressing maternal and foetal under nutrition through concerted multi-sector initiatives, community education and preconception care are key.

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