In Australia, just over 8 per cent of babies are born prematurely, which is as many as 26,000 every year. But that figure reflects the experience of birth near a major city. For people living in rural and remote areas, the premature birth rate almost doubles.

Fortunately, medical advances mean these babies have a much better chance of survival than in the past. But being born too early can lead to many adverse health conditions as well as increasing the risk of learning and behavioural problems.

Professor Ruth Stewart, National Rural Health Commissioner, highlighted the link between remoteness and likelihood of premature birth and the importance of strengthening rural primary care to improve outcomes for mothers and their babies on World Prematurity Day.

"The more rural or remotely a mother lives, the more likely it is that her baby will be born prematurely; in fact, remote women are nearly twice as likely to give birth prematurely.

"In 2018, 8.4% of births in major cities were premature compared with 13.5% in rural, remote and very remote Australia.

"These averaged figures hide pockets of greater complexity – in East Arnhem Land communities, 22% of babies are born prematurely," said Prof Stewart.

Professor Stewart, a GP obstetrician with over 30 years of rural practise experience, explained that premature birth is not just a risk for infant survival, but also impacts the child's future health.

"Survivors can face a lifetime of disability including cerebral palsy, learning difficulties, visual, hearing, dental, behavioural or psychological problems.

"Premature birth is also associated with an increased risk of preventable adult chronic diseases such as diabetes, cardiovascular disease, and renal disease."

The implementation of a National Rural Generalist Pathway is a central focus for Professor Stewart, who believes rural generalists are vital to improving access to primary care for rural and remote communities.

"Rural Generalists can provide both comprehensive general practice, emergency care, and components of other medical specialist care in rural hospital and community settings; they work as part of a rural multidisciplinary healthcare team.

"I believe that this primary care, from known professionals and health workers close to home, will change the inequity rural communities experience in rates of premature birth and other health outcomes," said Prof Stewart.

Regional Health Minister, Mark Coulton, said premature birth was a universal concern, with access to services being integral to good outcomes.

"As many as 15 million babies are born preterm each year across the globe, and it goes without saying the chances of surviving and thriving from this position are closely linked to the access one has to appropriate services when they need it.

"Data shows the likelihood of premature birth increases with remoteness, and while many rural women give birth in larger centres, we know that women want care close to home from known health professionals.

"By having doctors in rural settings who can help manage pregnancies and deliver babies, we know more women will have the opportunity to give birth closer to home, leading to both safer pregnancies and speedy recoveries.

"That's why it is so important we continue to develop the National Rural Generalist Pathway to encourage a medical workforce in the bush that can deliver a broad suite of skills, whether that be obstetrics, psychiatry, anaesthetics, emergency, or geriatrics," said Mr Coulton.

Midwife and lactation consultant Rebecka Kubenik said lack of quality maternity care and closure the closure of rural hospitals are to blame for the increased risk of premature birth.

"The lack of continuity of quality care and skilled health professionals available are leading to more preterm births. 

"The closure of rural hospitals means that expectant families have further to travel, have fewer services available and likely increased anxiety. 

"This often results in fewer infants receiving breastmilk, as they are separated from their mother.  For some women expressing milk does not come easy due to the stress of having a preterm infant.

"Improvement can be achieved through a continuity of care model, skilling more rural GPs to deliver a broader range of medical services. 

"Primary care from familiar local medical support is vital," said Ms Kubenik. 


What is preterm labour?

Preterm labour occurs when contractions lead to an opening of the cervix before 37 weeks' gestation. Preterm labour can result in preterm birth, which increases the risk of many health conditions for the baby.

Health risks for preterm babies

• Cerebral palsy
• Learning difficulties
• Visual, hearing, dental problems
• Behavioural or psychological issues.
• Diabetes
• Cardiovascular disease
• Renal disease

What causes preterm labour?

Living in a rural or remote community is a significant risk for preterm birth, but the following are also contributing factors, said Ms Kubenik.

• Maternal weight
• Smoking
• Alcohol consumption
• Social disadvantage
• Gestational diabetes
• Urogenital infections
• Ethnicity
• Exposure to antidepressants
• Overall health and wellbeing
• Environmental temperature
• HPV and hepatitis C

"Improving the health of women prior to pregnancy will improve the outcomes and ensuring the expectant mother goes to term," said Ms Kubenik.