Why is the rate of premature births so high in this community?

Investigating the High Premature Birth Rate in a Pakistani Community

Life in Rehri Goth

Ecorescuezone.com – Along the edges of Karachi, Pakistan’s bustling port city, lies the fishing settlement of Rehri Goth. Here, dried sewage—accumulated over many years on an arid riverbed—is whipped into the air by strong winds. In narrow alleyways, residents navigate daily life amid piles of refuse. One man can be seen squatting beside discarded waste, retrieving a bruised peach to eat.

Sughran resides in this dusty compound with her extended family. Known only by a single name, she has no record of her age. Around her wander approximately twelve children dressed in worn garments. Five of these little ones belong to her, and they are the ones who have survived.

A Mother’s Loss

When we met Sughran, she shared that seven days had passed since she laid her baby Gulshan to rest. He arrived at seven months of gestation. When contractions intensified, her husband transported her to a hospital several miles away in Karachi. Unfortunately, the facility refused admission because she was not registered as a patient there. She then hurried to a nearby hospital, only to find it closed for the evening.

So my family told me to go to another hospital. I said that I would not go anywhere and decided to deliver the child at home.

Sughran buried Gulshan in the cemetery close to his brother Roshan, who had passed away the previous year. Roshan was also born prematurely, reportedly at around seven months as well. “One was alive for eight days, and the second was alive for two hours,” she expressed with sorrow.

Understanding the Crisis

In wealthier nations, premature infants—especially those born after thirty-two weeks, roughly eight months—enjoy strong survival prospects. However, conditions differ significantly in low-income regions. According to the World Health Organization, approximately fifty percent of premature babies born at thirty-two weeks in impoverished countries do not survive. Many who live face permanent challenges with vision, hearing, and cognitive development.

Rehri Goth records one of the highest prematurity rates across Pakistan. Dr. Fyezah Jehan, who chairs Paediatric Infectious Diseases at Agha Khan University in Karachi and focuses on maternal health, notes that roughly one out of every four babies here arrives before thirty-seven weeks. This figure approaches twice the national average of just over fourteen percent, which already ranks among the highest globally.

Researchers have identified several contributing factors. Women and girls in this community show clear signs of malnutrition. Extreme temperatures and inadequate sanitation also play roles. Yet, as Dr. Jehan observes, other nations share similar environmental challenges without experiencing equally elevated rates. This prompted her team to investigate further.

The Microbiome Connection

Dr. Jehan’s department became fascinated with the microbiome—the vast collection of microorganisms residing within the human body. Growing evidence suggests this ecosystem significantly influences adverse pregnancy outcomes. These microbes perform essential functions: extracting crucial vitamins and nutrients, training immune systems to identify threats, and generating anti-inflammatory compounds that protect against illness-causing organisms.

While numerous Western studies examine the gut microbiome during pregnancy, data from Pakistan remained scarce. This gap proved critical, since an individual’s microbiome develops through both dietary habits and local surroundings.

To address this, Dr. Jehan’s team analyzed stool samples from Pakistani women who had recently delivered. They selected 108 specimens gathered around Rehri Goth over twenty years. Approximately half came from mothers who carried their pregnancies to full term; the remainder belonged to women who experienced premature births.

What we found was — there’s this one bacterium, Prevotella copri, which was far less in women who had delivered pre-term compared to women who delivered term. It was a eureka moment for us. We were like, oh, there is a bug, you know, which could potentially explain prematurity.

Dr. Jehan explains that while initial findings provide promising signals, the research has not yet reached a point where results can inform policy decisions. Her team is now replicating experiments using samples from different locations and collected in separate years. Additionally, they are cultivating Prevotella copri in laboratory settings, hoping to administer it to pregnant women at risk of early delivery to determine whether it supports carrying pregnancies to term.

Dr. Vincent B. Young, an infectious disease specialist at the University of Michigan Medical School, has also contributed insights to this growing field of research.