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Undernourishment in the womb can lead to diminished potential and predispose infants to early death

A baby’s weight at birth is a strong indicator of maternal and newborn health and nutrition. Being undernourished in the womb increases the risk of death in the early months and years of a child’s life. Those who survive tend to have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, cognitive abilities and IQ throughout their lives. As adults, they suffer a higher incidence of diabetes and heart disease.

The incidence of low birthweight, defined as the proportion of newborns weighing less than 2,500 grams, is monitored through both health system surveillance and household surveys. In 2012, more than 20 million newborns—an estimated 15 per cent of all babies born globally that year—had low birthweight. Accurate monitoring is challenging, however, since nearly half of the world’s infants are not weighed at birth.  

LOW BIRTHWEIGHT INCIDENCE AND TRENDS

Among regions, South Asia has the highest incidence of low birthweight, with one in four newborns weighing less than 2,500 grams. South Asia also has the highest rate of infants not weighed at birth, at 66 per cent. Although data on low birthweight are adjusted to account for under-reporting, they are still likely to underestimate the true magnitude of the problem in the region.

The incidence of low birthweight is highest in South Asia
Percentage of infants weighing less than 2,500 grams at birth and percentage of infants not weighed at birth, by region

* Excludes China.

Note: Regional aggregates presented where adequate population coverage is reached.

Source: UNICEF global databases, 2014, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative surveys, 2008─2012, with the exception of India and Indonesia. 

More than half of the world’s low-birthweight babies live in just 10 countries; India alone accounts for one third of them.

More than half of the world’s low-birthweight babies are in 10 countries
Number of infants weighing less than 2,500 grams at birth (thousands), 2008─2012

Source: UNICEF global databases, 2014, based on MICS, DHS and other nationally representative surveys, 2008─2012, with the exception of India. 

Trend data from household surveys (MICS and DHS) are limited, covering about 60 per cent of the developing world's population, excluding China. However, the data indicate that the incidence of low birthweight remained unchanged from the 1990s to 2010 in both sub-Saharan Africa and Asia. Data coverage was insufficient to calculate estimates for other regions.

REFERENCES

UNICEF and WHO, Low Birthweight: Country, regional and global estimates, UNICEF, New York, 2004.

Barker, D.J. (ed.), Fetal and Infant Origins of Adult Disease, BMJ Books, London, 1992.

Blanc, A.K., and T. Wardlaw, ‘Monitoring Low Birth Weight: An evaluation of international estimates and updated estimation procedure, Bulletin of the World Health Organization, vol. 83, no. 3, March 2005, pp. 161─240.

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Notes on the Data

Birthweight is the first weight of the newborn obtained after birth. For live births, birthweight should preferably be measured within the first hour of life, before significant post-natal weight loss has occurred.

Low birthweight is defined as less than 2,500 grams (up to and including 2,499 grams).

THE INDICATOR

The indicators presented on this page, ‘incidence of low birthweight’ and ‘children not weighed at birth’ are defined in the table below.

 

Indicator name

Definition

Numerator

Denominator

Incidence of low birthweight

The number of live births in a given population and over a given time period that weigh less than 2,500 grams

Total number of live births in the given population during the same period

Children not weighed at birth

The number of live births in a given population and over a given time period for which the birthweight is unknown

Total number of live births in the given population during the same period

DATA SOURCES

For industrialized countries, the main sources of information on low birthweight are service-based data and national birth registration systems. For developing countries, low-birthweight estimates are primarily derived from national household surveys, as well as data from routine reporting systems.

ADJUSTMENT PROCEDURES FOR HOUSEHOLD SURVEY DATA

Globally, nearly half of all babies are not weighed at birth. Moreover, those that are tend to be better off (more likely to be born in health facilities, urban areas and of better-educated mothers), which can lead to an underestimation of low-birthweight incidence. To complicate matters even further, when infants are weighed at birth, the readings tend to cluster around multiples of 100 grams. As a result, a certain proportion of infants whose birthweights are reported as exactly 2,500 grams actually weigh less than 2,500 grams. This would suggest further underestimation of low-birthweight incidence. Prior to acceptance in UNICEF’s global database, household survey data from MICS and DHS are adjusted to account for under-reporting and misreporting of birthweights using methods published by Blanc and Wardlaw (2005). The assumptions implicit in this adjustment are the following:

  • Births with numerical birthweights reported are as likely to be low birthweight as those without reported birthweights
  • Within the same country, the relationship between birthweight and the mother’s assessment of infant size does not depend on whether the infant was weighed.

It should be noted, however, that adjusted rates may still underestimate the true magnitude of the problem. It is critical, therefore, that all babies be properly weighed at birth.