Preterm birth, and its consequences, remains one of the most intransigent research problems in the area of pregnancy and delivery. To date, few successful interventions have been identified. However, a wide array of research projects is being funded by a number of institutes and centers at the National Institutes of Health (NIH), lead by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Some progress has been made in identifying the factors that may be connected with prematurity, as well as ruling out certain treatments that have not been shown to be effective. In addition to continuing strong support for this research, the Surgeon General has asked the NICHD to take the lead on planning the upcoming Surgeon General’s conference on prematurity, scheduled for late spring of 2008. In its report on the Fiscal Year 2007 budget for the Department of Health and Human Services, the House Committee on Appropriations stated: “The Committee commends NICHD for its commitment to reducing the incidence of premature birth and its consequences through its longstanding support for the Maternal-Fetal Medicine Unit and the Neonatal Research Network, as well as the new Genomics and Proteomics Network for Premature Birth Research. The Committee is pleased that NICHD is one of the sponsors of an Institute of Medicine study to define and address the health related and economic consequences of premature birth and looks forward to publication of the recommendations. The Committee encourages NICHD to expand its research on the causes of preterm labor and delivery and improving the care and treatment of preterm and low birth weight infants, to work with the Office of the NIH Director to develop a strategic plan for research, and to coordinate its research with other institutes.” (House report No. 109-515, page 104/105) In response to this request, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) prepared the following report. Background Preterm delivery is a major public health problem. The preterm birth rate is over 12 percent of all live births, accounting for over half a million premature births each year. One in eight infants in the United States is born preterm. Preterm birth is the leading cause of death among African-American infants and the second leading cause in Caucasians, and is associated with an increased risk for developmental disabilities. Over the last two decades, preterm birth rates have risen approximately 30%, reaching 12.7% in 2005. Concomitant with the rise in preterm births is a rise in multi-fetal gestations, due in a large part to the increased use of assisted reproductive technologies. Between 1980 and 2000 there was a 74% increase in twin births in the US. Not only were there more twin births, but a higher proportion of the twins were delivered preterm, with 22% more twin births delivering preterm in 1996-1997 than in 1981-1982. The sequelae of preterm birth include immediate complications, specifically mortality, and significant morbidity. In 2001, preterm birth surpassed birth defects as the leading cause of neonatal mortality. Preterm birth accounts for one of five children with mental retardation, one of three children with vision impairment and almost half of children with cerebral palsy. In the long term, children born low birth weight have an increased risk for cardiovascular disease such as myocardial infarction, stroke and hypertension as an adult, an increased risk for diabetes as an adult, and a possible increase in cancer risk. For the mother, delivering preterm increases her risk of a subsequent preterm delivery. One of the strongest risk factors for preterm birth is having had a prior preterm birth; after a prior preterm birth, the incidence of a recurrent preterm birth in a subsequent pregnancy is increased two-fold from the background risk. In addition, there is a racial disparity in both 4 the baseline rates and recurrence rates of preterm births. In 2004, preterm births occurred in 11.5% of Caucasian women and 17.9% of non-Hispanic black women. With one previous preterm birth, the recurrence rates of preterm births are 15-20% in Caucasian women, and 26% in black women. The recurrence risk varies depending on the gestational age of the prior preterm birth. In addition, the gestational age of subsequent preterm delivery is similar to the initial preterm birth, with 50% delivering within one week and 70% delivering within two weeks of the previous preterm delivery. Increasing numbers of prior preterm deliveries also increases the risk of subsequent preterm delivery, and those with a recent preterm birth are at higher risk of recurrence than those with a remote preterm birth followed by a term delivery. The additive risk associated with multiple prior preterm births is especially evident when early preterm births are considered. Women with one prior preterm delivery. Infant and young child feeding is context specific. Although the optimal breastfeeding and complementary feeding behaviors can be (and have been) defined (see Annex A), to what extent (and how) the range of behaviors—from initiation of breastfeeding, continuation of breastfeeding, and introduction of complementary foods, to introduction of family foods, among others—is practiced varies tremendously according to culture, geography, social, economic, and other family and community factors. Formative research is the key to open up our understanding on: what motivates or inhibits the optimal practice of the most critical (or least practiced) behaviors in households; perceptions about these practices; and possible ways to facilitate new or improve current practices. Formative research on infant and young child feeding is a critical activity in