This week (2-8th November 2026) marks International Multiple Birth Awareness week (IMBAW), a week to celebrate the uniqueness of multiple birth family experiences and also to highlight the challenges that twins, triplets and multiple birth families face. In this blog to mark the start of the week, Professor Elizabeth Bailey and Dr Lara Alamad reflect upon why every multiple matters.
International multiple birth week is led by the International Council for Multiple Birth Organisations (ICOMBO) seeking to build on the awareness work of the multiple-birth organisations whose membership makes up the council (including the Elizabeth Bryan Multiple Birth Centre).
The benefits or barriers of being born a multiple vary greatly depending on your situation at birth and the way in which society and the wider community support you. The degree to which the additional financial and social pressures of having more than one infant at a time affects your family environment, and how your status as a multiple is viewed by your community and social structures may be hugely variable.
Even more critically, as multiple pregnancy is associated with additional maternal and fetal complications including prematurity, the chances of surviving pregnancy, birth or infanthood are very much impacted by the health and social care infrastructure in communities.
Globally, the rates of multiple births are increasing. Twins account for 12 per 1,000 deliveries representing a 33% increase since the 1980s meaning one of every 42 children born on earth is a twin (Monden et al, 2021). Twinning rates vary significantly from region to region with the highest twinning rates seen in low-income countries.
For some high-income countries, there has been a reduction in the practice of multi-embryo transfer in assisted conception reducing the previously seen steep increase in multiple births associated with this practice. This means some countries have seen a dip in the multiple birth rates. Nonetheless, the overall global trend of increasing of older age maternities, together with increased availability of assisted fertility, means that the global rate of multiple births is predicted to rise significantly over the 2000s (Lee & Barclay, 2024)
There is growing recognition around the globe of the unique challenges that are faced by those having a multiple birth and the babies that are born from a multiple pregnancy. The most common risk associated with multiple pregnancy is preterm birth, with possible additional complications arising from when more than one fetus shares a placenta.
For pregnant women carrying more than one fetus, there is an increased risk of preeclampsia, gestational diabetes and postpartum haemorrhage, complications which significantly impact maternal health as well as fetal and neonatal health. Figures from a UK confidential enquiry (MBRRACE-UK, 2021) show that twins are more than twice as likely to die in pregnancy and more than 3 times more likely to die in the neonatal period than singletons. This is similar to rates seen in other high-income countries, but in regions where access to maternal healthcare is poor, this perinatal mortality rate could be much higher (Monden & Smits, 2017).
While it is likely that multiple pregnancies are inherently riskier than singleton pregnancies, this international variation in perinatal mortality rates and the fact that in the recent past, UK perinatal multiple birth mortality rates have been lower, shows that with good quality pregnancy and birth care the mortality and morbidity rates for twins and multiples could be considerably improved.
The ability to apply the most recent advances in maternal and neonatal medicine to this more vulnerable group could certainly have big impact on the suboptimal outcomes for multiple birth infants. Yet, multiple pregnancies are often routinely excluded from clinical trials or observational studies because of complexity of risk of outcomes such as preterm birth, which means that additional consideration may be required for management of their data in research design.
In a special statement from the Society for Maternal Fetal Medicine research committee in 2019, it was reported that a review of recent perinatal research studies showed that while multiple pregnancies were represented in studies about preterm birth, they were underrepresented in research on preeclampsia and gestational diabetes, and on interventions recognised to improve outcomes of preterm birth such as corticosteroids, magnesium sulphate and predictive tests for perinatal complications. The statement recognised that due to their disproportionately high population-attributable risk of perinatal morbidity and death, greater attention should be given to the inclusion of multiple pregnancies in perinatal research.
Futhermore, the potential challenges faced reaches beyond birth. Parents of multiples experience more pre- and postnatal depression, social isolation, financial hardship, schooling issues, identity problems and strains on family relationships. Child safeguarding reviews have also highlighted that twins and multiples are at increased risk of abuse and neglect (Groothuis et al, 1982; Lang et al, 2013) .
Most of the research underpinning the advice given to parents around early years assumes of one infant rather than caring for two or more at the same developmental stage. Any parents of twins or more will be able to explain the unique challenge this presents, but from birth through to childhood, education and adolescence, through to adulthood and independence, yet there is limited research into the experiences of multiple birth families, resulting in an inadequate evidence base to help guide and support them.
In raising awareness of multiple births through the international multiple birth awareness week, ICOMCO and its members will highlight the rights and needs of multiple birth families globally. While many of us will have twins in our own families, friendships and social groups and may consider them as curiously interesting in terms of their similarities or differences or ask questions about their relationships and perspectives, this week asks us to reflect further, recognise the risks and challenges faced and consider the needs and rights of multiple birth and their families.