In a majority of cases, the cause of preterm birth remains unknown though a number of factors including sociodemographic (e.g age under 25 years and over 35 years, socio-economic factors such as household strain, income, educational levels), nutritional (lack of micronutrients) biological (genetics, infections, non-communicable diseases, obesity, substance abuse) environmental factors (environmental toxins, household pollution, smoking) and maternal stressors (stress, psychological distress, depression, anxiety) are under investigation. Ability to access early quality prenatal care and follow up/referral to higher level facilities has potential to reduce occurrence of preterm birth. Despite all these preparations and precautions, a woman can still deliver preterm since in a majority of cases no single cause can be identified, argues Dr Joseph Wangira Musana, a consultant obstetrician Gynaecologist at Aga Khan University Hospital, Nairobi in a recent op-ed.