Every year, 1 in 10 babies are born too soon. Preterm birth is the leading cause of under-5 child deaths and accounts for over one third of all newborn deaths. A preterm baby’s chances of survival are starkly different based on where they are born: newborns in sub-Saharan Africa and Southern Asia are 10 times more likely to die in their first month than newborns in high-income countries. In 2012, an impressive global coalition of partners launched Born Too Soon: The Global Action Report on Preterm Birth, setting a pathway for intensified advocacy and action on maternal and newborn health. Today there is much progress to celebrate, especially in the care of preterm babies. However, rates of preterm birth have barely shifted and the burden of preterm birth remains huge, impacting babies, families, communities and whole societies through a staggering loss of human capital. At this juncture – 10 years since the original report – partners from over 60 organizations and 40 countries have come together again to develop Born Too Soon: A Decade of Change for Preterm Birth. This report looks back at the progress and challenges of the past decade and grapples with contemporary challenges, such as conflict, climate change, COVID-19 and the cost-of-living crisis. Born Too Soon elevates the voices of survivors and affected families and puts a strong emphasis on upholding their rights and providing respectful and family-centered care. The report identifies priority investments and solutions needed at scale to accelerate action; country examples demonstrate that progress is possible.