Karachi: More than 2.6 million stillbirths continue to occur globally every year with very slow progress made to tackle this ‘silent problem’. Despite significant reductions in the number of maternal and child deaths, there has been little change in the number of stillbirths, in the third trimester of pregnancy, even though the majority are preventable, according to the Ending Preventable Stillbirth research series published in The Lancet.
The research series was developed by 216 experts from more than 100 organisations in 43 countries and comprises five papers. The authors of the first, third and fifth papers include Professor Zulfiqar A Bhutta, Founding Director, Centre for Excellence in Women and Child Health, Aga Khan University and Co-Director, SickKids Centre for Global Child Health in Toronto, Canada; Professor Marleen Temmerman, Chair, Department of Obstetrics & Gynaecology and Director, Women’s Health and Research, AKU in East Africa; and Dr Jai K Das, Senior Instructor and Ms Arjumand Rizvi, Senior Data Analyst, AKU in Pakistan.
These papers build on AKU’s efforts in 2011 and 2014 on highlighting the importance of prevention and integration of maternal and newborn health services. Looking at the way forward, the authors identify what needs to be done in the context of the Sustainable Development Goals.
“Despite knowledge and advocacy over the last many years, stillbirths, especially those that occur during the process of childbirth, remain a huge global challenge, and an unrecognised public health issue. These papers highlight the huge burden of morbidity and grief associated with stillbirths and also provide a template of solutions that can end this preventable tragedy within our lifetime,” said Professor Bhutta.
New estimates of stillbirth rates for 195 countries developed by the London School of Hygiene & Tropical Medicine with the World Health Organization and UNICEF reveal huge inequalities around the world. Ten countries account for two-thirds of stillbirths with India having the highest number, estimated at 592,100 in 2015. The highest rates are in Pakistan (43.1 per 1,000 total births) and in Nigeria (42.9). The lowest rates are in Iceland (1.3), Denmark (1.7), Finland (1.7) and the Netherlands (1.8). Netherlands is also making the fastest progress, reducing stillbirths by 6.8 per cent per year. The United States is one of the slowest progressing countries with a reduction of 0.4 per cent per year.
“The report indicates that there has been no decline in the rates of stillbirth delivery in Kenya, which is currently estimated at 22/1,000 against an average estimate of 2-3/1,000 in Europe. The majority of stillbirths occur during childbirth when the baby is being born, meaning that despite an increase in access to health care facilities and skilled birth attendants in the country, the quality of care still needs to be greatly improved,” added Professor Temmerman.
Half of all stillbirths occur during labour and birth, usually after a full nine month pregnancy, and the research highlights that most of these 1.3 million deaths could be prevented with improved quality of care. Globally, 98 per cent of all stillbirths occur in low- and middle-income countries. At the current rate of progress, it will be more than 160 years before a pregnant woman in Africa has the same chance of her baby being born alive as a woman in a high-income country today.
However, the problem also remains significant in high-income countries where the number of stillbirths is now often higher than infant deaths. Also underscored by Professor Bhutta were the findings from studies in Pakistan that over half of all stillbirths in Pakistan were during the process of childbirth and eminently preventable.
The series states the annual rate of reduction for stillbirths is 2.0 per cent, much slower than progress made for maternal (3.0 per cent) and child deaths (4.5 per cent). It also reveals the hidden consequences of stillbirth, with more than 4.2 million women living with symptoms of depression, often for years, in addition to economic loss for families and nations.
In every region around the world there are countries that are outperforming their neighbours, for example Rwanda is the fastest progressing country in Africa (annual rate of reduction of 2.9 per cent) demonstrating that most stillbirths are preventable and progress is achievable.
The new research includes the first global analysis of risk factors associated with stillbirth, underlining that many deaths can be prevented by treating infections during pregnancy; tackling the global epidemics of obesity and non-communicable diseases, notably diabetes and hypertension – at least 10 per cent of all stillbirths are linked to each of these conditions; strengthening access to and quality of family planning services – especially for older and very young women, who are at higher risk of stillbirth; and addressing inequalities – women in the most disadvantaged communities face at least double the risk of stillbirth.
The research provides compelling evidence of the preventability of most stillbirths, forming the basis for action from parents, health care professionals, and politicians. It follows the research group’s 2011 series on stillbirths also published in The Lancet.