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Centre for Global Child Health

SickKids joins global experts in call for stillbirth prevention in new Lancet research series

Maternal and child deaths have halved while stillbirth remains a neglected global epidemic. More than 2.6 million stillbirths continue to occur globally every year with very slow progress made to tackle this ‘silent problem’, according to new research published in The Lancet. 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. 

The Lancet’s Ending Preventable Stillbirth Series was developed by 216 experts, including Dr. Zulfiqar A. Bhutta from the Centre for Global Child Health at The Hospital for Sick Children (SickKids), from more than 100 organizations in 43 countries. The series comprises five papers. 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. 

“Despite growing knowledge and advocacy over many years, stillbirths, especially those that occur during the process of childbirth, remain a huge global challenge, and an unrecognized public health issue. These papers highlight the huge burden of morbidity and grief associated with stillbirths and also provides a template of solutions that can end this preventable tragedy within our lifetime”, said Bhutta. 

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% 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. 

The Ending Preventable Stillbirth research series states the annual rate of reduction for stillbirths is 2.0%, much slower than progress made for maternal (3.0%) and child deaths (4.5%). 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. 

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). 

The new research includes the first global analysis of risk factors associated with stillbirth [6], underlining that many deaths can be prevented by: 

  • Treating infections during pregnancy – 8.0% of all stillbirths are attributable to malaria, increasing to 20.0% in sub-Saharan Africa, and 7.7% of all stillbirths are associated with syphilis, increasing to 11.2% in sub-Saharan Africa.
  •  Tackling the global epidemics of obesity and non-communicable diseases, notably diabetes and hypertension – at least 10% 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. 
  • Addressing inequalities – in high-income countries, women in the most disadvantaged communities face at least double the risk of stillbirth. 

The research also highlights the underappreciated psychological, social and economic impacts of stillbirth on parents, families, caregivers, and countries. New estimates suggest at least 4.2 million women around the world are living with symptoms of depression due to stillbirth, suffering psychological distress, stigma and social isolation, as well as increased risk of family breakdown, and even abuse and violence. All papers from the 2016 Lancet Stillbirth Series can be read here.