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News 2009
Aga Khan University Co-Authors Ground-Breaking Research in
Stillbirths with Johns Hopkins Bloomberg School of Public Health,
Save the Children
First-Ever global review examines measures to prevent over 3.2 million stillbirths globally

May 7, 2009

Every year 3.2 million stillbirths occur around the world; 98 percent take place in low- to middle-income countries. Stillbirths are still underreported and largely absent from data records and national policy making. The global burden of intrapartum stillbirths - stillbirths that take place during labour - is around 1 million, again mostly in low- and middle-income countries, which is more than all child deaths from malaria worldwide. Despite this, the investment and attention given to tackling stillbirths is low.

“In low-income countries the numbers are overwhelming at around 9,000 a day with 3,000 a day occurring during birth – yet behind each death families suffer the pain of loss, often compounded with guilt, but societal taboos keep this grief hidden. Studies show that even 20 years after experiencing a stillbirth women, have unresolved grief,” said Dr. Joy Lawn of Save the Children's Saving Newborn Lives programme.

A first-ever global review of potential interventions to avert stillbirths, especially in low-income countries, was published on-line at the open access journal BMC Pregnancy and Childbirth today, and is available at the following website Stillbirths – the global picture and evidence-based solutions. Lead investigators from the Aga Khan University (Karachi, Pakistan), and colleagues from Johns Hopkins Bloomberg School of Public Health (Baltimore, USA) and the global organisation Save the Children reviewed evidence for the impact of these interventions and strategies for delivering them.

This collaborative research initiative was led by Professor Zulfiqar A. Bhutta, Head, Division of Maternal and Child Health with Dr. Yawar Yakoob at Aga Khan University, Drs. Gary L. Darmstadt and Rachel A. Haws from Johns Hopkins Bloomberg School of Public Health and Dr. Joy E. Lawn of Save the Children's Saving Newborn Lives programme.

“We chose to study the greatly neglected area of interventions to address stillbirths globally, with a special emphasis on developing countries. We suspected, and our review confirms, that few research groups have focused on addressing the burden of stillbirths through evidence based interventions. Our systematic review provides the platform on which to build recommendations for research and policy,” said Professor Zulfiqar A. Bhutta, Head, Division of Maternal and Child Health, Aga Khan University.

The release of the study coincides with the opening of an International Conference on Prematurity and Stillbirth. This event is bringing together global leaders in science, public health and policy to examine the neglected but enormous issues of prematurity and stillbirth. One of the conference goals is to develop a coordinated strategy for successfully preventing these devastating pregnancy outcomes, both of which are major concerns in low- middle- and high-income countries. The conference is being co-convened by the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), the Bill & Melinda Gates Foundation, March of Dimes, PATH, Save the Children, UNICEF, and the World Health Organization.

The BioMed Central supplement, Stillbirths – the global picture and evidence-based solutions, has been funded by Save the Children's Saving Newborn Lives programme through a grant from the Bill & Melinda Gates Foundation, and consists of six papers. BioMed Central is a leader in the new field of open access publishing, offering free on-line access to medical advances.

Paper 1 addresses the global burden, the epidemiology, risk factors and the causes of stillbirths and lays down the methodology and framework for this worldwide review. Papers 2 and 3 cover the behavioural and medical interventions used before and during pregnancy, which include interventions targeted at medical conditions and infections in the mother. Paper 4 focuses on screening and monitoring interventions during pregnancy and labour, including ultrasound and Doppler studies, managing maternal diabetes, and partographs and cardiotocography, among others. Paper 5 deals with the evidence of interventions during labour, while Paper 6 examines health system solutions, including training health workers in facilities and also at community level to improve care during pregnancy and childbirth.

This collaborative analysis is a crucial foundation to strengthen the knowledge and efforts to prevent this enormous health burden, and emphasises the need for stillbirth data to be included in global data tracking systems and policy dialogue.

"We found compelling evidence for impact of several interventions on preventing stillbirths, especially emergency obstetric care, screening and treatment for maternal infections such as syphilis, and prevention and treatment of malaria. Key data gaps remain, however, the largest remaining gap is for more widespread recognition and political commitment to reduce this massive loss of life," said Dr. Gary Darmstadt, former Director of the International Center for Advancing Neonatal Health in the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA, now Interim Director, Integrated Health Solutions Development and Team Lead, Maternal, Neonatal and Child Health, Global Health Program, Bill & Melinda Gates Foundation.

The full set of papers can be accessed at: Stillbirths – the global picture and evidence-based solutions

Commentary: Reducing the world's stillbirths
Article available at: http://www.biomedcentral.com/1471-2393/9/S1/S1

Paper 1: 3.2 million stillbirths: epidemiology and overview of the evidence review
Article available at: http://www.biomedcentral.com/1471-2393/9/S1/S2

Paper 2: Reducing stillbirths: behavioural and nutritional interventions before and during pregnancy
Article available at: http://www.biomedcentral.com/1471-2393/9/S1/S3

Paper 3: Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy
Article available at: http://www.biomedcentral.com/1471-2393/9/S1/S4

Paper 4: Reducing stillbirths: screening and monitoring during pregnancy and labour
Article available at: http://www.biomedcentral.com/1471-2393/9/S1/S5

Paper 5: Reducing stillbirths: interventions during labour
Article available at: http://www.biomedcentral.com/1471-2393/9/S1/S6

Paper 6: Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand
Article available at: http://www.biomedcentral.com/1471-2393/9/S1/S7