Every day, more than 7,000 babies are stillborn, a death just when a parent expects to welcome a new life, and more than 2.6 million lives that will never be lived each year. Yet there are effective interventions that can make inroads into stillbirth mortality – just 10 interventions, with 99 per cent coverage, that would reduce stillbirths by around half in low-income and middle-income countries according to The Lancet at the launch of its Series on Stillbirths.
“Key actions by 2020 can halve this event that devastates parents and families,” says Dr Zulfiqar Bhutta, Founding Chair, Division of Women and Child Health at Aga Khan University and lead authorof Paper 3.
The Series provides the most comprehensive assessment of stillbirths to date, bringing together an international team of 69 authors from more than 50 organisations in 18 countries who have worked for over 2 years on the analysis, primarily funded by the Bill and Melinda Gates Foundation. With six papers and two research articles, it provides a new overview of the problem and offers solutions.
In the first-ever set of nationally reviewed stillbirth estimates undertaken with the World Health Organization, the new data shows that just 10 countries represent two-thirds of all stillbirths. In order from highest to lowest, these are India, Pakistan, Nigeria, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and Tanzania. The top five alone represent half of all stillbirths worldwide. Pakistan has a rate of 47 stillbirths per 1,000 total births compared to Finland at 2 and a global rate of 19 per 1,000.
Worldwide, around two-thirds of stillbirths occur in rural families where skilled birth attendance is at least 50 per cent lower than in urban areas and caesarean section mostly unavailable. But there have been notable successes in stillbirth reduction in many developing countries. Columbia, China, Mexico and Argentina have all reduced their stillbirth rate by 40 per cent to 50 per cent.
Just 10 interventions across the 68 priority countries of the ‘Countdown to 2015’ initiative to track progress on the MDGs for maternal and child health, would reduce stillbirths by around 45 per cent.
From basic emergency obstetric care and insecticide-treated bednets to prevent malaria, to folic acid supplementation and management of diabetes of pregnancy and more, some 1.1 million stillbirths could be averted.
Stillbirth rates can also potentially be brought down by a combination of primary care (outreach) and facility-based interventions in community settings. The role of community health workers in addressing maternal care and promotion of facility-based births is of special relevance to Pakistan as exemplified in a recent publication based on studies with Lady Health Workers in rural Sindh, published earlier in The Lancet.
The vision for 2020 is for all countries with a rate over 5 to reduce their stillbirth burden by at least 50 per cent. “Pakistan needs to develop and implement a plan to improve maternal and neonatal health that includes a reduction in stillbirths, and to count stillbirths in their statistics and other health outcome surveillance systems,” says Dr Bhutta.
The Series culminates in a call for action to the international community, individual countries, professional organisations and families to take a stand for stillbirths. Everyone has a role to play and together stillbirths can and must be counted and reduced.
Rasool Sarang, Assistant Manager Media, Department of Public Affairs, Aga Khan University, Stadium Road, Karachi, on +92 21 3486 3920 or firstname.lastname@example.org