Published On: Tue, Jan 19th, 2016

World making barely any progress on preventing stillbirths

Sughra Ramzan waits for a doctor at Muzaffargarh district hospital’s maternity ward in Punjab province, PakistanThe rate of progress on reducing the number of babies stillborn each year will need to double in some countries if agreed international targets are to be achieved, according to research that found most of the estimated 2.6 million stillbirths last year could have been prevented.

In a series of papers on ending preventable stillbirths, published in the Lancet this week, researchers from the London School of Hygiene and Tropical Medicine (LSHTM), found the number of stillbirths had remain unchanged since 2011 and was still unacceptably high. The average stillbirth rate had fallen from 24.7 per 1,000 total births to 18.4 between 2000 and 2015, but was still way above the World Health Assembly (WHA)-endorsed target of 12 or fewer in all countries by 2030.

The drop is equivalent to a 2% annual rate of reduction, slower than progress on avoiding maternal, newborn and child deaths, which recorded yearly rates of reduction over the past 15 years of 3%, 3.1% and 4.5% respectively. Stillbirth is an infant who has died in the womb having survived at least the first 28 weeks of pregnancy. A neonatal deaths is one that occurs in the first 28 days.

Country Stillbirth rate
Pakistan 43.1
Nigeria 42.9
Chad 39.9
Guinea-Bissau 36.7
Niger 36.7
Somalia 35.5
Djibouti 34.6
Central African Republic 34.4
Togo 34.2
Mali 32.5

The authors of Ending Preventable Stillbirths found that most stillbirths could be prevented with improvements to women’s antenatal care, when problems can be more easily detected, and if women are monitored during labour. Researchers said scaling up proven antenatal and delivery care in the 75 worst-affected countries could prevent 823,000 stillbirths, 1.1 million neonatal deaths and 166,000 maternal deaths each year.

Dr Hannah Blencowe, from the LSHTM, said more than 80% of women now attend antenatal classes, but the quality of care they receive is patchy. “We’re not talking hi-tech [care], we’re talking about taking blood pressure, taking urine [samples], making sure sure they don’t have malaria,” she said. “And women need to be closely monitored throughout labour. Unfortunately many women don’t get monitored quickly enough. Half of all stillbirths happen during labour.”

But while more investment in health systems is needed to improve services for pregnant women, Blencowe said just as important is political will. “What we need is leadership on a global level and at national level and among health professionals and communities.

“And we need to listen more to the voices of women, families and communities because more than 7,000 [of them] will experience stillbirth each day, a tragedy for each one.”

Among high and middle-income countries, 94 have met the WHA target, but at least 56 countries will have to double their pace of progress to have any chance of hitting it.

According to the studies, 98% of stillbirths occur in low- and middle-income countries, with 75% in sub-Saharan Africa and Asia. About 60% occur in rural areas, which tend to have fewer health centres and qualified health professionals, and more than half in conflict and humanitarian situations.

Sub-Saharan Africa has the highest stillbirth rates and the slowest rates of progress worldwide. At the rate of progress, it will be more than 160 years before the average woman in Africa has the same chance of her baby being born alive as a woman in a rich country has today, said researchers.

Country Number of stillbirths 2015
India 592,090
Nigeria 313,710
Pakistan 242,560
China 122,340
Ethiopia 96,530
Congo DR 87,780
Bangladesh 83,060
Indonesia 73,440
Tanzania 47,060
Niger 36,220

Eleven of the 20 countries that recorded the highest number of stillbirths in 2015 are in Africa. India had the highest number of stillbirths last year, followed by Nigeria and Pakistan.

Of the 186 countries ranked, Pakistan had the highest rate of stillbirths, with 43.1 per 1,000 births. Nine of the bottom 10 countries were in sub-Saharan Africa. Iceland had the lowest rate of stillbirth, with 1.3 of 1,000 total births. The UK was ranked joint 21st with 2.9.

Since the previous Lancet series on stillbirth in 2011, researchers found that greater attention is now being paid to the problem. But “still, in most countries, implementation of the recommended community actions and health interventions for antenatal and intrapartum [during labour] care is generally low. Hardly any development funding for implementation has been disbursed.”

Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, said the series offered a “wake-up call to governments worldwide to make faster progress in reducing the number of stillbirths, which wreak untold damage on families, care givers and communities”.

He added: “In low- and middle-income countries, most stillbirths could be prevented with straightforward improvements to antenatal care and the care of women and their babies during childbirth, and we support the call for recommendations on preventing stillbirths to be included in every country’s newborn action plan.”

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