"Breaking the Silence on Stillbirths: The Urgent Need for Action" - One stillbirth occurs every 16 seconds

"A Neglected Tragedy: The Global Burden of Stillbirths" is a report by the UN Inter-agency Group for Child Mortality Estimation that highlights the urgent need to address the global burden of stillbirths. The report states that stillbirths are not only a devastating personal tragedy for families but also a significant public health issue, with more than two million stillbirths occurring annually, which is approximately one stillbirth every 16 seconds. The report also highlights that stillbirths are not evenly distributed globally, with the majority occurring in low- and middle-income countries, where access to quality healthcare is limited.

Defining Still Birth

A stillbirth is defined as a baby born with no signs of life after a given threshold, usually related to the gestational age or weight of the baby. For international comparison, UN IGME stillbirth estimates refer to “late gestation fetal deaths” as deaths occurring at or after 28 weeks of gestation, which ism in-line with the International Classification of Diseases.

Key facts and figures about stillbirths:

• More than 2 million stillbirths occur globally each year.
• Approximately 7,200 stillbirths occur every day.
• Stillbirths occur at a rate of 13.9 per 1,000 births globally.
• Most stillbirths occur in low- and middle-income countries, with over 75% of stillbirths occurring in sub-Saharan Africa and South Asia.
• Highest stillbirth rate across countries is 23 times higher than Lowest stillbirth rate across countries.
• About half of all stillbirths occur in 6 countries – India, Democratic Republic of the Congo, Pakistan, China, Nigeria, and Ethiopia
• Over 40 per cent of stillbirths worldwide occurred during labour.

The report identifies several factors that contribute to stillbirths, including:

• Poor maternal health: The health of the mother plays a critical role in the development of the fetus. Pre-existing medical conditions such as diabetes, hypertension, and obesity, as well as poor nutrition, can increase the risk of stillbirth.
• Inadequate antenatal care: Women who do not receive adequate antenatal care during pregnancy are at higher risk of stillbirth. This can be due to missed opportunities for identifying and managing complications during pregnancy.
• Complications during childbirth: Complications during labor and delivery, such as prolonged labor, obstructed labor, and fetal distress, can increase the risk of stillbirth
• Infections: Infections during pregnancy, such as syphilis, malaria, or toxoplasmosis, can increase the risk of stillbirth.
• Environmental factors: Exposure to environmental factors, such as air pollution, can increase the risk of stillbirth.

SLOW PROGRESS IN PREVENTING STILLBIRTHS

• Despite efforts to improve maternal and newborn health globally, progress in preventing stillbirths has been slow. According to the report, the global stillbirth rate decreased only slightly from 18.4 stillbirths per 1,000 births in 2000 to 13.9 stillbirths per 1,000 births in 2019.
• Moreover, stillbirths continue to occur disproportionately in low- and middle-income countries, where access to quality obstetric care is often limited. In 2019, over 98% of stillbirths occurred in these countries, with sub-Saharan Africa and South Asia accounting for the highest burden.

Poorer gains than in maternal or under-five mortality rates

Unfortunately, progress in reducing stillbirths has been slower compared to maternal or under-five mortality rates. While the maternal mortality ratio and under-five mortality rate have declined significantly in recent decades, the stillbirth rate has remained relatively unchanged.

According to the report, the stillbirth rate decreased from 18.4 stillbirths per 1,000 births in 2000 to 13.9 stillbirths per 1,000 births in 2019. In comparison, the maternal mortality ratio decreased by 38% during the same period, and the under-five mortality rate decreased by 47%.

India’s Position

• India has a high burden of stillbirths, accounting for the largest absolute number of stillbirths globally. According to the report, India had an estimated 470,000 stillbirths in 2019, representing over one-quarter of the global burden
• The stillbirth rate in India was 14.3 stillbirths per 1,000 births in 2019, which is higher than the global average of 13.9 stillbirths per 1,000 births.
• The stillbirth rate in India has decreased slightly from 23.1 stillbirths per 1,000 births in 2000, but progress has been slow compared to other maternal and child health indicators.
• Stillbirths in India are largely preventable with appropriate interventions, including improving access to quality obstetric care and addressing social and environmental determinants of health that contribute to stillbirths.
• GoI has implemented various initiatives to address stillbirths, such as increasing access to antenatal care and skilled birth attendants, promoting institutional deliveries, and improving the quality of care in health facilities.

THE WAY FORWARD: ESSENTIAL ACTIONS AND RECOMMENDATIONS

Here are some essential actions and recommendations:

1. Improve access to quality obstetric care: Strengthen health systems to provide quality antenatal, intrapartum, and postnatal care. Increase the number of skilled birth attendants and improve their training and competency.
2. Address social and environmental determinants of health: Address the underlying social and environmental factors that contribute to stillbirths, such as poverty, malnutrition, inadequate water and sanitation, and exposure to pollution
3. Improve data collection and analysis: Develop and implement robust systems for data collection, analysis, and reporting on stillbirths and neonatal deaths. Use data to inform policies, programs, and investments.
4. Increase awareness and advocacy: Increase awareness of the issue of stillbirths and neonatal deaths, and advocate for increased political commitment and funding for stillbirth prevention and carePromote research and innovation: Promote research and innovation to improve understanding of the causes and risk factors of stillbirths and neonatal deaths, and develop and test new interventions and approaches.

By implementing these essential actions and recommendations, we can accelerate progress in reducing the burden of stillbirths and preventable neonatal deaths and move closer to achieving the vision of "The Future We Want."

You can view the detail report - https://www.who.int/publications/m/item/a-neglected-tragedy-the-global-burden-of-stillbirths

Source - United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), ‘A Neglected Tragedy: The global burden of stillbirths’, United Nations Children’s Fund, New York, 2020.