Nearly all 2.6 million stillbirths worldwide occur in low-, middle-income countries, Lancet series says

Apr 15 2011

Approximately 2.6 million pregnancies worldwide end in stillbirth - most commonly defined as death in the final trimester - each year, "with the poorest nations worst affected," according to a series of articles published Thursday in the Lancet, BBC reports (4/14).

The series, compiled by 69 authors from 50 organizations and 18 countries, explores the "rates and causes of stillbirth globally, explores cost-effective interventions to prevent stillbirths (as well as maternal and neonatal deaths), and sets key actions to halve stillbirth rates by 2020," according to a Lancet press release. The project was funded primarily by the Bill & Melinda Gates Foundation.

One study in the series describes the variations in stillbirth rates between developed and developing nations, which range from 2.0 stillbirths per 1,000 total births in Finland to more than 40 per 1,000 in Nigeria and Pakistan (4/13).

The analysis revealed "that 98 percent of stillbirths in 2009 occurred in low- and middle-income countries, and two-thirds in rural areas where midwives and doctors are often not on hand to offer skilled obstetric care," Reuters reports. According to the study, "[m]any of the deaths - 1.8 million or 66 percent - are concentrated in 10 countries: India, Pakistan, Nigeria, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and Tanzania," the news service adds (Steenhuysen, 4/14).

While the "new estimate[s] sugges[t] that the number of deaths after the 28th week of gestation has declined from about 3.03 million in 1995 to 2.64 million in 2009 … if researchers use 22 weeks as a cutoff, as most high-income countries do, the numbers would be about 45% higher," the Los Angeles Times writes. In most developing countries, many stillbirths go unrecorded, complicating efforts to obtain an accurate assessment of the scope of the issue (Maugh, 4/14).

"Unfortunately, stillbirths don't count in data-collating efforts for the Millennium Development Goals. So this is a kind of first attempt at trying to capture a true picture of the problem," Joy Lawn of Saving Newborn Lives/Save the Children, a lead author of the series, said, according to Livemint.com. "Over time, we expect better numbers and data based on standard numbers to come out," she added (Koshy, 4/14).

Experts Call For Better Surveillance Of, Action To Reduce Stillbirths

"Stillbirths are the last big invisible global health issue," Lawn added, according to Reuters. "There are 2.65 million stillbirths a year - more than malaria and AIDS deaths combined - and yet they are never mentioned in global health data or policy," she said (4/14).

Reducing rates of stillbirth globally have been slow, "falling by about 1.1% a year, … significantly lower than the 2.3% yearly reduction in under-5 mortality and the 2.5% yearly reduction in maternal mortality," the Los Angeles Times reports (Maugh, 4/14). "In developing countries, most stillbirths are caused by delivery complications, maternal infections in pregnancy, fetal growth problems and congenital abnormalities," the Associated Press reports (4/14). Another study in the series examines the risk factors for stillbirth in high-income countries (Flenady et al., 4/14).

Health experts estimate that by "providing better obstetric care, treating conditions like syphilis, high blood pressure and diabetes in mothers, among other strategies … more than one million infants [could be saved] every year," the AP continues (4/14).

The Washington Post describes several other interventions that experts say could help drive down rates of stillbirths in developing countries, such as increased access to Cesarean-section delivery and folic acid supplements prior to conception.

"The WHO estimates that 1.1 million stillbirths and 1.6 million deaths of women and newborns could be prevented if 10 steps to prevent stillbirths were added to five previously proposed ones," according to the newspaper. "The latter include giving antibiotics after premature rupture of membranes and steroids to women in early labor to speed development of the fetal lungs. According to WHO calculations, that would add $2.32 to the cost of a pregnant woman's care in the 68 countries where nearly all those deaths occur," the Washington Post writes (Brown, 4/13).

The Lancet series "concludes with a vision for 2020 including a target for all countries with a current stillbirth rate less than 5 per 1,000 to eliminate all preventable stillbirths and for all countries with a rate over 5 to reduce their stillbirth burden by at least 50%," according to the Lancet press release. "We ask every country to develop and implement a plan to improve maternal and neonatal health that includes a reduction in stillbirths, and to count stillbirths in their vital statistics and other health outcome surveillance systems," the authors write, according to the release (4/13).

The Washington Post describes how the some of the funds in the Obama administration's proposed six-year, $63 billion Global Health Initiative (GHI) might be used to reduce the rates of stillbirth (4/13).