Sexual and reproductive health

The neglected tragedy of stillbirths

What is especially tragic about stillbirths is that they are largely preventable. We know key interventions such as syphilis treatment in pregnancy, fetal heart rate monitoring and labour surveillance have the potential to save around 1.5 million lives. The challenge is to deliver these within an integrated care package that extends from pre-pregnancy through delivery.

Ian Askew, Director, Reproductive Health and Research

Absent from the Millennium Development Goals and still missing in the Sustainable Development Goals, stillbirths remain a neglected issue, invisible in policies and programmes, underfinanced and in urgent need of attention.

Worldwide in 2015, for every 1000 total births, 18.4 babies were stillborn, mostly in low- and middle-income countries. Progress in reducing this rate has been slow and at present speed, 160 years will pass before a pregnant woman in Africa has the same chance of her baby being born alive as a woman in a high-income country today. Even in high-income countries rates vary from 1.3 to 8 per 1000 births, a variation that shows further improvements are possible.

Health care worker listening to heart sounds during a pregnancy consultation.
UNICEF/Michele Sibiloni

The perception that many stillbirths are unavoidable due to congenital abnormalities is commonplace but untrue with only 7.4% of stillbirths after 28 weeks being reported as such. Half of stillbirths occur during labour, mostly to infants delivered at term and who would have been expected to survive, wherein lies the greatest tragedy.

Cost to society

In addition to the grief, and often the stigma, attached to a stillbirth, there are other costs to parent(s), families and society. These costs are both direct – a stillbirth costs 10-70% more than a live birth with funeral costs generally being passed on to parent(s) and lost income from time taken off work; and indirect due to greatly reduced work productivity.

What needs to be done – integrated quality care.

The prevention and responsive care of stillbirths cannot be a stand-alone issue but needs to be part of an integrated approach that runs across the continuum of planning and preconception care; quality care during pregnancy skilled support during the birth and respectful and supportive care in the event of a death.

In addition, some evidence-based interventions have their greatest effect on stillbirths such as syphilis treatment in pregnancy which could prevent more than 200 000 stillbirths or fetal heart rate monitoring and labour surveillance, crucial for preventing 1.3 million intrapartum stillbirths and reducing neonatal deaths.

The Lancet Series

The Ending Preventable Stillbirth series was developed by over 200 experts including staff from WHO and HRP and published by The Lancet. It provides compelling evidence for action from parents, health care professionals and policy-makers. The series is comprised of the following papers: