Addressing stillbirths
A million stillbirths a year could be prevented around the world if mothers had received proper care during pregnancy and birth.
Health authorities and governments have paid little attention to addressing stillbirths, according to The Lancet medical journal, which published a special series on stillbirths earlier this month.

‘Every day more than 7200 babies are stillborn - a death just when parents expect to welcome a new life - and 98% of them occur in low- and middle-income countries,’ according to The Lancet.

‘Almost half of all stillbirths happen when the woman is in labour, and are directly related to the lack of skilled care at this critical time for mothers and babies,’ according to the World Health Organisation (WHO), which initiated the stillbirth research.

A stillbirth is the death of a viable foetus from 28 weeks and weighing at least 1kg.

‘Two-thirds of stillbirths happen in rural areas, where skilled birth attendants - in particular midwives and physicians - are not always available for essential care during childbirth and for obstetric emergencies, including caesarean sections,’ says the WHO.

Pakistan has the worst stillbirth rate (47 per 1000 births), followed by Nigeria and Bangladesh. The safest place to give birth is Finland (2 per 1000), followed closely by Singapore, Denmark and Norway.

Two thirds of all stillbirths some from just 10 countries: India, Pakistan, Nigeria, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and Tanzania.

‘The most effective way to reduce mortality is to strengthen the health system, starting with skilled care at birth and emergency obstetric care,’ argues The Lancet.

Emergency care alone could save almost 700 000 babies, while treating mothers for syphilis could save almost 140 000 babies.

The Lancet estimates show that the number of stillbirths has only declined by 1.1% per year between 1995 and 2009. The main causes of stillbirth are complications during birth, maternal infections in pregnancy including malaria and maternal disorders especially hypertension and diabetes. Problems with the growth of the foetus and congenital abnormalities also play a role.

‘Many stillbirths are invisible because they go unrecorded, and are not seen as a major public health problem. Yet, it is a heartbreaking loss for women and families. We need to acknowledge these losses and do everything we can to prevent them. Stillbirths need to be part of the maternal, newborn and child health agenda,’ says the WHO’s Dr Flavia Bustreo.

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