African woman 24 times more likely to have stillbirth than others – report

By James Ratemo

Despite advances in medical and health technology about 2.6 million third trimester stillbirths worldwide occur every year with Africa being the worst hit, reveals a new report.

This means, globally, every day more than 7,300 babies are stillborn.

The World Health Organisation-endorsed report is the first comprehensive set of stillbirth estimates published today in a special series in the medical journal The Lancet. "An African woman has a 24 times higher chance of having a stillbirth at the time of delivery than a woman in a high-income country," says Vicki Flenady, a perinatal epidemiologist and author of the paper on stillbirths in high-income countries for The Lancet’s Stillbirths Series.

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.

These estimates will be included, for the first time, in WHO’s World Health Statistics report for 2011. "Stillbirths often go unrecorded, and are not seen as a major public health problem," says Dr Flavia Bustreo, Assistant Director-General for Family and Community Health at the World Health Organisation.

"Yet, stillbirth is a heartbreaking loss for women and families. We need to acknowledge these losses and do everything we can to prevent them."

Skilled care

Almost half of stillbirths, 1.2 million, happen when the woman is in labour. These deaths are directly related to the lack of skilled care at this critical time for mothers and babies.

If all causes of stillbirth are taken together, the new estimates would place stillbirths fifth on the list of causes of deaths worldwide, according to The Lancet series, authored by 69 experts from more than 50 organisations in 18 countries. "Almost no burden affecting families is so big and yet so invisible both in society and on the global public health agenda," says Dr Joy, a lead author of The Lancet series who coordinated the new estimates, emphasizes. The number of stillbirths can be slashed, say most experts. "Stillbirths need to be an integral part of the maternal, newborn and child health agenda," says Dr Carole Presern, Director of The Partnership for Maternal, Newborn & Child Health (PMNCH) and a midwife. "We do know how to prevent most of them."

According to the report, the five main causes of stillbirths are childbirth complications, maternal infections in pregnancy, maternal disorders (especially pre-eclampsia and diabetes), foetal growth restriction and congenital abnormalities.

As expected, 98 per cent of stillbirths occur in low and middle-income countries. Wealthier nations though are not immune with one in 200 pregnancies resulting in a stillbirth, a rate that has stagnated in the last decade.

The number of stillbirths worldwide has declined by only 1.1 per cent per year, from three million per year in 1995 to 2.6 million in 2009. This is slower than reductions for child and maternal mortality.

Besides lacking visibility, stillbirths issues lack leadership both locally and internationally.

According to The Lancet’series, as many as 1.1 million stillbirths could be averted with universal coverage of comprehensive emergency obstetric care, syphilis detection and treatment, detection and management of foetal growth restriction detection and management of hypertension during pregnancy.

Other interventions include identification and induction for mothers with 41 weeks gestation, malaria prevention, including bednets and drugs, folic acid fortification before conception and detection and management of diabetes in pregnancy.

Women who experience stillbirth suffer the most because of the stigma attached to it and their perceived failure as a mother. Often they suffer depression, anxiety, and post-traumatic stress. "By shining a spotlight on the tragic toll of stillbirths, we can prevent stigma, and improve the health of every woman and every newborn," says Purnima Mane, Deputy Executive Director of United Nations Population Fund.