Stillbirth is a global issue that impacts millions of women and families around the world each year. Sadly, it is also a burden that falls heaviest on the poorest families. An estimated 98 percent of stillbirths occur in low- and middle-income countries. Stillbirth rates in low-income countries are now where they were in high income countries over 100 years ago. The Lancet Stillbirth Series, released to much attention today, builds on recent, extensive reviews and provides the most comprehensive assessment to date of global numbers and causes of stillbirths, perceptions and beliefs around the world, and the solutions to prevent stillbirths.
The Lancet Stillbirth series is a remarkable multi-author, cross-organization effort consisting of six papers, two articles, and eight linked commentaries and demonstrates how stillbirths have been neglected by the global public health community. But it also shows us what happens when stillbirth prevention is incorporated into existing health care for mothers and babies, with examples of success and missed opportunities especially for the poorest families.
Fortunately, a great deal of progress can be made to prevent stillbirths if we invest in strengthening existing family health programs.
A strong case has been made for the benefits for mothers and newborns in this series. The authors identify 15 proven interventions that, if implemented, could avert the deaths of more than 2.7 million mothers and newborns, as well as stillbirths, each year by 2015.
In other words, to make progress, we do not need to create new interventions specific to stillbirth, or new health system elements. What is needed is a change in the way we think about stillbirth as separate from maternal, newborn and child health. In fact, the health and well-being of mothers and babies, and stillbirths, are integrally linked and should be counted and managed as such.
The Stillbirth Series also emphasizes how important it is that women receive safe and effective care during childbirth. When a woman is in labor, there is a critical and narrow window for action. This is when nearly half of stillbirths, three-fourths of maternal deaths, and one-quarter of newborn deaths occur. If women had access to quality care during childbirth, at a cost of less than $1 per person, we could prevent the deaths of 1.4 million mothers and newborns, and stillbirths, each year.
Antenatal care, also known as prenatal care, is shown to have a moderate effect on stillbirths, but is very feasible and low-cost. For example, identifying and treating all pregnant women with syphilis would prevent about 136,000 stillbirths a year – many more than even the newborn lives saved through this intervention. Yet this tremendous benefit, of treating syphilis in pregnancy, is often not counted. In African countries almost three quarters of women receive prenatal care, yet many are not screened or treated for syphilis. It’s a missed opportunity.
Prenatal care has the potential to play a larger role in reducing the number of stillbirths in ways that current modeling does not capture. For example, prenatal care has the potential to be tied to the uptake of other health-promoting behaviors and increase the chances that, for example, a woman will come back to a facility to give birth.
Family planning is also highlighted in this series as playing an important role in reducing maternal and neonatal deaths as well as stillbirths.
To improve women’s and children’s health, we need to take advantage of every interaction that families have with health providers. We, as a medical and public health community, are learning more about how to effectively empower and enable families to take charge of their health, use preventive practices and seek care for complications. At the same time, the broader health system must support frontline workers so they stay connected and provide timely and effective care to families.
We can make a difference in stillbirths alongside women’s and children’s health by integrating health care for women and babies and making existing family health programs stronger. New research is also needed to develop innovations in science and technology, social and behavioral change and business models for delivery of solutions at scale.
The Lancet Stillbirth Series provides a lighted path forward. By focusing on strengthening family health programs to include stillbirth prevention, We can take further steps towards highlighting an all too often neglected health issue and prevent millions of stillbirths the world over.