Lack of Progress in Reducing Stillbirths Worldwide Continues

Researchers call for change by 2020

RESEARCH TRIANGLE PARK, N.C.—Millions of stillbirths occur each year, but they go unaccounted and are not reflected in the world's global health policy efforts, according to a series of new articles, two of which were coauthored by researchers at RTI International.

The series, published in the April 14 issue of The Lancet, 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—well-known interventions as well as innovations.

The series includes six papers, eight commentaries and two supplemental research papers involving 69 authors across 18 countries.

The first paper, coauthored by RTI epidemiologist Elizabeth McClure, presents a large global-scale survey of health care providers and parents in 134 countries, highlighting the lack of recognition and stigmatization surrounding stillbirth that has held back progress in reducing the number of these deaths.

"United Nations agencies and current global health reports generally don't mention stillbirths," McClure said. "Knowledge of stillbirth numbers and causes as well as feasible solutions is key to designing effective policies and programs."

Results from this survey found that most stillborn babies are disposed of without recognition or rituals, such as naming, funeral rites, or the mother holding or dressing the baby. About one-third of stillbirths are attributed to evil spirits or the mother's sins. There is general misunderstanding of the causes of stillbirth and lack of support for families experiencing one.

"Efforts are needed to overcome this fatalism, lessen the stigma associated with stillbirth, and provide bereavement support," McClure said. "Stigma and blame add to and prolong parents' grief. The silence surrounding stillbirths, compared with public clamor over AIDS deaths, hides the problem and impedes investment."

According to new estimates from Cousens et al., every day more than 7,300 babies are stillborn.

The sixth paper in The Lancet series, also coauthored by McClure, calls all countries to reduce the stillbirth rate to 5 per 1,000 births by 2020 and, in high-income countries, to eliminate all preventable stillbirths by the same year.

"Achieving a substantial reduction in stillbirths worldwide requires concerted and coordinated action by national and local governments and international organizations."

According to the research, more than 40 high-income countries and several middle-income countries have already achieved a stillbirth rate of less than 5 per 1,000 births. For example, China has halved stillbirth rates in the past 15 years, and the national rate is now close to 5 per 1,000. In the United States, the stillbirth rate is estimated to be 3.8 per 1,000 births.

"The international community, individual countries, professional organizations and families must take a stand to prevent stillbirths," McClure said. "Everyone has a role to play and together stillbirths can and must be counted and reduced."