Summary
Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible—not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed. A simple, programme-relevant stillbirth classification that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment.
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Published: April 14, 2011
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- Stillbirths: breaking the silence of a hidden grief
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A baby is born dead. A mother, who has waited many months to hold the child she has felt growing and taking form inside her, cradles a lifeless body. A father, who has been anticipating the joy of the birth and a future for his child, is faced with death. The extraordinary journey that they have all been on together through months of pregnancy comes to a shattering and heartbreaking end.
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- Bringing stillbirths out of the shadows
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The grief of a stillbirth is unlike any other form of grief: the months of excitement and expectation, planning, eager questions, and the drama of labour—all magnifying the devastating incomprehension of giving birth to a baby bearing no signs of life. Thankfully such events are rare. Or are they? As the Series we launch today shows, almost 3 million stillbirths happen worldwide every year,1 which, even for a country with a developed health system such as the UK, means that 11 sets of parents every day will take home their newborn baby in a coffin.
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- Stillbirths: the professional organisations' perspective
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The International Federation of Gynecology and Obstetrics (FIGO), the International Paediatric Association (IPA), and the International Confederation of Midwives (ICM) are well aware of the often forgotten issue of stillbirth, and recognise it as one of the most common adverse pregnancy outcomes worldwide—with about 2·6 million or more stillbirths happening every year.1 The explanation for many of these deaths is straightforward and terrible: all too often a trained health worker is not available when an expectant mother or woman in labour faces a situation endangering her baby's life.
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- Stillbirths: missing from the family and from family health
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Stillbirth is a devastating occurrence for families, and women bear the brunt of the consequences.1,2 Hopes and dreams are dashed, and expectant women might suddenly face scorn, isolation, and rejection. They can be pressured to become pregnant again soon, and hence face a shortened birth interval and an increased risk for themselves and for subsequent pregnancies. This cycle continues—unbroken and unvoiced—every day in homes and communities around the world, especially in poor families.
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- Addressing the complexity of disparities in stillbirths
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Although stillbirth is an issue in low-income countries because of many factors associated with poverty, such as access to basic obstetric care, it is also a public health priority in high-income countries. In the USA, the stillbirth rate is 6·2 per 1000 deliveries at 20 weeks' gestation or greater, affecting 25 894 fetuses in 2005;1 a number similar to the 28 384 infant deaths in 2005.2 A substantial component of the public health burden in high-income countries is disparity according to race and ethnic origin.
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- Counting stillbirths: women's health and reproductive rights
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Most of the world's 2·6 million stillbirths occur every year in low-income and middle-income countries. One of the most devastating myths that surrounds stillbirth is that women who are accustomed to high infant mortality and high rates of stillbirth somehow feel the individual loss of a wanted pregnancy less than women living in high-income countries.1,2 Women who have a stillbirth not only feel the loss of the pregnancy, but they also often bear an additional, if unwarranted, sense of responsibility or shame and, at times, blame from their husbands.
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