By Robin Gomes
In the first-ever joint stillbirth estimates, the UN children’s fund, UNICEF, the World Health Organization (WHO), the United Nations Department of Economic and Social Affairs (DESA) and the World Bank Group say that 84 per cent of stillbirths occur in low- and lower-middle-income countries.
The study entitled, “A Neglected Tragedy: The Global Burden of Stillbirths” analysed 117 countries in 2019, and found that 3 in 4 stillbirths occurred in sub-Saharan Africa or Southern Asia. The greatest number of stillbirths were concentrated in India, followed by Pakistan, Nigeria, the Democratic Republic of the Congo, China and Ethiopia.
The report defines stillbirth as a baby born with no signs of life at 28 weeks of pregnancy or more.
“Losing a child at birth or during pregnancy is a devastating tragedy for a family, one that is often endured quietly, yet all too frequently, around the world,” said Henrietta Fore, UNICEF Executive Director. “Every 16 seconds,” she noted, “a mother somewhere will suffer the unspeakable tragedy of stillbirth... For many of these mothers,” she said, “it simply didn’t have to be this way."
The report warns that the Covid-19 pandemic could exacerbate the global number of stillbirths. A 50 per cent reduction in health services due to the pandemic could cause nearly 200,000 additional stillbirths over a 12-month period in 117 low- and middle-income countries. This corresponds to an increase in the number of stillbirths by 11.1 per cent.
According to modeling done for the report by researchers from the Johns Hopkins Bloomberg School of Public Health, 13 countries could see a 20 per cent increase or more in the number of stillbirths over a 12-month period.
A separate study on data collected across 9 hospitals in Nepal reported in The Lancet Global Health in August showed that before the lockdown in late March there were 14 stillbirths per 1,000 births. This rose to 21 per 1,000 births by the end of May. The sharpest rise was observed during the first four weeks of the lockdown, when people were allowed to leave their homes only to buy food and receive essential care.
The study says that over 40 per cent of stillbirths occur during labour - a loss that could be prevented with access to a trained health worker at childbirth and timely emergency obstetric care.
Fore agreed, saying, “A majority of stillbirths could have been prevented with high quality monitoring, proper antenatal care and a skilled birth attendant.” According to WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, “the tragedy of stillbirth shows how vital it is to reinforce and maintain essential health services, and how critical it is to increase investment in nurses and midwives.”
The study says around half of stillbirths in sub-Saharan Africa and Central and Southern Asia occur during labour, compared to 6 per cent in Europe, Northern America, Australia and New Zealand.
Even before the pandemic caused critical disruptions in health services, few women in low- and middle-income countries received timely and high-quality care to prevent stillbirths.
Poor, minorities, but also the rich
The report, however, notes that stillbirth is not just limited to poor nations. In 2019, 39 high-income countries had a higher number of stillbirths than neonatal deaths and 15 countries had a higher number of stillbirths than infant deaths.
In both low- and high-income settings, stillbirth rates are higher in rural areas than in urban areas. Socioeconomic status is also linked to greater incidence of stillbirth. For example, in Nepal, women from lower castes had stillbirth rates between 40 to 60 per cent higher than women from upper castes.
The study notes that ethnic minorities in high-income countries, in particular, may lack access to enough quality health care. Inuit populations in Canada, for example, have been found with nearly three times higher stillbirth rates than the rest of Canada. Likewise, African American women in the United States have nearly twice the risk of stillbirth compared to white women. (Source: UN)