In 2015, about 2.6 million babies died worldwide during the final three months of pregnancy, of which 98 per cent were in low- and middle-income nations and 75 per cent in Sub-Saharan Africa and South Asia, says a series of articles published in medical journal The Lancet last week (18 January). The stillbirth rate per 1,000 births has fallen from 24.7 in 2000 to 18.4 in 2015, the series reveals.
The highest rate was recorded in Pakistan, with an estimated 43.1 stillbirths per thousand newborns in 2015, a drop from 53.3 in 2000.
One paper in the series singles out Bangladesh, Cambodia and Rwanda as countries showing signs of progress. Rwanda has, for example, increased its focus on antenatal care visits and the presence of skilled birth attendants during delivery. This has helped cut its stillbirth rate from 27.1 per thousand in 2000 to 17.3 in 2015.
Coauthor Hannah Blencowe, an epidemiologist at the London School of Hygiene & Tropical Medicine in the United Kingdom, says other countries can learn from this, since many underlying causes of stillbirths are similar in different settings.
Most of these deaths are indeed preventable, say the series’ authors. For example, weighing the mother to gauge her and her baby’s health, and listening to the baby’s heartbeat are useful, low-tech measures to spot problems and help prevent stillbirths, Blencowe says. Keeping accurate records of stillbirths and investigating what causes them is also important to improve care, she says.
More than 50 developing countries, mainly in Africa, will need to at least double the rates at which they are reducing stillbirths to meet a global target of 12 or fewer deaths per 1,000 live births by 2030, as part of the UN-backed Sustainable Development Goals (SDGs).
Blencowe says stillbirths may sometimes be neglected in favour of other health concerns, but adds that monitoring them helps to keep track of women’s health more widely, because some stillbirths are caused by infections and non-communicable diseases. “It’s a marker of the underlying health of your nation,” she says. Omrana Pasha, a health scientist at the Aga Khan University in Pakistan, says the country has the resources to make improvements, but would need to enhance coordination between the central government and the provinces’ healthcare provision, and increase oversight of private healthcare.
Meanwhile, Jeffrey Perlman, a neonatologist at Weill Cornell Medical College in the United States who also works as a consultant to Tanzania’s health ministry, says developing countries are unlikely to have the resources needed to meet the SDG target without clear government focus.
“Unless there is a concerted push driven by an individual low-resource country with targeted international financial assistance, I think countries will be spinning their wheels,” he says.