Global stillbirth burden: The time to act is now!

Although some progress has been recorded over the last 15 years by reducing global stillbirth rate to 18.4 stillbirths per 1000 total births in 2015, compared with 24.7 stillbirths in 2000, the number of stillbirths is still very high in many countries.

Recent estimates show that every year 2.6 million stillbirths occur worldwide. There is a wide gap between high-income countries (HIC) and low- and middle-income countries (LMIC); the majority (98%) of stillbirths occur in LMIC. About half of the 2.6 million annual stillbirths occur during labour and delivery, indicating a poor quality of healthcare services in many of the countries with high burden of stillbirth.

According the latest figures, countries with the highest stillbirth rates (per 1000 births), are: Pakistan (43.1), Nigeria (42.9), Chad (39.9), Guinea-Bissau (36.7), Niger (36.7), Somalia (35.5), Djibouti (34.6), Central African Republic (34.4), Togo (34.2) and Mali (32.5).  

The sad news is that stillbirth is not a priority in many countries. It is not captured as part of routine national data. It was not targeted in the Millennium Development Goals, and it is not directly targeted in the newly launched Sustainable Development Goals.

However, in 2014, the World Health Assembly endorsed a target of 12 or fewer stillbirths per 1000 births in every country by 2030. By 2015, some countries (mostly high-income and middle-income) have already met this target, but with noticeable disparities within countries. It has been estimated that at least 56 countries (mostly in Africa and in conflict-affected areas) have made very little progress and will have to at least double their present pace of progress to reach this target.

To help bring stillbirth to the top of global health agenda, The Lancet journal has launched its second series on stillbirth. Last week, at the London School of Hygiene and Tropical Medicine, many experts gathered for the launching, which also created a lot of conventional and social media buzz.

At the event, presentations were made to draw attention to some of the issues around the challenges of stillbirth and how best to approach the problem. In order to achieve the global targets for stillbirth, experts at the event have highlighted some key areas that need to be addressed.

Creating and maintaining global and local leadership is a critical prerequisite for progress. An analysis has shown that global network for stillbirth is not as effective as it should be. Among the 500 most frequently used words in relevant reports from global health organisations, the use of words relating to stillbirth was negligible. The UN and other global groups must take the lead in promoting and advocating investment into the problem of stillbirth.

The Lancet stillbirth series also highlights the need to prioritise better data to inform action towards 2030; challenge stigma, taboo, and fatalism; reduce the effect of stillbirth through social support and socially-acceptable bereavement care; empower women to demand quality healthcare services; implementation of integrated interventions with commensurate investment, and monitor social determinants in a bid to close the gap between rich and poor.

At the Centre for Maternal and Newborn Health, we remain committed to exploring innovative ways to improve the quality of health services delivered particularly in LMIC.

About the Authors:

Dr. Mamuda Aminu is a Researcher Associate at the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine and a Fellow of the Royal Society for Public Health with interests in maternal and newborn health.