Originally posted on the Impatient Optimists (Bill & Melinda Gates Foundation) by Mariam Claeson, Jerker Liljestrand and Janna Patterson.
©Melinda Gates Foundation/Frederic Courbet
As we begin a new year, we must recommit ourselves to preventing and responding to a tragedy that receives far too little attention. Despite tremendous advances in other health outcomes, the number of annual stillbirths remains unchanged and unacceptably high. In 2015 alone, there were 2.6 million stillbirths worldwide.
Fortunately, despite the widespread misconception that many of the 7,300 stillbirths that occur each day are inevitable, new research published in The Lancet proves that most of these deaths are preventable through quality care during labor and childbirth, especially when prevention efforts are integrated into the continuum of care for women and children. Efforts to prevent maternal and newborn deaths also prevent stillbirths and improve child development outcomes, resulting in a quadruple return on investment.
For too long, the stigma and taboo associated with stillbirths have obscured the psychological, social, and economic impacts of stillbirth on parents, families, and caregivers. At least 4.2 million women around the world are living with symptoms of depression due to stillbirth, adding to the huge burden of death and disability around childbirth – for families, communities, and society at large. We need to raise, amplify, and listen to the voices of communities, affected parents, and especially women.
Counting and taking action to end preventable stillbirths has been held back due to a lack of accurate records of stillbirths, and a wholly inadequate response in terms of investments in MNCH programs, especially quality of care. Accurate counting is essential as many deaths classified as stillbirth are actually preterm newborns that were not resuscitated. The fact that the number of deaths around birth (intrapartum and first day) double when you add stillbirths to maternal and newborn deaths is of significant programmatic implication, especially since so many of those stillbirths happen after a pregnant women has entered a health facility. No pregnant woman should enter a health facility to deliver and leave with a stillborn baby that is caused by delay or neglect by health care providers. In fact, we think that the monitoring of stillbirths is one of the best indicators we have of quality of services.
To save lives and help families – and countries – avoid the underappreciated costs of preventable stillbirths, we must bend the curve through five priority actions: First, we need intentional leadership especially of policymakers at the local, national and international level that supports mothers and their newborns and makes investment in the high impact interventions that help prevent stillbirths, newborn deaths, and maternal deaths.
Second, we need to keep the focus on the unfinished agenda of women and children and ensure investment in implementing integrated approaches and interventions for pregnant mothers and their newborns – specifically targeting stillbirths as part of the continuum of care. Program managers, professional associations and practitioners, all have a key role to play. Third, we must lift up and listen to the voices of mothers who have suffered the tragedy of stillbirth and newborn deaths and support affected mothers, fathers, and other family members with their grieving. Fourth, we need to establish metrics and monitor metrics that count every birth, provide a baseline, and serve to measure our progress and the quality and success of interventions during the months and years ahead. Most importantly, we need to start measuring the coverage of high impact interventions for pregnant women and their babies, and monitor quality of care during the antenatal period, intrapartum, and postpartum.
Fifth, we need to focus our implementation research on barriers to scaling up proven interventions for the prevention of stillbirths, newborn, and maternal deaths.
We must unite our efforts to ensure that no more preventable lives are lost giving birth. By making sure all women are receiving good quality care during pregnancy and childbirth over the next 15 years in the 75 countries with the worst stillbirth rates, we could prevent 823,000 stillbirths, 1,145,000 newborn deaths, and 166,000 deaths of pregnant women each year.
Together, we can end preventable stillbirths and help newborns, mothers, families, and countries thrive.