Guide to mobilizing action for stillbirths

The following piece was adapted from the International Stillbirth Alliance newsletter issue, Stillbirth Matters, by Joy Lawn

This is a moment when the huge, hidden tragedy of stillbirth has the best chance to date of moving from the shadows towards more attention and action on the global stage. The Lancet’s Neonatal series in 2005 was a landmark in bringing 4 million newborn deaths out of the shadows, and we now have that same hope for stillbirths. 

Each day more than 7,200 babies are stillborn - 2.6 million a year. Death just when a parent expects to welcome a new life. Each one is an individual story of a family devastated by the loss of their child. The loss is especially felt for women, who may be marginalized and even be blamed for the loss. The Lancet Series on Stillbirths represents the work of 69 authors from over 50 organizations and 18 countries, with the analysis on numbers and lives saved drawing on over 5 years of extensive reviews and analysis. Many organizations, some of which have not traditionally focused on stillbirths, have come together with a common purpose to work together for change. The International Stillbirth Alliance (ISA) and many partners have played key roles, and ISA especially brings the power of parents - a voice that has brought change in some higher income countries and yet a voice that is virtually unheard in low income settings. 98% of stillbirths happen for families in low and middle income countries while over 75% in South Asia and Sub Saharan Africa .These families also need recognition, need a voice, need to know that steps are being taken to avoid other such deaths.

Our new analysis suggests that the world’s 2.65 million third trimester stillbirths could be halved by 2015 at a cost of only $2.32 per person per year in the 68 highest burden countries. These same interventions are already being promoted to reduce maternal and neonatal deaths, and, indeed, almost 1.5 million newborns and around 201,000 women would be saved with the same interventions.

But a series is only a set of papers – even if it is The Lancet! Every page of the series has data and stories, and used for action - the building blocks for change. Yet change will come only if the words are read. The shared window for media attention is usually days, although with repackaging on local numbers this window may last longer. The real goal is policy and program action and the window for maximizing change is months, or at most a year or two, before this is old news. Policymakers have a short attention span and we have attention now and need to use it well. What can our community do?

1. Know and use the information

Read the papers: The Lancet has generously made the papers and executive summary free on line for all the world, not just subscribers. The headline messages in the executive summary and key messages in each paper give the main points clearly. PMNCH has also produced a Stillbirth Knowledge Summary - which synthesize the evidence in a short, user-friendly format to inform policy and practice.

Know your numbers: at least know the global number of stillbirths, and your local (national) number. Numbers are easier to understand than rates. Noting that in high-income settings the definition may differ from the WHO definition (>1000 g or >28 weeks gestation). For example in the USA using the WHO definition would report around 15,000 stillbirths a year for 2009 but the CDC 20 week definition reports 27,500 in 2009. If everyone is using different numbers then momentum will be compromised. Download an excel spreadsheet of the 193 countries, rates, number, progresss and ranking.

Consider a national Factsheet – a one pager, at most 2 pages with a report card of numbers, rates, rankings and key issues to address. See this example from South Africa.

2. Get the news out

Organize local or national events, inviting media and professional partners and parents to discuss what your community or country can do to prevent stillbirth, to better support parents. Contact your local print and other media to get the local story out highlighting parent’s personal stories.

Consider helping on translations and sponsor print copies. Sponsor print copies to reach key audiences. The International Confederation of Midwives Congress in South Africa in June 2011 is a key opportunity to engage with midwives who are the lynchpin for care at birth. Funds are needed to reach 4000 at the congress with messages on their role in preventing stillbirth.

3. Maximise the use of the data for use in policy and programs

Help disseminate the papers and adapt summaries for your community or country. Share with key partners including professional (obstericians and midwives) and United Nations agencies. The data for stillbirth rates, numbers, progress 1995-2009 and national rankings is available.

Adapt the series PowerPoints to have a local flavor with your data, parent stories and local photos. You can also use free software, Lives Saved Tool (LiST) to estimate how many stillbirths could be prevented with the 10 interventions highlighted, and also the lives saved for mothers and newborns.

Let us extend our efforts to facmilies affected in low and middle income countries. Their voices have not been part of the global dialogue – let us use this data in the series and draw in the reality of loss from parent stories and know that change really can happen if we work together.

> Learn more about how you can break the silence.