International researchers tackle stillbirth taboo
Every year there are more than 3 million stillbirths. Yet despite advances and, at times, information overload in the medical world, stillbirths remain underreported and are either not found in data records or not recognised in national policymaking, which suggests that stillbirths are a taboo subject. In a supplement of the journal BMC Pregnancy and Childbirth, researchers from around the globe examined the problem in an attempt to improve knowledge and help put a stop to the problem. Data show that more than 3 million stillbirths occur worldwide, and 98% of those are found in low- to middle-income countries. Intrapartum stillbirths, which are stillbirths that occur during labour, stand at around 1 million and are also usually found in low- and middle-income countries. Experts say stillbirth cases number more than malaria-based child deaths worldwide. Stillbirth cases are 3 to 4 per 1,000 full-term births in western European countries, while the US reports 7 per 1,000 full-term births. The supplement's six studies provided evidence supporting maternal interventions to reduce stillbirths, and focused on how to bolster knowledge and fuel efforts to put a stop to this huge problem. It also spotlighted the issue of how stillbirth data should be compiled in global data-tracking systems and addressed in policy dialogue. One paper focused on the global burden, epidemiology, risk factors and causes of stillbirths. It also outlined the methodology and framework for this internationally based review. Others assessed the behavioural and nutritional interventions used before and during pregnancy and covered the prevention and management of medical disorders and infections during pregnancy. Another paper reviewed the effectiveness of screening and monitoring during pregnancy and labour using techniques such as ultrasound and Doppler (a test to evaluate blood as it flows through a blood vessel) tests. It also looked at studies of the potential effects of cardiotocography and maternal diabetes management on still birth outcomes. A similar group of authors reviewed reports of the outcomes of eight different interventions during labour. The final paper in the supplement looked at ways to improve service supply and community demand, providing health-system solutions such as better care during pregnancy and childbirth and health-worker training. 'In high-income countries such as the US and the UK, there is increasing recognition of the problem of stillbirths since the progress to reduce stillbirths has been minimal compared to progress for neonatal deaths, and parent groups are increasingly active,' explained Dr Joy E. Lawn of the Institute of Child Health in London, UK. 'In low-income countries the numbers are overwhelming at around 9,000 a day, with 3,000 a day occurring during birth. Yet behind each death families suffer the pain of loss, often compounded with guilt, but societal taboos keep this grief hidden,' she added. 'Studies show that even 20 years after experiencing a stillbirth, women have unresolved grief.' 'Delivering interventions to reduce the global burden of stillbirths requires action at all levels of the health system,' the last study concludes. 'Effective strategies to prevent stillbirth are known; gaps remain in the data, the evidence and, perhaps most significantly, the political will to implement these strategies at scale.' The collaborative review involved researchers from Pakistan, South Africa, the UK and the US.
Countries
Pakistan, United Kingdom, United States, South Africa