More than 20,000 stillbirths worldwide are avoidable

Around 20,000 late-pregnancy stillbirths could have been avoided globally, according to research published in The Lancet medical journal today.

Author Vicki Flenady, from the Mater Research Institute at the University of Queensland, and colleagues concluded these reductions would occur if all high-income countries achieved stillbirth rates equal to the best-performing countries.

The findings were part of The Lancet’s Ending Stillbirth Series, which consisted of five papers estimating stillbirth rates in each country, numbers that could be avoided and new revelations on how they could be prevented.

How countries perform

Nordic countries occupied the top three places for lowest rates of stillbirths worldwide. In Iceland, Denmark and Finland, 1.3, 1.7 and 1.8 stillbirths occurred per 1,000 births respectively in 2015.

Australia came 15th in the world rankings, with 2.7 stillbirths for every 1,000 births. This compared to New Zealand in 10th place, with 2.3 for every 1,000.

“We estimate conservatively that 200 families every year in Australia would be spared the tragedy of a stillbirth in the last three months of pregnancy if we could get our rates down,” said Dr Flenady.

Among several ways in which to lower rates, the study authors called on the international community to acknowledge the burden of stillbirths, address actions needed to prevent stillbirths with appropriate care, and monitor stillbirths with a consistently agreed target.

Late-gestation stillbirths are those at 28 weeks or more, which is the World Health Organisation’s recommended cut-off for international comparison.

Dr Flenady and her team estimated there were 2.6 million stillbirths globally in 2015, equating to around 7,200 every day. This number hasn’t changed since The Lancet published a similar stillbirth series, with a call to action, in 2011.

“It’s probably even more than that, because we are limited by the fact that to compare across the globe we can only focus on stillbirths after 28 weeks. They’re often not counted below that,” said Dr Flenady.

She said about 50% of stillbirths occurred before this period, which, if included as official data, would bring the 2.6 million up to around 5 million.

The research showed while stillbirth rates have fallen marginally since 2000, these are failing to keep pace with falls in childhood and maternal mortality rates.

Authors estimated 98% of stillbirths happen in low and middle-income countries. But they also remain a problem for high-income countries where substandard care contributes to 20% to 30% of all stillbirths.

Another 30% remains unexplained, which is the basis for the authors' call for all high-income countries to implement national perinatal mortality audit programs.

Knowing the risks

Professor of Obstetrics and Gynaecology at Griffith University David Ellwood said many health providers still underestimated risk factors, including the increase in age of mothers and more people with obesity, contributing to stillbirths.

“There’s a delicate balance involved in not stigmatising women who are overweight and obese. Getting the balance right between treating people as human beings and recognising they have a health problem is a difficult balancing act,” he said.

“There is also an element of lack of awareness. I think there are some people who probably don’t appreciate the fact that those risk factors are there and there is a role for better education for health care providers.”

Dr Flenady said the research also showed disadvantaged women in high-income countries had double the stillbirth risk of women in higher socioeconomic brackets.

“Women who can’t understand English are at a real disadvantage,” she said, calling for access to culturally sensitive health care.

“Some groups in Indigenous communities are smoking in pregnancy, up to 60%, whereas around 16% to 17% do so in the general population. We’ve got to provide them with support to stop smoking, ideally before pregnancy.”

Another paper in the series estimated 60% to 70% of grieving mothers in high-income countries reported clinically significant depressive symptoms one year after their baby’s death.

If these figures are extrapolated to the 2.6 million women who had a stillbirth globally each year, an estimated 4.2 million women are living with depressive symptoms after stillbirth.

Data from 18 countries also suggested congenital abnormalities accounted for only 7.4% of stillbirths, dispelling the myth that all stillbirths were inevitable.