April 14, 2011

The Silent Tragedy Of Stillbirths

More than 7,300 babies are stillborn every day. That's more than 2.6 million pregnancies each year ending in death, according a study published in The Lancet.

The medical journal released a special series by researchers from the World Health Organization (WHO) and some 50 organizations from 18 countries, giving a comprehensive estimate of the number of stillborns and how this impacts the world.

The purpose of the series is to address the staggering stillbirth rates and causes for them in all countries and to challenge policy makers to help reduce 50% of the rate by 2020.

"Stillbirths are the last big invisible global health issue," said Dr. Joy Lawn of Saving Newborn Lives/Save the Children, a lead author of the stillbirths series in an email to Reuters reporter Julie Steenhuysen.

"There are 2.65 million stillbirths a year - more than malaria and AIDS deaths combined -- and yet they are never mentioned in global health data or policy," she added.

Low to middle-income countries suffered 98% of stillbirths in 2009, and two-thirds occur in rural settings where midwives and doctors are not available to offer their obstetric care, the studies found.

"Stillbirths often go unrecorded, and are not seen as a major public health problem," Dr. Flavia Bustreo, who is the assistant director-general for Family and Community Health at the WHO, said in a statement.

"Yet, stillbirth is a heartbreaking loss for women and families," Bustreo said. "We need to acknowledge these losses and do everything we can to prevent them."

A wide variation exists among developed and developing countries, the reports revealed. In Finland and Singapore rates are as low as 2 for every 1,000 births, whereas as much as 47 stillbirths occur for every 1,000 pregnancies in Pakistan and 42 per 1,000 in Nigeria.

Stillbirth is defined by WHO as a lost pregnancy after 28 weeks of gestation, or during the third trimester of pregnancy, reports Reuters.

Complications during childbirth, infections such as syphilis during pregnancy, health issues such as high blood pressure or diabetes, fetal growth restriction where babies do not grow at the proper rate, and birth defects are the most common causes of stillbirth.

In a telephone interview with Steenhuysen, Dr. Elizabeth Mason of the WHO, who is also a contributor of the reports said, "Over half of the stillbirths occur when the woman is in labor."

"These are really related to the care a woman gets during labor," she added.

Ten countries are major contributors to these stillborn deaths, reports the journal. About 1.8 million or 66% occur in India, Pakistan, Nigeria, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and Tanzania, reports Reuters.

However, these rates vary per country.

Progress to reduce rates has been slow with rates only dropping by 1.1% a year since 1995. This is lower than the 2.3% annual decrease in deaths of children under the age of 5 or the 2.5% annual reduction in maternal deaths, the studies found.

Although the rate is higher in poorer countries, high-income countries are not immune. 1 in 200 pregnancies in wealthy nations end in a stillbirth, reports Reuters.

More common causes for the losses in wealthier nations include obesity, smoking and advanced maternal age.

Rates also vary for these countries, with Finland's stillbirth rate of 2 for every 1,000 births compared to Australia rate of 3.9 and Britain's rate of 3.5.

For these countries, racial and ethnic disparities are major players. For example, among African American mothers in the U.S., stillbirth occurs two to three times more often when compared to white mothers, Reuter reports Dr. Wes Duke as saying. Dr. Duke is one of the study authors and is from the U.S. Centers for Disease Control and Prevention.

Indigenous women in Canada and Australia suffer twice as many stillbirths as white women.

"The fact that stillbirth rates vary among high-income countries suggests that further reductions are possible in some countries," Duke says.

Interventions before pregnancy should focus on weight control and adequate intake of folic acid, which can reduce neural tube defects, says Duke. During pregnancy, proper management of diabetes, hypertension, obesity, multiple pregnancy and smoking or substance abuse should be the main focus during pregnancy, he emphasizes.

Stillbirth remains a silent burden for many families

The report reveals that most babies are disposed of without proper funerals or the parents are not even allowed to hold or dress their baby. This find was according to a survey of health-care professionals and parents in 135 countries.

For some women, they face being seen as a failure as a mother, and in many countries, superstitions exists about stillbirth, Mason says.

"At the time when the woman is bearing a huge loss she also can be accused of infidelity or they might accuse a neighbor of giving them a curse," she says.

The study challenges countries with a high stillbirth rate, more than 5 per 1,000 births, to cut that rate in half by 2020.

According to researchers, improved health coverage will help.

The widespread coverage of emergency obstetric care, syphilis detection and treatment, monitoring for fetal growth problems, management of high blood pressure and diabetes and prevention and treatment of malaria could save about 1.1 million babies a year, reports the studies.

Access to skilled care during labor would be a great benefit to reducing stillbirths, Mason says.

"That is really paramount if we are going to save these babies," she says.


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