I’ve blogged in the past about the complete neglect of stillbirths in the global burden of disease. Only children who are born alive count towards our measures of infant and child mortality. If a child does not take a breath outside of the mother’s womb, than it is considered a stillbirth, and it is not counted. Technically, I understand some of the important methodologically challenges in the measurement of stillbirths, but philosophically, I find this oversight reprehensible.
The Lancet has published an entire series dedicated to what I believe is the most neglected cause of death globally – stillbirths. The newest estimates published in this series suggest that there are roughly 2.6 million stillbirths every year. My guess is that even this is an underestimate, in particular given the arbitrary nature of the definition used to define a stillbirth (death after 28 weeks gestion, but not at say 27.5 weeks). Current estimates of global child mortality are roughly 9 million deaths a year, so if we were to account for stillborn deaths, than child mortality would increase substantially.
There are some really interesting research papers in this series, including an overview of the risk factors and interventions that might be effective at reducing stillborn deaths. The biggest take-home for me from reading this series is that the main set of interventions that likely reduce stillbirths are exactly the same ones that are needed to address both maternal and child health. The intrapartum period – the labor process itself – is when about one half of stillbirths, three-quarters of maternal deaths, and one-quarter of newborn deaths occur. This means that prioritizing care during this crucial and critical time period would help to reducing millions of deaths. Antenatal services might also be important, but the key is to ensure that every woman undergoes birth in the presence of a skilled health professional and has adequate access to important life saving technologies – life saving for her and her baby – at the time of delivery. Period.
This series is a very important contribution. It is about time that this important global health issue receives proper attention from the global health community. It is now time for health system planners and policy makers to take the next step and ensure health systems are organized to provide adequate maternal care – millions of lives depend on it.Share on Facebook