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LATEST NEWS UPDATES | “Recognise, enumerate stillbirths” by Aarti Dhar

“Recognise, enumerate stillbirths” by Aarti Dhar

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published Published on Apr 15, 2011   modified Modified on Apr 15, 2011

Stillbirths are largely invisible as a social and public health problem. Millions of families experience stillbirth, yet these deaths remain unenumerated, unsupported, and the solutions undercooked.

Calling upon the international community and individual countries for action, British medical journal The Lancet has said better counting of stillbirths alongside maternal and neonatal deaths and strategic programmatic action would bring stillbirths under account.

The Lancet's series on stillbirths suggests that millions of such cases occur every year, only to remain unenumerated and unreflected in global policy. Until now, United Nations data collation systems have not included stillbirth. Global policy targets like the Millennium Development Goals (MDGs) omit stillbirths, as does the Global Burden of Disease.

The journal points out that data on stillbirths and other pregnancy outcomes could be improved immediately by strengthening existing data collection systems, especially household surveys, and vital registration. Stillbirths should be specified in post-MDG targets. Every country should have national estimates of stillbirth rate and causes with the global agencies collecting stillbirth data, facilitate yearly estimates and improve national death certificates and counting systems.

In society, stillbirths are also hidden. Even in high-income countries, acknowledgement of the parent's grief as a result of a stillbirth is a recent phenomenon, whereas in low-income countries, bereavement rituals for a stillbirth are not recognised by society.

Results from a large web-based survey of healthcare professionals, and parents in 135 countries showed that most stillborn babies were disposed of without recognition or ritual — such as naming, funeral rites or the mother holding or dressing a baby. A widespread belief persists that the stillbirth represents a natural selection of babies never meant to be loved. Almost one-third of stillbirth cases are often blamed on the mother or on evil spirits. Efforts are needed to overcome this fatalism, lessen the stigma associated with stillbirth, and provide bereavement support. The silence surrounding stillbirths hides the problem and impedes investment, The Lancet series points out.

At least 2.6 million third-trimester stillbirths occur every year, 98 per cent in low-income and middle-income countries. Nigeria and Pakistan have the highest stillbirth rates (42 and 46 per 1,000 births respectively) and Finland and Singapore account for the remaining two per cent. Ten countries account for 66 per cent of the world's stillbirths; India tops the list, followed by Pakistan, Nigeria, China, Bangladesh, Congo, Ethiopia, Indonesia, Tanzania and Afghanistan.

The five major causes of stillbirths are complications during child birth, maternal infections in pregnancy, maternal disorders, especially hypertension and diabetes, foetal growth restriction and congenital abnormalities. To prevent stillbirths, pre-pregnancy and pregnancy care such as nutritional interventions are important. Screening during pregnancy for infections, high-blood pressure and diabetes can reduce the incidence by between 10 to 20 per cent on average. During labour and delivery, emergency obstetric care and having a skilled professional attend to the birth are critical to prevent stillbirths, maternal and newborn deaths.

The Hindu, 15 April, 2011, http://www.hindu.com/2011/04/15/stories/2011041564201000.htm


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