The Lancet report: Ending Preventable Stillbirths

MAMA Academy today welcomes The Lancet report series Ending Preventable Stillbirths. The report shows that sadly the UK ranks 21st out of 186 countries in the world for stillbirth rates. The UK now has a stillbirth rate of 2.9 stillbirths per 1,000 total births (after 28 weeks of pregnancy) – this remains higher than many other high-income countries. Tomorrow, we will be launching a national campaign, #stillBORN, to give stillborn babies a voice by telling their story so lessons can be learnt to improve future maternity care.

The Lancet report also outlines:

• The rate of progress in reducing stillbirths has been slower than most other high-income countries – this places the UK in the bottom third of the table in 114th place out of 164 countries around the world.
• The rate of progress for neonatal deaths in the UK is around three times faster than for stillbirth. This may be due to significant investment in care and research for babies once they are born; the researchers call for similar investments in care and research before birth in order to identify risk and prevent stillbirth.
• In the UK the number of stillbirths is around 10 times higher than the number of cot deaths, but in comparison there is less awareness of stillbirth in society and stillbirths are not reviewed in the same way, meaning parents may be left without answers as to why their baby died.
• Within high-income countries, women in the poorest communities face double the risk of stillbirth. Making sure everyone has equal access to high-quality healthcare is essential in identifying risk and preventing stillbirth.
• Stillbirth is associated with significant psychological, social and economic impacts on parents, their families and for governments. High-quality, sensitive and respectful bereavement care reduces the long-term negative impact of stillbirth. This should be available consistently across the UK to help families through the experience of losing a baby.

More than 2.6 million stillbirths continue to occur globally every year with very slow progress made to tackle this ‘silent problem’, according to new research published in The Lancet. Despite significant reductions in the number of maternal and child deaths, there has been little change in the number of stillbirths (in the third trimester of pregnancy) even though the majority are preventable.

Half of all stillbirths occur during labour and birth, usually after a full nine month pregnancy, and the research highlights that most of these 1.3 million deaths could be prevented with improved quality of care. Globally, 98% of all stillbirths occur in low- and middle-income countries. At the current rate of progress, it will be more than 160 years before a pregnant woman in Africa has the same chance of her baby being born alive as a woman in a high-income country today. However, the problem also remains significant in high-income countries where the number of stillbirths is now often higher than infant deaths.

Series co-lead, Professor Joy Lawn from the London School of Hygiene & Tropical Medicine, said: “We must give a voice to the mothers of 7,200 babies stillborn around the world every day. There is a common misperception that many of the deaths are inevitable, but our research shows most stillbirths are preventable. Half of the 2.6 million annual deaths could be prevented with improved care for women and babies during labour and childbirth, and additionally, many more lives could be saved with effective care during pregnancy. We already know which existing interventions save lives. These babies should not be born in silence, their parents should not be grieving in silence, and the international community must break the silence as they have done for maternal and child deaths. The message is loud and clear – shockingly slow progress on stillbirths is unacceptable.”

The new research includes the first global analysis of risk factors associated with stillbirth, underlining that many deaths can be prevented by:

– Treating infections during pregnancy.

– Tackling the global epidemics of obesity and non-communicable diseases, notably diabetes and hypertension.

– Strengthening access to and quality of family planning services – especially for older and very young women, who are at higher risk of stillbirth.

– Addressing inequalities – in high-income countries, women in the most disadvantaged communities face at least double the risk of stillbirth.

The research also highlights the underappreciated psychological, social and economic impacts of stillbirth on parents, families, caregivers, and countries. New estimates suggest at least 4.2 million women around the world are living with symptoms of depression due to stillbirth, suffering psychological distress, stigma and social isolation, as well as increased risk of family breakdown, and even abuse and violence.

The economic impact of stillbirth for families ranges from funeral costs for their baby to loss of earnings due to time off work, with data suggesting 10% of bereaved parents remain off work for six months. The direct financial cost of stillbirth care is 10-70% greater than for a live birth, with additional costs to governments due to reduced productivity of grieving parents and increased welfare costs.

Dr Alexander Heazell, Series co-author from the Tommy’s Stillbirth Research Centre at St Mary’s Hospital, University of Manchester, said: “The consequences of stillbirth have been hugely underestimated. Our research suggests that grief and symptoms of depression after stillbirth often endure for many years. It is vital we, as carers, see the loss through the eyes of those parents affected to provide sensitive and respectful bereavement care. We know that something as simple as supporting parents to see and hold their baby and providing bereavement support can reduce the long-term negative impact of stillbirth. Dealing with stillbirth can also have a psychological impact on health workers; consequently, better training and provision of support for those looking after affected families should also be a priority.”

While there is currently significant investment in care and research for babies after they are born, the research calls for more focus on the baby before birth, with increased funding that reflects the scale of 2.6 million deaths a year. They argue that high-quality care during pregnancy and labour would result in a quadruple return on investment by saving lives of mothers and newborns, preventing stillbirths, and also improving child development.

Series co-lead, Vicki Flenady, Associate Professor from the Mater Research Institute – University of Queensland, said: “There is a huge variation in progress on stillbirths, even in high-income countries, from rates of 1.3 to 8.8 stillbirths per 1,000 total births, with stigma, taboo and fatalism still a reality. All countries should implement and respond to high quality national audits of these deaths, which will lead to improvements in quality of care. This has been the case in the Netherlands, which has had the steepest reduction in stillbirth rates. If every high-income country achieved stillbirth rates of 2 or less, like the best performing countries, then nearly 20,000 stillbirths could have been prevented in 2015.”

The Ending Preventable Stillbirth Series was developed by 216 experts from more than 100 organisations in 43 countries and comprises five papers. The research provides compelling evidence of the preventability of most stillbirths, forming the basis for action from parents, health care professionals, and politicians.

Read more about the report on The Lancet website: http://www.thelancet.com/series/ending-preventable-stillbirths