India has the dubious distinction of having the highest number of stillbirths in the world.

This finding comes after the country recorded the worst female child sex ratio ever (Census 2011). India figures at the top of 10 countries that have the highest number of stillbirths, according to the Stillbirth series published in the British medical journal, The Lancet.

As high as 66 per cent (1.8 million) stillbirths in the world occur in just 10 countries. India is followed by Pakistan, Nigeria, China, Bangladesh, Congo, Ethiopia, Indonesia, Afghanistan and Tanzania.

The top five — India, Pakistan, Nigeria, China and Bangladesh — alone represented half of all stillbirths worldwide. In India, the stillbirth rates varied from 20 to 66 per 1,000 total births in different States. China has made some progress over the years to reduce its figure.

Almost half of all stillbirths, 1.2 million, happen when the woman is in labour. These deaths are directly related to the lack of skilled care at this critical time for mothers and babies. Two-thirds occur in rural areas, where skilled birth attendants — midwives and physicians in particular — are not always available for essential care during childbirth and for obstetric emergencies, including Caesarean section.

About 2.6 million stillbirths occurred worldwide in 2009. Every day, more than 7,200 babies are stillborn — 98 per cent of these occur in low and middle-income countries. These deaths occur mainly during the last trimester of pregnancy (after 28 weeks' gestation).

Of these 2.6 million, approximately 1.2 million stillbirths occur during birth (intrapartum) and 1.4 million before birth (antepartum). Most intrapartum stillbirths are associated with obstetric emergencies (childbirth complications).

In high-income countries, obesity, smoking, and advanced maternal age are among the big risk factors. Childbirth complications, maternal infections in pregnancy, maternal disorders, especially hypertension and diabetes, foetal growth restriction, and congenital abnormalities are the biggest reasons for stillbirths.

The overall number of stillbirths fell from an estimated 3.03 million in 1995 to 2.64 million in 2009.The global rate has been reduced from 22 stillbirths per 1,000 total births to 19. Analyses suggested that stillbirths had decreased by 1.1 per cent per year since 1995, lower than the 2.3 per cent annual reduction rate in child under-five mortality, and 2.5 per cent annual reduction in maternal mortality. A survey of healthcare professionals and parents in 135 countries showed that most stillborn babies were disposed of without recognition or rituals.

Keywords: LancetstillbirthsIMR