Policy & Issues

'Recognise, enumerate stillbirths'

Damaged beds at a Government Maternity Hospital in Hyderabad after it was ransacked by attendents of a mother and infant who died. The British medical journal Lancet called for counting of stillbirths alongside maternal and neonatal deaths. File photo   | Photo Credit: P_V_SIVAKUMAR

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

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

The Lancet’s series on stillbirths suggests that millions of stillbirths occur uncounted each year and are not reflected in global policy. Until now, UN 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.

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, The Lancet points out.

In society, stillbirths are also hidden. Even in high-income countries, recognition of parent’s grief after a stillbirth is recent while in a low-income country, bereavement rituals for a stillbirth are a rarity and are not recognised by society.

Results from a large web-based survey of health care professionals, and parents in 135 countries showed that most stillborn babies are disposed of without recognition or ritual, such as naming, funeral rites or the mother holding or dressing a bay. A widespread belief is that the stillbirth represents a natural selection of babies never meant to love. Almost one-third of the stillbirths are almost always or often blamed on the woman or 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 ever, 98 per cent in low-income and middle-income countries. Nigeria and Pakistan have the highest stillbirth rates (42 and 46 per 1000 births respectively) and Finland and Singapore the two (two per 1000 births). Ten countries account for 66 per cent of the world’s stillbirths with India topping 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 birth are critical to prevent stillbirths as well as maternal deaths and newborn deaths.

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Printable version | Jan 16, 2022 6:25:20 PM | https://www.thehindu.com/sci-tech/health/policy-and-issues/Recognise-enumerate-stillbirths/article14683180.ece

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