52 Million Stillbirths Expected in Next 20 Years

An additional 52 million stillbirths—many of which are preventable—could occur in the next 20 years unless the issue is taken more seriously by the global health community, experts say.

Writing in the BMJ a team of U.K. and U.S. scientists argued that targets for reducing stillbirths should be included in the U.N.'s Sustainable Development Goals. More than 150 world leaders are due to attend the U.N. Sustainable Development Summit from September 25-27, where a set of goals for the next 15 years will be adopted. The current draft of the goals includes a resolution to drive down neonatal and under-five mortality rates, but does not specifically address the issue of stillbirths.

A stillbirth is defined by the World Health Organization (WHO) as a baby born with no signs of life at or after 28 weeks' gestation. Neonatal mortality refers to a death during the first 28 days of life.

Despite difficulties in recording stillbirths, latest WHO data estimates that 2.6 million children were stillborn in 2009, equating to more than 8,200 deaths a day. Ninety-eight percent of stillbirths occurred in low and middle-income countries—with South Asia and Sub-Saharan Africa showing particularly high rates—and the issue is described as an "invisible public health problem" by the WHO.

Zeshan Qureshi, an international child health expert at at University College London and the recent BMJ article's lead author, says that urgent action must be taken to address what is a largely-preventable problem. "We have a lot of evidence at the moment that stillbirth is a huge problem, and we have a lot of evidence that there are interventions available to reduce that burden," says Qureshi.

The key problem in addressing stillbirths is keeping track of them. Less than five percent of global stillbirths are officially registered, compared to two-thirds of all live births which are recorded, Qureshi says. Woman in rural areas of developing countries can have a stillbirth with no medical professionals around and there is "no record of that baby entering or leaving the world," which exacerbates the problem. "If we don't have stillbirths being counted then it is incredibly difficult for there to be targeted interventions to reduce them," he says.

A coordinated effort to tackle the issue of stillbirths would likely not entail unsustainable investment. A 2014 review published in medical journal The Lancet, looked at the 75 countries hit hardest by these problems, and found that an estimated 531,000 stillbirths per year could be prevented—as well as 113,000 maternal deaths and 1.325 million neonatal deaths annually—at a cost of $4.5 billion per year up to 2020. This equates to an investment of just $0.90 per person in those 75 countries.

However, the issue lies in making stillbirths a politically viable issue, and one in which people believe is worth investing. The BMJ article cites the Millennium Development Goals—adopted by the U.N. in 2000 with a 2015 deadline—as prompting greater investment in areas such as postneonatal child survival rate, which improve by 5 percent per year between 1995 and 2009. Stillbirths, by comparison, decreased by just 1 percent per year in the same period.

Qureshi says that another key is tackling the taboos surrounding stillbirths. In the developing world, stillbirths are often connected to some kind of fault in the mother or possession by evil spirits, resulting in mothers not admitting to stillbirths or coming forward to seek support after the traumatic event. The researchers suggested that families must be encouraged to report stillbirths and that such cultural challenges must be accounted for when implementing program to keep track of stillbirths.