Stillbirths: the vision for 2020

Abstract

Stillbirth is a common adverse pregnancy outcome, with nearly 3 million third trimester stillbirths occurring world-wide each year. Ninety-eight percent occur in low and middle income countries (LMIC), resulting in a ten-fold disparity in stillbirth rates between high and LMIC. Nevertheless, stillbirth is practically unrecognized as a health problem, either in global health metrics or within most LMIC data reports. Confusion regarding stillbirths is compounded by inconsistent definitions and over 35 different classification systems. One million or more stillbirths occur in the intrapartum period and are preventable with obstetric care that would also save the lives of mothers and newborns. The large disparities in stillbirth rates between HIC and LMIC, and those often seen in minority, disadvantaged and rural populations, are major themes among the papers in this series. Important interventions to reduce stillbirth include some components of antenatal and intrpartum obstetric care including timely cesarean section when required, although the effective implementation of these interventions remains a challenge in many LMIC. In this final paper, we call for inclusion of stillbirth as a recognized outcome in all relevant international health reports and initiatives. We ask every country to develop and implement a plan to improve maternal and newborn health that includes a reduction in stillbirths, and to count stillbirths in their vital statistics and other health outcome surveillance systems. We also ask for increased investment in stillbirth-related research, and especially research aimed at maternal and neonatal health system improvements in LMIC. Finally, we ask all those interested in reducing stillbirths to join with advocates for improvement of other pregnancy-related outcomes for mothers and their offspring so that a united front for improved pregnancy and newborn care for all will become a reality.