Stillbirths: economic and psychosocial consequences

This paper highlights the substantial costs, both economic and psychosocial, that result from a stillbirth. Systematic reviews of the literature and new analyses were undertaken by the research team to bring together new evidence of the costs of stillbirths, and the cost-effectiveness of key interventions. Most of the data focused on high income country contexts.Direct financial costs include medical care, whereas indirect costs may come in the form of welfare payments. Care for a stillbirth was calculated to cost between 10% and 70% more than with a live birth. Parents’ employment was affected with leave of absence, as well as reduced productivity after normal working hours resumed.A great degree of the effect of stillbirth was non-monetary. The psychological and social effects on bereaved parents include social stigma, grief and social isolation.  The most frequently reported psychological effects of stillbirth were depressive symptoms, anxiety, post-traumatic stress, suicidal ideation, panic and phobias. Many studies reported disenfranchised grief – where parents felt that their bereavement was not legitimised by society.In low and middle income country contexts, women reported feeling less valued by partners and society after a stillbirth, with some lingering cultural beliefs that women who have stillbirths have either procured an abortion or are possessed by evil spirits.Stillbirths are also reported to have a substantial effect on health providers, causing traumatic stress, depression, guilt, self-blame, and grief. Fear of litigation is another factor that impacts on health professionals following a stillbirth.The summary of what works outlines several needs for better care of those affected by stillbirths.

• staff who understand what different parents and families need;
• communities that acknowledge grief and loss and do not stigmatise;
• employers who provide effective leave arrangements; and governments that provide tangible support, such as funeral costs, and paid leave from work commitments.

The authors used a Lives Saved Tool analysis to estimate the effect and cost of quality antenatal and intrapartum care – resulting in an estimated 823,000 stillbirths that could be prevented in the 75 highest burden countries by 2030 (along with an estimated 1145000 neonatal and 166000 maternal deaths averted). The analysis concludes that most of the deaths and stillbirths would be prevented by interventions in the intrapartum (birth) period. To read this article, click here. Free registration is required.To read other articles in the 2016 Lancet Ending Preventable Stillbirths Series, click here.Heazell, A.E.P., Siassakos, D., Blencowe, H., Burden, C., Bhutta, Z.A., Cacciatore, J., Dang, N., Das, J., Flenady, V., Gold, K.J., Mensah, O.K., Millum, J., Nuzum, D., O’Donoghue, K., Redshaw, M., Rizvi, A., Roberts, T., Saraki, H.E., Storey, C., Wojcieszek, A.M. & Downe, S. (2016). Stillbirths: economic and psychosocial consequences. Early online publication.