Stillbirths: recall to action in high-income countries

This is the fourth of five articles published in the 2016 Lancet Series on Ending Preventable Stillbirths. The 2011 Stillbirth Series highlighted the limited progress in reducing stillbirths in high-income countries (HICs).  This article outlines the current scale of stillbirths in HICs and identifies strategies for decreasing stillbirths and meeting the needs of parents whose baby is stillborn.Methods:Multiple methods were used to collect the information for this article:

• Web-based surveys with bereaved parents, healthcare providers, and the general public
• Calculations of stillbirth rates in HICs using Blencowe and colleague’s stillbirth rates and total births.
• A review of literature and programmes focused on reducing disparities in stillbirths
• A search of national polices on perinatal mortality audits
• A search of national guidelines and recommendations on preventing stillbirths and investigating them.

 Key findings:

• Every year, in 49 HICs, there are on average 3.5 stillbirths per 1,000 births.  However, these rates vary greatly between HICs, ranging from 1.3 to 8.8 stillbirths at 28 weeks or more per 1,000 births.
• Women living in disadvantaged social conditions in HICs are twice more likely to have a stillbirth than women who are living in more advantaged social conditions.
• Negative views of stillbirth still exist in HICs, including more than 40 per cent of parents asked agreeing that “parents should try to forget their stillborn baby and have another child” and “parents should not talk about their stillborn baby because it makes people feel uncomfortable”.
• In general, healthcare providers were aware of the risks associated to stillbirths. However, the risks of having a baby more than 35 years in age and being overweight while pregnant were underestimated.

 Conclusions and recommendations:The authors provide several recommendations for accelerating the reduction in stillbirths:

• Strong partnerships between parents and care providers are needed to help undermine negative views towards stillbirths.
• Social conditions affecting the well-being of mothers and her unborn baby should be monitored and improved using education, ending poverty, and improving health care access.
• Audits and investigations into perinatal deaths and stillbirths need to be carried out in all countries in order to analyse and improve quality of care. Also, a standard definition of stillbirths is needed.
• Bereavement care for parents who have had a stillbirth should be given by trained health care workers with community support.
• Future research should focus on predicting stillbirths and understanding the reasons for them, particularly those that are early, spontaneous or unexplained. 

The authors conclude that stillbirths are a major concern for public health in HICs. We can end preventable stillbirths in HICs by improvements to women’s health and quality of maternity health care, as well as reducing social inequality.To read the Lancet Ending Preventable Stillbirths Series, click here.To read the article for free, click here.Flenady, V., Wojcieszek, A. M., Middleton, P., Ellwood, D., Erwich, J. J. , Coory, M., Khong, T. Y., Silver, R. M., Smith, G. C. S., Boyle, F. M., Lawn, J. E., Blencowe, H., Hopkins Leisher, S., Gross, M.M., Horey, D., Farrales, L., Bloomfield, F., & McCowan, L., Brown, S. J., Joseph, K. S., Zeitlin, J., Reinebrant, H.E., Ravaldi, C., Vannacci, A., Cassidy, J., Cassidy, P., Farquhar, C., Wallace, E., Siassakos, D., Heazell, A.E.P., Storey, C., Sadler, L., Petersen, S., Frøen, J. F., Goldenberg, R. L. (2016). Stillbirths: recall to action in high-income countries. The Lancet, 6736(15), 1–12.