Long-term tends in fetal mortality: implications for developing countries

Abstract

This paper discusses the problems of defining and measuring late-fetal mortality (stillbirths). It uses evidence from 11 developed countries to trace long-term trends in fetal mortality. Issues associated with varying definitions and registration practices are identified, as well as the range of possible rates, key turning points and recent convergence. The implications for developing countries are spelt out. They emphasize the possible limitations of WHO estimation methods and survey-based data by examining the cross-sectional associations among 187 countries in the year 2000. The important role of skilled birth attendants is emphasized in both data sets, but the different effects on maternal mortality and late-fetal mortality are also noted.

Stillbirths: Where? When? Why? How to make the data count?

“…If no new eff orts are made to prevent stillbirths or to reduce unwanted pregnancies, particularly for lowincome families in rural settings, then we estimate that, by 2020, more than 2 million stillbirths will still occur every year, with potentially 90% in sub-Saharan Africa and south Asia. Long-term trends in selected high-income countries, from 1750 to 2000 indicate that most of these countries had a stillbirth rate of about 30 per 1000 total births in 1900, 22 which is similar to current stillbirth rates in many low-income countries. High-income countries reported a substantial reduction in stillbirth rates of two-thirds between 1950 and 1975 related to prevention and treatment of infection and improved obstetric care.…”

“…High-income countries reported a substantial reduction in stillbirth rates of two-thirds between 1950 and 1975 related to prevention and treatment of infection and improved obstetric care. 22 This reduction occurred before more complex fetal surveillance and diagnostics and also coincided with major reductions in maternal and neonatal mortality. 60 years later, the poor progress to reduce all three of these pregnancy outcomes in low-income countries is not a knowledge gap but an action gap.…”

“…8 The terminology has changed over time and, despite clear worldwide guide lines, there is much variation between countries, with greater variability in high-income countries than in lowincome countries. 22,23 The International Classifi cation of Diseases, 10th revision (ICD-10) 24 refers to fetal deaths, not stillbirths. Fetal death is defi ned as "death prior to the complete expulsion or extraction from its mother of a product of conception...the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles".…”

National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis

“…Comparison of the estimated trends with reported trends by country suggests that the current model's accuracy of predicting trends is close to that of the actual reported trends. 27,28 Furthermore, the variation in the estimated declines by region needs recognition. For example, the reduction Numbers are rounded; rates were calculated with raw, unrounded data.…”

Stillbirths: what difference can we make and at what cost?

“…The estimated 41-45% reduction in stillbirths at 90-99% coverage by the suggested interventions is probably an underestimate because most high-income and some middle-income countries have been able to reduce intrapartum stillbirths and related neonatal deaths to a greater extent. 109,110 The challenge now is to translate this evidence into policy and make these interventions accessible to individuals in greatest need 111 in an integrated manner 112 and at a faster pace than secular trends. Implementation and integration will be the focus of the fourth paper in this Series.…”