Stillbirths: missing from the family and from family health

Impact of stillbirths on international comparisons of preterm birth rates: a secondary analysis of the WHO multi‐country survey of Maternal and Newborn Health

“…At the same time, more than 2.6 million stillbirths occur per year . Compared with other indicators of perinatal health, the stillbirth rate has long been neglected . Only recently has its importance been acknowledged; the World Health Organization now includes it in ‘100 Core Health Indicators’, and the World Health Assembly has targeted the reduction of stillbirths to below 12 per 1000 total births in every country by 2030 …”

“…However, in populations where the burden of stillbirths is large, such exclusions may limit the utility of the preterm birth rate as a robust perinatal indicator. The majority of stillbirths occur before term, and major causes of stillbirth and preterm birth (such as maternal malnutrition and infection) overlap . Preterm delivery rates might therefore be larger in populations with high stillbirth rates if stillbirths were included when calculating preterm birth rates.…”

“…9 Compared with other indicators of perinatal health, the stillbirth rate has long been neglected. 10 Only recently has its importance been acknowledged; the World Health Organization now includes it in '100 Core Health Indicators', 11 and the World Health Assembly has targeted the reduction of stillbirths to below 12 per 1000 total births in every country by 2030. 1 Although WHO defines preterm birth as any birth before 37 weeks of pregnancy, 3,12,13 stillbirths are usually excluded when calculating and reporting preterm birth rates, and hence in international comparisons.…”

“…The majority of stillbirths occur before term, 14,15 and major causes of stillbirth and preterm birth (such as maternal malnutrition and infection) overlap. 10,11 Preterm delivery rates might therefore be larger in populations with high stillbirth rates if stillbirths were included when calculating preterm birth rates. Additionally, improved provision of obstetric interventions to prevent stillbirth often involve an increase in provider-initiated early delivery.…”

Evidence‐Based Stillbirth Prevention Strategies: Combining Empirical and Theoretical Paradigms to Inform Health Planning and Decision‐Making

“…Phase 4 focuses on identifying programs and services at health system, public education, and policy levels that will lead to desired changes specified in phases 1–3. Opinion leaders agree that substantive, sustainable change requires the involvement of diverse stakeholders and activists, as well as multiple levels of governmental and nongovernmental agencies to ensure effective stillbirth prevention strategies become part of the policy agenda and health system strengthening efforts in HICs and LMICs (Bhutta et al., ; Darmstadt, ; Goldenberg et al., ; Rubens, Gravett, Victora, Nunes, & the GAPPS Review Group, ). Evidence from HICs shows correlations between declining rates of stillbirth and increased socioeconomic investment in health systems, education, and environment (Nimeri et al., ).…”