Stillbirth: A global problem exposed

In what was the first official estimate of its kind, The Lancet medical journal, in partnership with the World Health Organisation, recently published a major study on the rate of stillbirths around the world.

The seminal analysis was written by 69 authors from more than 50 organisations and 18 countries. The study was the first comprehensive assessment of global numbers and causes of stillbirths, which have been largely neglected by the global healthcare community.

Of crucial importance, the study recommended interventions to prevent stillbirths from occurring, which, according to the The Lancet, is the fifth most common cause of death worldwide.

The report contained some bleak statistics. Approximately 2.6-million babies are stillborn every year and, of those, 1.2-million babies would have reached full term and died at birth. A staggering 98% of stillbirths occur in low and middle-income countries.

The Lancet said African women are 24 times more likely to have a stillbirth at the time of delivery than women living in the developed world. And 66% of stillbirths occur in rural settings where healthcare workers are in short supply.

Moreover, the study pointed out that the top five causes of stillbirths are closely related to the leading causes of maternal deaths: childbirth complications, maternal infections in pregnancy, maternal disorders such as hypertension and diabetes, foetal growth restrictions and congenital abnormalities.

Half of all stillbirths occur in five countries: India, Pakistan, Nigeria, China and Bangladesh. The country with the highest rate of stillbirths in the world is Pakistan with 47 stillbirths per 1 000 births. Countries with the lowest rates are Finland and Singapore, which both record only two stillbirths per 1 000 births.

South Africa ranks 176 out of 193 countries surveyed for stillbirth numbers. This translates to more than 22 500 stillbirths a year, or 20.36 stillbirths per 1 000 births.

Improving the quality of care at birth and targeting healthcare disparities are key priorities for action.

The quality of healthcare, overcrowding and understaffing at health facilities all need to be addressed.

This is a big challenge for South Africa’s already overstretched and understaffed public healthcare system, especially in rural areas where 46% of the population lives.

High on the list of risk factors for stillbirths are smoking and alcohol consumption during pregnancy. The fact that South Africa has the highest rates of foetal alcohol syndrome in the world does not bode well for stillbirth rates.

Being overweight has also been linked to stillbirths. Again, alarm bells should ring because obesity is a growing problem in South Africa.

Lifestyle diseases, such as diabetes and hypertension, which are fast becoming endemic in this country, are also high-risk factors.

The challenges for South Africa are immense.

But other countries have overcome equally daunting circumstances. Mexico, for instance, has halved its stillbirth rate in the past 15 years and now experiences just over five stillbirths per 1 000 births.

China, though it sits in the top five of countries with the highest rates of stillbirths, has also managed to halve its rates of stillbirths since 1995.

According to The Lancet, if key interventions are implemented, 44% of stillbirths or 1.1-million worldwide a year could be averted.

The interventions include comprehensive emergency obstetric care; syphilis detection and treatment; malaria prevention; the detection and management of foetal growth restriction, hypertension during pregnancy and diabetes and malaria prevention.

Stillbirths will be the topic of Bonitas House Call on August 20 on SABC2 at 09:00

This article originally appeared in the Mail & Guardian newspaper as a sponsored feature

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