Stillbirths: why they matter

doi:10.1016/S0140-6736(10)62232-5

The Lancet

Volume 377, Issue 9774, 16–22 April 2011, Pages 1353-1366

https://doi.org/10.1016/S0140-6736(10)62232-5 Get rights and content

Summary

In this first paper of The Lancet's Stillbirths Series we explore the present status of stillbirths in the world—from global health policy to a survey of community perceptions in 135 countries. Our findings highlight the need for a strong call for action. In times of global focus on motherhood, the mother's own aspiration of a liveborn baby is not recognised on the world's health agenda. Millions of deaths are not counted; stillbirths are not in the Global Burden of Disease, nor in disability-adjusted life-years lost, and they are not part of the UN Millennium Development Goals. The grief of mothers might be aggravated by social stigma, blame, and marginalisation in regions where most deaths occur. Most stillborn babies are disposed of without any recognition or ritual, such as naming, funeral rites, or the mother holding or dressing the baby. Beliefs in the mother's sins and evil spirits as causes of stillbirth are rife, and stillbirth is widely believed to be a natural selection of babies never meant to live. Stillbirth prevention is closely linked with prevention of maternal and neonatal deaths. Knowledge of causes and feasible solutions for prevention is key to health professionals' priorities, to which this Stillbirths Series paper aims to contribute.

Section snippets

Why stillbirths matter

A mother gives birth to her baby after many months of pregnancy. But her baby is dead. Few words are needed to convey the tragedy of stillbirth. At the beginning of the third-trimester of pregnancy, the baby weighs about 1 kg, and most babies have the capacity to live outside the womb.¹ At this stage of pregnancy, the risk of stillbirth is about 2%, and the risk of death at the very beginning of life is only matched when people reach their 80s.2, 3, 4, 5 Once regular contractions have indicated

Stillbirth in the global health arena

In global health policies, the high burden of stillbirths seems incongruent with global action to prevent them. Stillbirths have been the invisible losses. Whereas motherhood has been the focus of global initiatives and interventions over the past decades, there has been a lack of focus on most mothers' own aspiration: a live baby. Unlike the intertwined issues of maternal and infant deaths, prevention of stillbirths is not among the priorities of the UN Millennium Development Goals.²⁴ At the

Perceptions of stillbirth

In many settings, safe and effective health care is consistently provided for pregnant women and their babies. If a stillbirth occurs, a mother will receive respect and support from health-care providers. But, although pregnant mothers in western societies are generally “encouraged to think of an unborn baby as a precious person, a valued subject”,17, 39 society often diminishes the value of the baby once the baby is dead, and, implicitly, diminishes the dignity of the grieving mother. Faced

The politics of stillbirth

Not surprisingly, we identified that stillbirth rates inversely correlate with the wealth and development of nations (figure 4). However, even when those factors are considered, stillbirth rates are inversely associated with indices of sex equality such as secondary education and reproductive control, such as the use of contraceptives (figure 4). In many poor rural areas, the low priority for interventions to prevent stillbirth might relate to women's lack of power and voice.⁷¹ Women's rights

The priorities of health professionals

Although variations in preventability by gestational age and cause exist, stillbirths can be prevented in both high-income and low-income settings.8, 13, 22 Bringing the mortality of the highest burden settings (stillbirth rate ≥25 per 1000 births)⁷ down to the global average (19 per 1000 births)3, 7 would eliminate a quarter of the world's stillbirths. In terms of stillbirth rates, low-income countries are now where high-income countries were 50–100 years ago,⁷² and bringing global stillbirth

A dilemma in reproductive health?

Although knowledge of burden, causes, and prevention feasibility might be key to health professionals' priorities for stillbirth, precedence for health initiatives is not formed exclusively by perceived opportunity.73, 74 Priority indicates comparison, and initiatives in global maternal and child health might be weighed against stillbirth prevention initiatives. Yet it is well established that both maternal and child health would benefit substantially from stillbirth prevention initiatives.8, 23

The void of ownership

Many individuals, organisations, institutions, and governments have the power to prioritise stillbirth, but have not done so. The present status of stillbirth is not dissimilar to that of neonatal mortality only a decade ago, when it also lacked global visibility and before a dedicated group assumed leadership and brought the topic onto the global health agenda.⁷⁴ The case of newborn survival indicates that the rapid emergence of global priority for such neglected issues is indeed possible if a

Making stillbirth a priority

The dissimilar customs across cultures indicate the facets of the universal burden of stillbirth, not only the loss that every stillbirth represents, but also the additional burden through stigma and marginalisation. Stillbirth prevention initiatives will be most effective if aligned with efforts to provide better support and understanding for affected women. The research gap in understanding and improvement of conditions for women affected by stillbirth leads to the continued harm of women

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Cited by (253)

Support interventions to reduce psychological distress in families experiencing stillbirth in high income countries: A systematic review
2024, Women and Birth
Previous research indicates disparities in the care of bereaved parents and siblings following a stillbirth in the family. The aim of this systematic review was to assess the effects of interventions aimed at reducing psychological distress among parents or siblings in high-income countries after experiencing a stillbirth.
The databases CINAHL, Medline, PsycInfo, Cochrane Library, and EMBASE were searched in August 2022.
Four intervention studies from the United States (US), the United Kingdom (UK), Finland, and Australia, met the inclusion criteria. The interventions comprised a perinatal grief support team; a perinatal counselling service; a grief support program; and a support package including contacts with peer supporters and health care staff. No studies of interventions for siblings were found. The results could not be synthesised due to disparities in interventions and outcome measures. The risk of bias was assessed as high in all four studies and the certainty for all outcomes was rated as very low.
More controlled trials with rigorous methods are needed to evaluate the effect of bereavement support interventions in parents and siblings after stillbirth. Future studies should include a core outcome set to make them more comparable. Most of the studies in this review were assessed to have an overall high risk of bias, mainly due to problems with missing outcome data; thus, future studies could specifically target this problem.
An exploration of women's lived experiences of care and support following perinatal death in South-Western Nigeria: A hermeneutic phenomenological study
2024, Women and Birth
Perinatal death results in long-lasting intense grief for bereaved mothers with a potential to negatively impact on their short- and long-term outcomes and quality of life if inadequately supported in coping with and managing their experience.
This study aimed at exploring the lived experience of women, of care and support following perinatal death in South-Western, Nigeria.
A qualitative methodology using Heideggerian phenomenology was used. Fourteen women who had experienced perinatal death in South-Western Nigeria within the last (5) five years were interviewed, and Van Manen’s approach to hermeneutic phenomenology was used in data analysis.
Four main themes were identified: “they did not tell me the baby died”, “response of health care professionals after the baby died”, “moving on from hospital”, and “support from family”. The physical health status of mothers determined how they were informed of perinatal death. Health care professionals were distant, rude, nonempathetic and did not offer emotional support, in some cases. Mothers were given opportunity to see and hold their babies. There was no routine follow-up support in the community, besides a postnatal check-up appointment offered to all mothers regardless of their birth outcome. Family provided emotional support for mothers on discharge.
This study was the first to explore the lived experience of women of the care and support following perinatal death in South-Western, Nigeria. There is a need for healthcare systems to review bereavement care and support provisions for women who experience perinatal death.
The needs of women experiencing perinatal loss: A qualitative systematic review and meta-synthesis
2023, Women and Birth
There have been some studies on the needs of women experiencing perinatal loss in various socio-cultural contexts, but there is no research that systematically and comprehensively synthesizes these needs.
Perinatal loss has profound psychosocial effects. The misconceptions and prejudices existing in the public, the lack of satisfactory clinical care, and the available social support may all increase the negative impact.
To synthesize evidence for the needs of women experiencing perinatal loss, attempt to explain the findings, and provide insights into the application of evidence.
Published papers were searched in seven electronic databases until 26 March 2022. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the methodological quality of the included studies. Through meta-aggregation, the data was extracted, rated, and synthesized, resulting in new categories and findings. The credibility and dependability of the synthesized evidence were evaluated by ConQual.
Thirteen studies that fulfilled the inclusion criteria and quality assessment were included in the meta-synthesis. Five synthesized findings were identified, covering information needs, emotional needs, social needs, clinical care needs, as well as spiritual and religious needs.
Women’s perinatal bereavement needs were individualized and diverse. There is a necessity to understand, identify, and respond to their needs in a sensitive and personalized way. Families, communities, healthcare institutions, and society form a coordinated whole and provide accessible resources to improve recovery from perinatal loss and a satisfactory outcome in the subsequent pregnancy.
Perinatal grief creates vulnerability to anxiety in subsequent pregnancy: the mediating role of bereavement-related guilt
2024, Journal of Reproductive and Infant Psychology
(In)visibilising pregnancy loss in Southern Malawi
2024, Culture, Health and Sexuality
Contemporary Issues in Women's Health
2024, International Journal of Gynecology and Obstetrics

View all citing articles on Scopus

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SeriesStillbirths: why they matter

Summary

Section snippets

Why stillbirths matter

Stillbirth in the global health arena

Perceptions of stillbirth

The politics of stillbirth

The priorities of health professionals

A dilemma in reproductive health?

The void of ownership

Making stillbirth a priority

Lancet

Lancet

Eur J Obstet Gynecol Reprod Biol

Am J Obstet Gynecol

Reprod Health Matters

BJOG

Lancet

Midwifery

Lancet

Soc Sci Med

Soc Sci Med

Lancet

Lancet

Soc Sci Med

Int J Gynaecol Obstet

Lancet

Lancet

Maternal antenatal profile and immediate neonatal outcome in VLBW and ELBW babies

Indian J Pediatr

Life tables for WHO member states

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

Lancet

Neonatal and perinatal mortality—country, regional and global estimates 2004

Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done?

Int J Gynaecol Obstet

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

Lancet

Stillbirths: how can health systems deliver for mothers and babies?

Lancet

List of member states by WHO region and mortality stratum

Human development reports. UN 2010

Statistics and indicators on women and men. UN 2010

Stillbirths: the way forward in high-income countries

Lancet

Making stillbirths count, making numbers talk—issues in data collection for stillbirths

BMC Pregnancy Childbirth

Stillbirth: the mother's experience and implications for improving care

J Soc Work End Life Palliat Care

Psychological complications after stillbirth—influence of memories and immediate management: population based study

BMJ

Grief reactions to perinatal death—a follow-up study

Can J Psychiatry

Long-term psychosocial sequelae of stillbirth: phase II of a nested case-control cohort study

Arch Womens Ment Health

The psychological effects of stillbirth and neonatal death on fathers: systematic review

J Psychosom Obstet Gynaecol

The global burden of disease: 2004 update

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

Lancet

Stillbirths: the vision for 2020

Lancet

General Assembly Resolution 55/2 United Nations Millennium Declaration

Series
Stillbirths: why they matter