Review: How can we reduce the global stillbirth rate? By Karen Hofman

The article begins with the significant attention being showered on Maternal and child deaths in a bid to meet the Millennium Development Goals by the end of 2015, while "Stillbirth targets were omitted from the MDGs and remain absent from the post-2015 Sustainable Development Goals," the writer stated.

Stillbirth : according to the American National Stillbirth Society, is defined as the intrauterine death and subsequent delivery of a developing infant that occurs beyond 20 completed weeks of gestation.

The article however describes still births as the death of babies either during pregnancy or during delivery. Deaths earlier than 28 weeks were categorized as miscarriages.

This is in tune with the WHO definition.

Statistics:

A significant 98% of the occurrence takes place in low- and middle-income countries.

A ranking of stillbirths in 193 countries by the Lancet medical journal, placed South Africa in the 148th position, India at 154th and Nigeria at 192nd. 

Hence, the launch of the Every Newborn action plan in 2014 by the WHO, with a global target to reduce stillbirth rates to ten for every 1000 births by 2035.

In South Africa, the rate is currently 18 still births per 1000 births. However, South Africa hopes to achieve the WHO target by 2016.

The article highlighted the following risk factors :

- Maternal age greater than 34

- Conditions such as :

*High blood pressure

*Diabetes

*Obesity

-Maternal bleeding

-Insufficient oxygen to the baby.

Various efforts and strategies at different levels have been implemented in South Africa to curb this menace.

Some of the strategies implemented include:

- detecting and treating HIV earlier in pregnant women

- managing hypertension and diabetes better

- improving both essential and emergency obstetric care during labor and delivery

- advocating good nutrition well before pregnancy so as to prevent obesity

According to the article, of all the interventions; improved labor and delivery management would have the highest impact and could potentially avert 60% of the stillbirths.

Scaling up these interventions could prevent an additional 5400 stillbirths annually while also preventing the deaths of additional 1300 mothers and 4900 newborns, resulting in a triple return on investment.

The resultant effect will be a drop by 30% of South Africa’s stillbirth rate, thus enabling the Nation to meet the World Health Organization's interim goal for 2030.

The interventions were also found to be affordable and would amount to little more than 0.5% of the total health budget.

Other highlighted areas of improvement include:

- Improvements in the quality of care :

By eliminating delays in accessing services,

ensuring cleanliness, infection prevention, reduced waiting times, drug availability and improved staff attitudes.

- Increased community awareness to enable families recognize danger signs and seek care promptly.

- More research to understand the causes of stillbirths before labor.

- The elimination of "under-reporting" of cases.

In conclusion the article alluded to the fact that although some of the causes are unknown, many of the deaths are preventable. 

According to the Lancet better clinical care, monitoring and interventions could halve stillbirths in poorer countries by 2020.

In my opinion, given the huge global burden of this issue with about 2.6 million deaths annually and majorly in sub Saharan Africa more attention needs to be focused on looking into the causes and possible applicable interventions.   

This is a shout out to the International community to prioritize issues pertaining to still births in the post 2015 era as the World transitions from the MDGs to the SDGs.