Every 16 seconds the world records a stillbirth in some part of the planet. This translates to around two million stillbirths annually in recent years and many of these were preventable if there was adequate care.
These startling estimates on stillbirths were revealed in the ‘Global Burden of Stillbirths’ report released by UNICEF, World Health Organization and World Bank. India accounts for a large number of these deaths as it is one among six countries alongside Nigeria, Pakistan, Ethiopia, Democratic Republic of the Congo and China who bear half the burden of all stillbirths. The report also warned that the Covid-19 pandemic could exacerbate the stillbirths issue due to restrictions on health services.
Even as the rate of stillbirths declined by 53 per cent in India since 2000, in terms of absolute numbers the country still recorded the highest number of stillbirths, 3,40,622, in the world. As of 2019, its stillbirth rate was 13.9 stillbirths per 1,000 births. With 1,90,483 stillbirths per 1,000 births, neighbouring Pakistan recorded the second most number of stillbirths in the world with Nigeria, in the third position recording 1,71,428 deaths.
A stillbirth is defined in the report as a baby born with no signs of life at 28 weeks of pregnancy or more. Though this definition was not used in a third of all stillbirth data analysed for the report, the agencies involved adjusted the data as per the standard definition wherever possible.
The stillbirth rates varied vastly, ranging from 1.4 to 32.2 stillbirths per 1,000 total births in 2019. Sub-Saharan Africa, followed by Southern Asian, had the highest stillbirth rate and the greatest number of stillbirths, the report said. In 2019, three in four stillbirths occurred in sub-Saharan African or Southern Asia. Over 40 per cent of all stillbirths occur during labour – a loss that could be avoided with improved monitoring and timely access to emergency obstetric care when required, the report added.
Worryingly, even 39 high-income countries had a higher number of stillbirths than neonatal deaths and 15 countries had a higher number of stillbirths than infant deaths. According to the report, childbirth complications, post-term pregnancy, maternal infections in pregnancy such as malaria, HIV; maternal disorders, congenital disorders and fetal growth restrictions were some of the major causes of stillbirth.
Covid-19 and stillbirth
The report warned that the globally, the Covid-19 pandemic could worsen stillbirth numbers. “A 50 per cent reduction in health services due to the pandemic could cause nearly 200,000 additional stillbirths over a 12-month period in 117 low- and middle-income countries. This corresponds to an increase in the number of stillbirths by 11.1 per cent,” the report said.
Earlier, a modelling study of the John Hopkins Bloomberg School of Public Health carried out for the report said that 13 countries could see a 20 per cent or more rise in stillbirths by over a 12-month period.
The concerns surrounding the issue are linked to reduction in health services during various national and provincial lockdowns, overburdening of midwives and health workers with Covid-19 responsibilities. Additionally, the pandemic also disrupted medical supplies affecting maternal care in many parts of the world, the report said.
“Covid-19 has triggered a devastating secondary health crisis for women, children and adolescents due to disruptions in life-saving health services,” said Muhammad Ali Pate, Global Director for Health, Nutrition and Population at the World Bank and Director of the Global Financing Facility for Women, Children and Adolescents.
“Pregnant women need continued access to quality care, throughout their pregnancy and during childbirth. We are supporting countries in strengthening their health systems to prevent stillbirths and ensure that every pregnant woman can access quality health care services,” Pate said.
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