By Sarah-Jane O'Connor 19/01/2016

Women from lower socioeconomic backgrounds face twice the risk of stillbirths as their wealthier counterparts, a new study has detailed.

Addressing the inequalities would require across-the-board improvements, including treating infections during pregnancy and improving family planning services.

The Australian-led study, published today in The Lancet, suggested nearly 20,000 stillbirths could have been prevented in 2015. Though maternal and child deaths have halved globally, stillbirth remains a global epidemic with an estimated 2.6 million deaths per year.

The article was one of a five-part series on ending preventable stillbirths, which coincided with The Lancet launching a campaign to draw attention to the issue.

New Zealand’s rate of 2.3 stillbirths (occurring after 28 weeks of pregnancy) per 1000 births in 2015 fares better than other countries, including Australia (2.7 per 1000 births) and has reduced in recent years.

University of Auckland’s Professor Lesley McCowan, study co-author, said while New Zealand was doing well, tenth in the global ranking, “but we can still do better with research aimed to identify modifiable risk factors for stillbirth here”.

Globally, 98 percent of all stillbirths occur in low- and middle-income countries and while the annual rate of reduction for stillbirths is two percent, that is slower than progress made for maternal (3 percent) and child deaths (4.5 percent).

Ten countries account for two-thirds of stillbirths: India has the highest number, estimated at 592,100 in 2015, while the highest rates are in Pakistan (43.1 per 1000 births) and Nigeria (42.9). Rates are lowest in Iceland (1.3), Denmark (1.7), Finland (1.7) and the Netherlands (1.8).

In high-income countries, women living under adverse socioeconomic circumstances have about twice the risk of a stillbirth as their wealthier counterparts. In Europe or Australia, women of south Asian or African origin have a stillbirth risk two to three times higher than white women.

In Sub-Saharan Africa, with high rates of stillbirth and slow progress, it would take over 160 years before the average pregnant woman had the same chance of her baby being born alive as a woman living in a high-income country does now.

The research series included the first global analysis of risk factors associated with stillbirth, which concluded that many deaths could be prevented by treating infections during pregnancy, tackling obesity and non-communicable diseases (notably diabetes and hypertension), improving access to and quality of family planning services and addressing inequalities.

London School of Hygiene and Tropical Medicine’s Professor Joy Lawn, who co-led the series, said there were hidden consequences of stillbirth: with more than 4.2 million women living with symptoms of depression, often for years, in addition to economic loss for families and nations.

“We must give a voice to the mothers of 7,200 babies stillborn around the world every day. There is a common misperception that many of the deaths are inevitable, but our research shows most stillbirths are preventable,” Lawn said.

“Half of the 2.6 million annual deaths could be prevented with improved care for women and babies during labour and childbirth, and additionally, many more lives could be saved with effective care during pregnancy. We already know which existing interventions save lives.”

“These babies should not be born in silence, their parents should not be grieving in silence, and the international community must break the silence as they have done for maternal and child deaths,” said Lawn. “The message is loud and clear – shockingly slow progress on stillbirths is unacceptable.”

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