First-Ever Global Review Examines Measures to Prevent over 3.2 million Stillbirths Globally
May 7, 2009
Aga Khan University, Johns Hopkins Bloomberg School of Public Health, Save the Children Co-Author Ground-Breaking Research
London, Karachi, Baltimore and Seattle
A first-ever global review of potential interventions to avert stillbirths, especially in low-income countries, was published on-line at the open access journal BMC Pregnancy and Childbirth today, and is available at the following website Stillbirths – the global picture and evidence-based solutions. Lead investigators from the Aga Khan University (Karachi, Pakistan), and colleagues from Johns Hopkins Bloomberg School of Public Health (Baltimore, USA) and the global organization Save the Children reviewed evidence for the impact of these interventions and strategies for delivering them.
This collaborative research initiative was led by Professor Zulfiqar A. Bhutta, Head, Division of Maternal and Child Health (AKU), with Dr. Yawar Yakoob at Aga Khan University, Drs. Gary L. Darmstadt and Rachel A. Haws from Johns Hopkins Bloomberg School of Public Health and Dr. Joy E. Lawn of Save the Children’s Saving Newborn Lives program.
“We chose to study the greatly neglected area of interventions to address stillbirths globally, with a special emphasis on developing countries. We suspected, and our review confirms, that few research groups have focused on addressing the burden of stillbirths through evidence based interventions. Our systematic review provides the platform on which to build recommendations for research, programs and policy,” said Professor Zulfiqar A. Bhutta, Head, Division of Maternal and Child Health, Aga Khan University (AKU).
The release of the study coincides with the opening of an International Conference on Prematurity and Stillbirth. This event is bringing together global leaders in science, public health and policy to examine the neglected but enormous issues of prematurity and stillbirth. One of the conference goals is to develop a coordinated strategy for successfully preventing these devastating pregnancy outcomes, both of which are major concerns in low-, middle- and high-income countries. The conference is being co-convened by the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), the Bill & Melinda Gates Foundation, March of Dimes, PATH, Save the Children, UNICEF, and the World Health Organization.
Every year 3.2 million stillbirths occur around the world; 98 percent take place in low- to middle-income countries. Stillbirths are still underreported and largely absent from data records and national policy making. The global burden of intrapartum stillbirths – stillbirths that take place during labour – is around 1 million, again mostly in low- and middle-income countries, which is more than all child deaths from malaria worldwide. Despite this, the investment and attention given to tackling stillbirths is low.
“In high- income countries such as the U.S. and the U.K. there is increasing recognition of the problem of stillbirths since the progress to reduce stillbirths has been minimal compared to progress for neonatal deaths, and parent groups are increasingly active,” said Dr. Joy Lawn of Save the Children's Saving Newborn Lives program. “In low- income countries the numbers are overwhelming at around 9,000 a day with 3,000 a day occurring during birth - yet behind each death families suffer the pain of loss, often compounded with guilt, but societal taboos keep this grief hidden. Studies show that even 20 years after experiencing a stillbirth women, have unresolved grief."
The BioMed Central supplement, Stillbirths – the global picture and evidence-based solutions, has been funded by Save the Children’s Saving Newborn Lives program through a grant from the Bill & Melinda Gates Foundation, and consists of six papers. BioMed Central is a leader in the new field of open access publishing, offering free on-line access to medical advances.
Paper 1 addresses the global burden, the epidemiology, risk factors and the causes of stillbirths and lays down the methodology and framework for this worldwide review. Papers 2 and 3 cover the behavioural and medical interventions used before and during pregnancy, which include interventions targeted at medical conditions and infections in the mother. Paper 4 focuses on screening and monitoring interventions during pregnancy and labour, including ultrasound and Doppler studies, managing maternal diabetes, and partographs and cardiotocography, among others. Paper 5 deals with the evidence of interventions during labour, while Paper 6 examines health system solutions, including training health workers in facilities and also at community level to improve care during pregnancy and childbirth.
Public access at the following links - for citation use below links
Commentary: Reducing the world’s stillbirths
Paper 1: 3.2 million stillbirths: epidemiology and overview of the evidence review
Paper 2:Reducing stillbirths: behavioural and nutritional interventions before and during pregnancy
Paper 3:Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy
This collaborative analysis is a crucial foundation to strengthen the knowledge and efforts to prevent this enormous health burden, and emphasises the need for stillbirth data to be included in global data tracking systems and policy dialogue.
"We found compelling evidence for impact of several interventions on preventing stillbirths, especially emergency obstetric care, screening and treatment for maternal infections such as syphilis, and prevention and treatment of malaria. Key data gaps remain, however, the largest remaining gap is for more widespread recognition and political commitment to reduce this massive loss of life," said Dr. Gary Darmstadt, former Director of the International Center for Advancing Neonatal Health in the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA, now Interim Director, Integrated Health Solutions Development and Team Lead, Maternal, Neonatal and Child Health, Global Health Program, Bill & Melinda Gates Foundation.
Media Contacts:
- Aga Khan University, Rida Turabi, .(JavaScript must be enabled to view this email address), T: +92 21-486-2931 (Karachi)
- Johns Hopkins University Bloomberg School of Public Health, Natalie Wood-Wright, .(JavaScript must be enabled to view this email address), T: 410-614-6029 (Baltimore)
- Save the Children, Dinah Lord, .(JavaScript must be enabled to view this email address), T: 202-640-6663 (Washington DC)
- GAPPS, Gretchen Sorensen, .(JavaScript must be enabled to view this email address), T: 206-794-1057 (Seattle)
- BioMed Central, Charlotte Webber, .(JavaScript must be enabled to view this email address), T: +44 (0)20-3192-2129, M: +44 (0)7825-317-342 (London)
Aga Khan University
Aga Khan University seeks to prepare individuals for constructive and exemplary leadership roles, and shape public and private policies through strength in research and excellence in education. As a private international university, it has teaching sites in eight countries across three continents. The University is part of Aga Khan Development Network, a group of private international development agencies working to improve living conditions and opportunities in the developing world through social, economic and cultural development.
Johns Hopkins Bloomberg School of Public Health
The Johns Hopkins Bloomberg School of Public Health is dedicated to the education of a diverse group of research scientists and public health professionals, a process inseparably linked to the discovery and application of new knowledge, and through these activities, to the improvement of health and prevention of disease and disability around the world.
Save the Children
Save the Children is the leading independent organization that creates lasting change for children in need in the United States and around the world. Save the Children USA is a member of the International Save the Children Alliance, a global network of 27 independent Save the Children organizations working to ensure the well-being and protection of children in more than 110 countries. Save the Children’s Saving Newborn Lives program, supported by the Bill & Melinda Gates Foundation, works in partnership with 18 countries to reduce newborn mortality and improve newborn health.
GAPPS
The Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s, works to eliminate prematurity and stillbirths globally. The one million annual deaths from prematurity contribute to more under-five deaths than AIDS, malaria or tuberculosis. In addition, a staggering three million stillbirths occur each year, yet this often-taboo topic is rarely addressed. In collaboration with diverse global partners in science, public health and policy, GAPPS is advancing research to understand causes; accelerating delivery of low-cost, effective interventions; and raising awareness about these neglected issues. GAPPS is also building a repository of data and specimens from pregnant women, such as blood and tissues, which will serve as a significant global resource in advancing medical and public health research.
BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth is an open access journal publishing original peer-reviewed research articles in all aspects of pregnancy and childbirth. BMC Pregnancy and Childbirth (ISSN 1471-2393) is indexed/tracked/covered by PubMed, MEDLINE, CAS, Scopus, EMBASE and Google Scholar.