Q&A: Less than two thirds of countries are on track to prevent stillbirths

Dr. Nick Kassebaum highlights the significant burden of stillbirths and the challenges of gathering accurate data.

This transcript has been lightly edited for clarity

What are the key findings from the research?

One of the main findings that we uncovered is that the burden of stillbirths, number one, is as big as the entirety of neonatal mortality, in terms of the actual number of pregnancies that are lost each year.

And then also, importantly, that historically we’ve only looked at stillbirths at 28 weeks’ gestation or longer, which leaves a big portion, up to a third of them, uncounted.

What challenges do you face obtaining stillbirth data?

It’s common within global health, where there’s actually uneven data coverage throughout the world. Over time, certain countries have lots of data, certain time periods have lots of data. And what we find is that the bigger the problem is, and the more in the shadows it sits, the less data are available. And stillbirths is probably the worst example that I’ve seen in that regard. The data coverage is often spotty, and the quality is really questionable.

With stillbirths decreasing, why does this research matter?

This research still matters because we do, on a regular basis, try to make the best assessments of all the available evidence. One of the conclusions of our assessment is that the burden is big and only slowly declining. Another assessment is that the data are lacking. We know that we haven’t made enough progress, and the only way to keep up with monitoring that progress is continuing to do the research. 

Are countries meeting global targets for declining stillbirths?

The Every Newborn Action Plan, much like many of the international goals for improving health and improving equity throughout the world, are universal targets that every country should be able to reach. The fact that only less than two-thirds of the countries in the world are on track is really concerning for progress in improving pregnancy health and minimizing stillbirths.

Where does the problem persist, and why?

The “where” is a lot easier. Most of the countries in Africa are not on progress to meet the Every Newborn Action Plan target, and many countries and areas of South Asia, and other low- and middle-income settings are similarly not on track.

The “why” is much more complicated because stillbirths are really a litmus test and a proxy for the health of a health system, in addition to the health of a mother and a community. There can be diseases that have not been adequately prevented, diseases and conditions in pregnancy that have not been adequately detected and managed, or delivery care is not as good as it should be, or not as available as it should be. 

What needs to be done, particularly at global and national levels?

We measure what we care about. That’s a common phrase, and we care about what we measure. So one thing that needs to change is for those countries, and at the global level, who are not yet doing it, to routinely and comprehensively track stillbirths, including gestational age. At the national level, for those countries that are not on target, real close looks, introspective looks, at health system structure and function are incredibly important to start bending the needle.