Giving Voice to the Realities of Stillbirth

By Dr. Hannah Blencowe, London School of Hygiene & Tropical Medicine and Betsy McCallon, CEO, White Ribbon Alliance

She stands there staring at you. After nine months of pregnancy she holds out her empty arms. Her baby died before it had a chance to live. She is from every country and most commonly from poorer, younger, marginalized or conflict-affected populations. How she reacts to the stillbirth may vary according to her culture.

But wherever she is from, stigma and taboo exacerbate her trauma. And she will never be the same.

The midwife who assisted her wants to provide quality and dignified care but is often working in an overloaded, under-resourced system. She needs to move on to attend the next patient and has limited capacity to support her.

What she may not know — because this is such a taboo subject — is that she is not alone.

Maternity ward bed in a district hospital in Malawi, copyright 2016 White Ribbon Alliance

More than 2.6 million women were affected by a stillbirth in 2015, half of these deaths occurring during childbirth. The effect of these deaths ripple outward, placing a heavy psychological and economic burden on women, families, communities and nations. An additional 4.2 million women are currently suffering from depression associated with stillbirth. Both parents may experience various psychological symptoms that persist long after the death of their baby.

She stands there staring at you. Her sister tells her, “It was meant to be.” Such fatalism abounds. We must change the social norms that allow these deaths to be acceptable or inevitable: they are neither. In fact, most stillbirths result from preventable conditions such as maternal infections, non-communicable diseases and obstetric complications.

We have solutions. We need to start by investing in the health of women before and between pregnancies, during pregnancy and childbirth, to achieve universal access to quality family planning, and antenatal and intrapartum care for every woman and baby. Everywhere.

Investing in just seven high-impact interventions to prevent stillbirths along the continuum of care could yield a 10–25 fold return in the economic and social value living children would provide their families, communities and nations. Yet donors, practitioners and advocates rarely mention stillbirth outcomes. We believe this is a missed opportunity in women’s and children’s health to measure the full impact of these investments and of the benefits of integration.

She stands before you, staring. Her baby entered and left this world unrecorded. There is no birth or death certificate. Her midwife did not record the outcome in the labor register for fear of being blamed for her death. Her baby is invisible. This must change.

To achieve the global target of ending preventable deaths by 2030, as outlined in the Global Strategy for Women’s Children’s and Adolescents’ Health, we need to count every birth and death, including stillbirths. We must promote the use of no-blame perinatal audits — a systematic analysis of the quality of perinatal care, including capturing and reviewing the causes and avoidable factors linked to deaths — in order to learn what went wrong and how we can improve outcomes. We also need to invest in better measurement of the coverage of high-quality care that will enable women and their babies to survive, thrive and transform — to achieve long-term well-being.

The way forward requires leadership from UN agencies, ministries of health, professional associations and civil society to improve data and break stigma and taboos around stillbirth. A holistic approach is required to build the capacity of the health workforce into one that encompasses empowerment, personal safety, respect and dignity in addition to clinical skills.

Most importantly, we must support women and their families to demand quality, equitable and dignified care, so that when a mother stands before you, after nine months of pregnancy with empty arms and a broken heart, she knows that her baby’s life mattered and that she is not alone.

This blog was adapted from presentations made in support of the Lancet Ending Preventable Stillbirth Series at the Women Deliver conference and the World Health Assembly. To learn more about the Lancet Ending Preventable Stillbirth Series and details about the estimates, please watch this webinar by Dr. Hannah Blencowe.