Stillbirth grief buried

IT IS a silent epidemic that is grieved over behind closed doors. Even then, the grief is not legitimised – not by healthcare workers, families or society.

Stillbirth, in a five-paper series titled “Ending preventable stillbirths” in the medical journal The Lancet, explores the epidemic that sees the loss of 2.6 million babies’ lives annually. Of this figure, 98 percent occur in lowincome and middle-income countries, and 75 percent in subSaharan Africa and south Asia.

According to the report, released this month, half of all stillbirths (1.3 million) occur during labour and birth. Most result from preventable conditions such as maternal infections (notably syphilis and malaria), non-communicable diseases and obstetric complications. Few are due to congenital disorders, but some of these are preventable.

In Africa, five countries are in the top 10 countries with the highest stillborn numbers in 2015. Nigeria came in second with 314 000 babies born stillborn, Ethiopia had 97 000, Democratic Republic of Congo 88 000, Tanzania 47 000 and Niger 36 000. India recorded the highest number of stillbirths, with 592 000 delivered last year.

“Although most stillbirths occur in health facilities, more than 40 million women give birth unattended at home each year. Major equity gaps exist for coverage of intrapartum care, especially for home births in Africa and Asia. The belief that many stillbirths are unavoidable due to congenital abnormalities is widespread, yet these account for a median of only 7.4 percent of stillbirths after 28 weeks,” the paper states.

In high-income countries, 90 percent of stillbirths occur in the antepartum period, often associated with preventable lifestyle factors such as obesity and smoking, and suboptimal antenatal care.

The paper explains how stillbirths remain hidden from society.

“Disenfranchised grief is common, whereby parents’ grief after the death of their child is not legitimised or accepted by health professionals, their family or society. In a survey undertaken for this series, around half of 3 503 bereaved parents felt their community believed that ‘parents should try to forget their stillborn baby and have another child’.

“Many parents suppress their grief in public. Women whose babies have been stillborn especially feel stigmatised, socially isolated and less valued by society and, in some cases, are subject to abuse and violence.”

A further estimated 4.2 million women are living with depression associated with stillbirth. In 2014, the World Health Assembly endorsed a target of 12 or fewer stillbirths per 1 000 births in every country by 2030. By 2015, 94 mainly high-income and middle-income countries had already met this target.