Table 4 Stillbirths – priorities for action based on the data

GLOBAL DATA AND POLICY PRIORITIES

• Tracking mortality reduction: Almost all (98%) of the world's 3.2 million stillbirths occur in low- or middle-income countries, yet stillbirths are rarely mentioned by global decision makers or United Nations Agencies. This is a missed opportunity for large scale maternal, newborn and child health (MNCH) investment programmes to track significant mortality benefit. Stillbirths should be included in mortality tracking wherever child and/or maternal outcomes are being assessed in household surveys or in health system or research evaluations.

• Intrapartum priority: Given that 1 million stillbirths occur during the time of labour and that half of the world's births are in facilities, improved obstetric care offers an immediate opportunity to reduce these deaths and the linked 840,000 neonatal deaths that are intrapartum-related. However, many intrapartum stillbirths occur at home or on the way to a facility, so innovative approaches are required to address delays in accessing obstetric care.

• Effective antenatal care: Around 2.2 million stillbirths occur during the last trimester but before the onset of labour. Given that over 75% of pregnant women globally access antenatal care (72% in Africa and 68% in South Asia), there are many missed opportunities for effective interventions to be provided through antenatal care. Priority conditions to address include pregnancy induced hypertension; antepartum haemorrhage; maternal infections such as syphilis, malaria and HIV; and obstetric risk conditions such as multiple pregnancy and abnormal lie.

NATIONAL DATA AND PROGRAMME PRIORITIES

• In many high-income countries, stillbirth rates have not been declining at the expected rate. Improvements are possible with increased use of confidential enquiry data and attention to implement well what is known but also to innovate to address key challenges.

• In middle-income countries, strengthening vital registration data for stillbirths and scaling up perinatal audit will give more data for priority setting and tracking of programme effectiveness.

• In low-income countries, urgent attention should be given to how to better measure stillbirth rates in existing large-scale household surveys (for example the use of pregnancy history instead of birth history modules) and consideration of post-survey verbal autopsy to increase data on stillbirth cause of death.

• In all country programmesfor maternal and neonatal health, when scaling up, specific attention should be paid to including high-impact interventions to reduce stillbirths and to tracking key indicators for quality of care such as intrapartum stillbirth rate.

• Research studiesfor maternal and neonatal health outcomes should consider measuring and reporting stillbirth outcomes.