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From: IRIN <[email protected]>
Date: Wed, Apr 27, 2011 at 2:33 PM
Subject: GLOBAL: Stillbirths could be halved
To: Jean-Francois Darcq <[email protected]>
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*GLOBAL: Stillbirths could be
halved<http://www.irinnews.org/report.aspx?reportid=92590>
*
[image: lead photo]DAKAR, 27 April 2011 (IRIN) - Preventing stillbirths can
cost just US$2.32 per mother if governments, the private sector and
international institutions adopt a package of 10 health interventions,
rather than allowing stillbirths to be an almost invisible problem.
If ten recommended interventions were 99 percent implemented in 68 priority
[low and middle-income] countries, the number of stillbirths could be
halved, said Professor Zulfiqar Ahmed Bhutta of the Aga Khan University
Medical Centre in Karachi, Pakistan, author of one of a series of papers on
stillbirth published in The Lancet medical journal
papers<http://www.irinnews.org/report.aspx?ReportID=92476>.
Even if the interventions were 60% covered, stillbirths could be reduced by
one-quarter. Some 2.64 million foetuses die after the 28th week of
pregnancy, mostly in low- and middle-income countries.
Interventions include: basic and comprehensive emergency obstetric care;
skilled care at birth; detection and management of foetal growth
restriction; detection and management of hypertension in pregnancy; elective
induction in post-term pregnancies; insecticide-treated bed nets and
intermittent prophylaxis to prevent malaria; detection and treatment of
syphilis; folic acid supplementation; and management of diabetes in
pregnancy.
*Identifying solutions
*
Stillbirths have largely been neglected in policy prioritizing for a variety
of reasons. "There was little in terms of verified data for stillbirths and
even less for its categories - whether intrapartum [during childbirth] or
antepartum [before childbirth] - and risk factors, and little confidence
that interventions could make a difference," said Bhutta.
The Lancet series hopes to change this perception by re-framing stillbirths
so that they are not seen as an unexplained event that occurs in the womb,
but as something that is potentially preventable if appropriate care is
given during pregnancy and birth.
Bhutta suggested in his paper that cheaper solutions, such as improving
antenatal care, preventing malaria, detecting and treating syphilis, be
adopted immediately, while more expensive interventions, such as training
health workers, and procuring equipment for emergency births, could be built
up gradually.
Other interventions would require improved long-term funding allocations,
including addressing hypertension, diabetes, post-term pregnancy (which
lasts longer than usual) and monitoring foetal growth problems.
Providing skilled attendants at birth would reduce intrapartum stillbirths
by about 23 percent, said Dr Joy Lawn, of NGO Save the Children, making it
the most effective single intervention. Almost half the women in low- and
middle-income countries give birth at home, without any skilled assistance.
Voucher schemes or conditional cash transfers could be used to encourage
women to have their babies in a facility, since in settings where the
highest infant mortality occurs, only half of all births take place in
facilities.
*Maternal mortality
*
In high-income countries, where most women receive fairly good quality care
while giving birth, the proportion of stillbirths is less than 10 percent of
all births.
Sub-Saharan Africa, which has a scarcity of skilled birth attendants, has
been making swifter progress than Asia in encouraging women to give birth in
a facility. "One year ago, the international community became acutely
nervous about the lack of progress on reducing maternal mortality," Lawn
said.
A year later, maternal
mortality<http://www.irinnews.org/Report.aspx?ReportID=90490>in
sub-Saharan Africa had fallen by 2.6 percent. "This marks significant
progress. For stillbirths, a lot of the focus in high-income countries has
been because parents have called for it. Setting a global policy goal is one
good way of getting it on the agenda."
One-third of African countries could meet the Millennium Development Goal to
reduce childhood mortality (Goal Four) and to improve maternal health (Goal
Five), which would also reduce stillbirths.
Some investments in reducing maternal mortality are already having a
positive effect on the number of stillbirths, but these results are not
given due significance. "Governments could argue for more investment if they
counted stillbirths in the work they're already doing," Lawn told IRIN.
Saving mothers' lives costs $23,000 per death averted, but if stillbirths
and neonatal deaths are included, the figure drops to $2,700 per life saved.
"Our single message is, 'Care at birth may be more expensive, but it gives
you the biggest bang for your same buck if you count it properly'."
aj/he
Read report online <http://www.irinnews.org/report.aspx?reportid=92590>
------------------------------
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