The heartbreaking reality of stillbirth—the loss of a fetus before or during delivery—remains a significant global health crisis, with devastating emotional, physical, and societal impacts on families worldwide. Despite considerable advancements in medical technology and neonatal care, stillbirths continue to claim the lives of millions of babies each year. A new study, published in The Lancet on November 4, 2023, by the Institute for Health Metrics and Evaluation (IHME), estimates that approximately 3 million stillbirths occurred globally in 2021 after 20 weeks’ gestation, highlighting the urgency of addressing this issue.
Stillbirths: A Devastating, Yet Often Preventable Outcome
Stillbirths are tragically common, and while many can be attributed to preventable factors, they remain largely underreported and underestimated in global health statistics. Traditionally, stillbirths have been counted from 28 weeks’ gestation onward, in line with the World Health Organization’s (WHO) recommendations. However, this approach has been criticized for excluding fetal deaths that occur between 20 and 28 weeks’ gestation, a significant gap where technological advancements have allowed for the survival of babies born extremely prematurely.
The recent study challenges this limitation by using a lower gestational age cutoff—20 weeks’ gestation—to more accurately capture the true scope of stillbirths. The researchers found that globally, approximately 8,328 stillbirths occur every day, or about one stillbirth every 10 seconds. Nearly one-third of these fetal deaths occurred between 20 and 28 weeks, a critical period where babies born prematurely are increasingly surviving due to improvements in medical care.
The Need for Comprehensive Recording and Reporting
As the study highlights, there is a glaring gap in the global reporting of stillbirths, which limits the ability to identify trends, allocate resources, and implement targeted interventions. Accurate data is essential for informing public health strategies and driving policy changes aimed at reducing stillbirth rates.
Global stillbirth statistics have historically excluded data on fetal deaths before 28 weeks, creating a skewed picture of the issue. By including stillbirths from 20 weeks’ gestation, health officials can better understand the factors contributing to these tragic events and develop effective interventions. Comprehensive efforts to record stillbirths are crucial for establishing accurate data on pregnancy loss and facilitating the necessary healthcare responses that can prevent future deaths.
The Role of Technological Advancements in Reducing Stillbirths
One of the key findings of the study is the significant role that technological innovations have played in improving the detection of pregnancy complications and the survival chances of premature babies. Among these innovations is cardiotocography, a technique that monitors a baby’s heartbeat and the mother’s contractions during pregnancy. This continuous monitoring provides valuable information on the baby’s well-being and helps detect potential complications early, allowing healthcare providers to intervene more effectively.
Studies have shown that computerized cardiotocography can reduce infant deaths around the time of birth by 80%, compared to traditional methods of monitoring that rely on manual pen-and-paper recordings. These technological advances have led to a significant decrease in infant mortality, particularly in preterm births, and offer hope for reducing stillbirth rates, especially among pregnancies that fall in the 20-28 week window.
Neonatal care has also evolved dramatically in recent years, with advances in respiratory support, nutrition, and temperature regulation for extremely premature infants. These developments have enabled babies born as early as 21 weeks to survive and thrive, further justifying the need to include 20-28 week stillbirths in global health statistics. The ability to support these infants medically has dramatically increased the chances of survival for babies born on the cusp of viability.
Why the 20-28 Week Window Matters
One of the most compelling arguments for updating stillbirth reporting guidelines is the fact that babies born between 20 and 28 weeks’ gestation are now more likely to survive due to advanced neonatal care. For instance, in some high-income countries, there have been documented cases of babies born at 21 weeks and one day who survive after receiving intensive medical intervention. This early viability is a direct result of improvements in preterm care technologies and has made it clear that stillbirths occurring in this gestational window are not only tragic but, in many cases, preventable.
In addition to improved survival rates for extremely premature babies, the ability to monitor fetal heart rates and detect fetal distress in utero has allowed clinicians to intervene earlier in cases where a stillbirth might have been otherwise inevitable. Early detection of complications such as pre-eclampsia, placental issues, or infections can help doctors manage these conditions before they lead to fetal death.
A Call to Action: Addressing the Global Stillbirth Crisis
Reducing the global stillbirth rate is a complex challenge that requires a multi-faceted approach. It involves improving access to quality prenatal care, better birth outcomes for preterm babies, and increased education for expectant mothers about the warning signs of complications. Furthermore, there must be a global commitment to tracking and reporting stillbirths more accurately, which in turn will help policymakers direct resources where they are most needed.
Governments and international organizations must invest in infrastructure that supports maternal health, especially in low- and middle-income countries where stillbirth rates remain alarmingly high. Addressing healthcare inequities, such as access to trained healthcare workers and medical technologies, is also a crucial step in reducing the global burden of stillbirths.
Finally, public health interventions should focus on raising awareness about the importance of prenatal care, the risks of preterm births, and the use of technology to monitor fetal health. Governments should prioritize investment in healthcare systems, particularly in high-risk areas where stillbirths are more prevalent.
Conclusion: A Global Imperative to Act
Stillbirth is not just a personal tragedy for families—it is a global public health issue that deserves urgent attention. With one stillbirth occurring every 10 seconds, the scale of the problem is vast, and the need for action is clear. By updating global standards to count stillbirths from 20 weeks’ gestation, improving prenatal monitoring, and leveraging new technologies, we can take meaningful steps toward reducing stillbirth rates and improving the lives of millions of families worldwide.
The findings of this study offer a powerful call to action for governments, healthcare providers, and international organizations to address stillbirth as a preventable tragedy, with the hope that, in the future, fewer families will have to endure the heartbreak of losing a child before birth.
References:
- Institute for Health Metrics and Evaluation (IHME), “Global Burden of Disease Study 2023: Stillbirths,” The Lancet, November 4, 2023.
- World Health Organization (WHO), “Stillbirths: Global Health Estimates,” 2023.
- Think Global Health, “A Stillbirth Every 10 Seconds,” Think Global Health, November 2023.
