KARACHI: Out of 186 countries measured on child mortality, Pakistan is the worst performer with 43.1 stillbirths per 1,000 births, according to a quintet of studies published by The Lancet on Tuesday.

The rest of the bottom 10 countries are Nigeria, Chad, Niger, Guinea-Bissau, Somalia, Djibouti, Central African Republic, Togo and Mali.

According to the medical journal, about 7,200 babies are stillborn every day — some 2.6 million per year — the overwhelming majority of stillbirths, about 98 per cent, occur in low- and medium-income countries and half of these deaths occur during delivery.

“But the truly horrific figure is 1.3 million” stillbirths that occur during delivery, The Lancet editors Richard Horton and Udani Samarasekera wrote in a comment.

“The idea of a child being alive at the beginning of labour and dying for entirely preventable reasons during the next few hours should be a health scandal of international proportions. Yet it is not,” they stated. The figures for 2015 represented a meagre drop from around 24.7 to 18.4 deaths for every 1,000 total births from year 2000 to last year, the journal reported.

The series found that prolonged pregnancy — delivery several days beyond the estimated birth date — was the main cause of stillbirths, contributing 14 per cent. Next in line were maternal health problems.

Nutrition, lifestyle factors such as obesity or smoking, and non-infectious diseases like diabetes, cancers or cardiovascular problems, each accounted for about 10 per cent of stillbirths.

Malaria infection accounted for about eight per cent of stillbirths and syphilis 7.7 per cent.

“Despite the fact that a lot of advocacy has been done over the last many years, stillbirths, especially those that occur during the process of childbirth, remain a huge global challenge, and an unrecognised public health issue.

“These papers highlight the huge burden of morbidity and grief associated with stillbirths and also provide a template of solutions that can end this preventable tragedy within our lifetime,” said Prof Zulfiqar A Bhutta, founding director, Centre for Excellence in Women and Child Health, Aga Khan University and Co-Director, Sick Kids Centre for Global Child Health in Toronto, Canada.

Published in Dawn, January 20th, 2016