KARACHI, April 13: Every day more than 7,000 babies worldwide are born dead, with Pakistan ranking second among the top five countries that represent half of all the stillbirths, a medical survey has revealed. Effective interventions, however, exist that have proven to save life and reduce stillbirths by around half in low-income and middle-income countries, according to the latest edition of The Lancet as part of its newly launched Series on Stillbirths.
The new data — the first-ever set of nationally reviewed stillbirth estimates undertaken with the World Health Organisation — showed that just 10 countries represented two-thirds of all stillbirths. The countries (in order from the highest to the lowest stillbirths) were: India, Pakistan, Nigeria, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and Tanzania.
The survey showed that Pakistan had a rate of 47 stillbirths per 1,000 total births compared to the global rate of 19 per 1,000.
“Pakistan’s stillbirth rate has dropped only six per cent, from 51 to 47 per 1,000 live births between 1995 and 2009. Worse, Pakistan’s ranking at 193 in 1995 remains unchanged in 2009. The problem is ‘highest’ in the poorest provinces such as Khyber Pakhtunkhwa, Balochistan and Sindh,” said Dr Zulfiqar Bhutta, founding chair of women and child health division at the Aga Khan University and one of the lead authors of the report, while replying to Dawn queries.
According to the report, more than 2.6 million babies are born dead every year and around two-thirds of stillbirths occur in rural families worldwide, where skilled birth attendance is at least 50 per cent lower than in urban areas and caesarean section mostly unavailable.
Citing examples of other countries, the report stated that there had been notable successes in stillbirth reduction in many developing countries. China, Columbia, Mexico and Argentina had reduced their stillbirth rate by 40 per cent to 50 per cent, it added.
The report mentioned that 98 per cent of all stillbirths were reported in low-income and middle-income countries and more than three quarters (76pc) occurred in South Asia and sub-Saharan Africa in 2009. Most high-income countries had rates less than five per 1,000 while the high-burden countries had rates of 25 or more per 1,000.It stated that only 10 interventions across the 68 priority countries of the ‘Countdown to 2015’ initiative to track progress on the millennium development goals for maternal and child health would reduce stillbirths by around 45 per cent.
The interventions included provision of basic emergency obstetric care, primary care (outreach) involving community health workers and facility-based support, use of insecticide-treated bed-nets to prevent malaria and use of folic acid supplementation and management of diabetes in pregnancy.
“Of the 10 suggested interventions, childbirth care reduced the highest number of stillbirths, and should be the first priority, especially because of the additional benefits to women and newborns,” said Dr Bhutta, highlighting as to how the low-cost antenatal care that was effective against the stillbirths related to infection and malnutrition could be provided through outreach workers and services.
Regarding the opportunities available for intervention in developing countries, he said that voucher schemes or conditional-cash transfers could be used to encourage births at health facilities.
Dr Bhutta said, “Extra training and education could be given to community workers to support pregnant women. However, quality care is not the only issue. It is also a matter of getting women to that care.
“Many stillbirths occur due to the delay women can experience in receiving appropriate care, including delays in the recognition of high-risk maternal disorders, and in arranging transportation to health facilities,” he said.
Speaking about the vision for 2020, he said all countries with a stillbirth rate of over five should reduce the rate by half.
“Pakistan needs to develop and implement a plan to improve maternal and neonatal health that includes a reduction in stillbirths, and to count stillbirths in their statistics and other health outcome surveillance systems,” he said.
The Lancet series provides a comprehensive assessment of stillbirths to date, bringing together an international team of 69 authors from more than 50 organisations in 18 countries who have worked for over two years on the analysis, primarily funded by the Bill and Melinda Gates Foundation.