This article is part of the supplement: Stillbirths – the global picture and evidence-based solutions
Commentary: reducing the world's stillbirths
1 Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19102, USA
2 Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
3 Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
BMC Pregnancy and Childbirth 2009, 9(Suppl 1):S1 doi:10.1186/1471-2393-9-S1-S1Published: 7 May 2009
One of the major success stories of modern obstetrics in high-income countries in the last 5 decades is the reduction of stillbirths from rates as high as 50 per 1000 births to about 5 per 1000 births today. Fetal mortality associated with obstructed labour, asphyxia, hypertension, diabetes, Rh disease, placental abruption, post-term pregnancies and infections such as syphilis all have declined. Much of this success has occurred in term births in the intrapartum period so that most stillbirths in high-income countries now occur in the antepartum period and are pre-term. Current stillbirth rates in many low- and middle-income countries, and especially in those areas within the countries with poorly functioning health systems, approximate those seen in high-income countries 50 years ago. A major difference between the stillbirths occurring in high-income countries and those occurring elsewhere is the preponderance of late pre-term, term and intrapartum stillbirths in low-resource countries. Those stillbirths should be relatively easy to prevent by known risk assessment methods and prompt delivery, often by Cesarean section. This commentary addresses an extensive six-paper review of stillbirths with an emphasis on low- and middle-income countries. Among the conclusions are that while a number of interventions have been shown to be effective in reducing stillbirths, unless there is a functioning health system in which these interventions can be implemented, the potential for a sustainable and substantial reduction in stillbirth rates will not be reached.