Covid-19 to worsen stillbirth epidemic, while SA's record is poorest of Brics countries

Welcoming a baby into the world should be a time of great joy, but for too many mothers it’s associated with grief as their babies die even before they catch their first breath.

According to a new UN and World Health Organisation report on stillbirths, released on Thursday, nearly 2m babies around the world are stillborn, with 5,400 stillbirths recorded daily. The report, titled A Neglected Tragedy: The Global Burden of Stillbirths, reports that three out of four stillbirths occur in Africa.

But now with many countries health systems under pressure due to the Covid-19 pandemic, the report warns that the number of stillbirths could shoot up even more. It has estimated that with a reduction of about 50% in health services as a result of Covid-19, nearly 200,000 additional stillbirths over a 12-month period could be recorded in low and middle income countries.

While SA has fared much better than its African counterparts such as Nigeria, Ethiopia and Somalia, which recorded about 25 stillbirths per 1,000, it is the worst performing country compared to its Brics counterparts.

In 2019, SA had 16.4 stillbirths for every 1,000 births. This is more than double the number of stillbirths in Brazil, which had 7.5 per 1,000 births. China had 7.5 stillbirths while Russia only had 3.8 stillbirths for every 1,000 babies born in that country. Other African countries with weaker economies also recorded fewer stillbirths compared to SA. Botswana recorded 15.2, Zimbabwe had 16 and Zambia had 14.8 stillbirths for every 1,000 births.

The report estimates that if the current trends continue there will be 16,500 stillbirths in SA in 2030, about three times more than Brazil, which is expected to record 4,900 stillbirths. China will have 43,700 stillbirths and India will see the biggest number at 210,700. If nothing changes, Nigeria will have 177,100 in the next 10 years and South Sudan will have 11,300 stillbirths.

The burden of stillbirths is highest in Africa and South Asia, with the two regions accounting for three quarters or 84% of all stillbirths. In Sub-Saharan Africa, the stillbirth rate of 21.7 per 1,000 total births was seven times higher than the lowest regional rate of 3.1 found in the Europe, US, Australia and New Zealand.

More worryingly, Africa’s portion of the global number of stillbirths has increased from 27% in the year 2000 to 42% in 2019 as population growth has outpaced decreases in stillbirth rates.

About half of all stillbirths occurred in six countries, that is Nigeria, Ethiopia, the DRC, India, Pakistan and China.

Most stillbirths were due to poor quality of care during pregnancy and birth. Over 40% of stillbirths occur during labour — a loss that could be avoided with access to a trained health worker at childbirth and timely emergency obstetric care — the report noted.

Researchers bemoaned the lack of investments in antenatal and intrapartum services including midwifery services, as the major driver of stillbirths.

They said despite advances in health services to prevent or treat causes of child death, progress in lowering the stillbirth rate has been slow. From 2000 to 2019, the annual rate of reduction in the stillbirth rate was just 2.3%, compared to a 2.9% reduction in neonatal mortality, and 4.3% in mortality among children under the age of five.

But progress is possible with “sound policy, programmes and investment”, they noted.

Dr Tedros Adhanom Ghebreyesus, WHO director-general, said the tragedy of stillbirth showed how vital it is to reinforce and maintain essential health services, “and how critical it is to increase investment in nurses and midwives”.

“Welcoming a baby into the world should be a time of great joy, but every day thousands of parents experience unbearable sadness because their babies are stillborn.”

In both low- and high-income settings, stillbirth rates are higher in rural areas than in urban areas. Socioeconomic status is also linked to greater incidence of stillbirth. For example, in Nepal, women of minority castes had stillbirth rates between 40 to 60% higher than women from upper-class castes.

Henrietta Fore, Unicef executive director, said the loss of babies during birth was not only a devastating tragedy for families, but often it was endured quietly, yet too frequently.

“Every 16 seconds, a mother somewhere will suffer the unspeakable tragedy of stillbirth. Beyond the loss of life, the psychological and financial costs for women, families and societies are severe and long-lasting,” she said.

“For many of these mothers, it simply didn’t have to be this way. A majority of stillbirths could have been prevented with high quality monitoring, proper antenatal care and a skilled birth attendant.”

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