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Women's Health

Q&A: Why are Stillbirths still Societal Taboo?

There are nearly two million stillbirths every year. Credit: UNSPLASH/Claudia Wolff

There are nearly two million stillbirths every year. Credit: UNSPLASH/Claudia Wolff

UNITED NATIONS, Oct 26 2020 (IPS) - Societal taboo and a lack of understanding about stillbirth  can cause the issue to be neglected among health practitioners, according to Dr. Danzhen You, a senior adviser on Data and Analytics at the United Nations Children’s Fund (UNICEF).

She shared her insight with IPS after a U.N. high-level meeting organised to raise awareness and to end preventable stillbirths last week.

There are nearly two million stillbirths every year, according to a joint statement released ahead of the event by UNICEF, the World Health Organisation (WHO), and the World Bank Group and the Population Division of the U.N. Department of Economic and Social Affairs.

At the talk, WHO Director General Dr. Tedros Adhanom Ghebreyesus called for an end to the stigma surrounding stillbirths and for higher investments to prevent them. In the last 20 years, he said, 14 countries, including Cambodia, India and Mongolia have been able to reduce their stillbirth rate by more than half.

But this growth regressed because of the coronavirus pandemic.

With reference to the mothers who suffer from stillbirth, he said: “They need support, not shame.”

Christine Wangechi from Kenya, who suffered a stillbirth last year, said during her trauma, she was not aware that there are other women who had similar experiences.

She said her experience was very “silent” and that she hopes that in speaking publicly, she can help other grieving mothers feel less alone.

Istiyani Purbaabsari, a midwife from Indonesia who spoke at the event, also added that a lack of awareness may be impeding the progress on lowering stillbirths.

The stigma, combined with the lack of awareness or communication about the issue, means it remains left out of conversations, according to You of UNICEF, who is also the Coordinator of the U.N. Inter-agency Group for Child Mortality Estimation.

Excerpts of the interview with You follow:

Inter Press Service (IPS): According to UNICEF, the issue of stillbirths remains low as a priority on the global public health agenda. Why has it not been a priority in these conversations?

Dr. Danzhen You (DY): With two million babies stillborn every year, the burden of stillbirths is enormous. They are invisible in policies and programmes and under-financed as an area requiring intervention.

Most people (including some clinicians) do not have a common understanding of what a stillbirth is; definitions vary across and within countries and cultures. The death of an unborn baby remains a taboo topic in many cultures. Communications work has been insufficient in raising awareness among communities, health professionals, and policy makers about the burden of stillbirth, including numbers, preventability, and the pain and grief it causes to women and families

There is also a lack of understanding of stillbirths, leading to fatalism, guilt and blame. Many clinicians are not aware that most stillbirths are preventable with known interventions; many families and communities also do not realise this, meaning it is often the woman who is blamed or feels responsible for the loss.

IPS: How do the stigma and misconceptions surrounding stillbirth hamper the efforts to end stillbirths?

DY: Stillbirths are often regarded as inevitable events and may be grouped with miscarriages for reporting. In some cultures, stillbirths are perceived as the mother’s fault, resulting in public shaming or individual feelings of guilt or shame that prevent public mourning of their loss.

Moreover, the lack of opportunity to publicly grieve can cause stillbirths to be considered “non-events”. In some countries, stillbirths are perceived as rare, accounting for a negligible fraction of the burden of disease in countries or at global level.

These social taboos, stigmas and misconceptions often silence families or impact the recognition and grieving of stillbirths, contributing to their continuing invisibility.

IPS: How has the coronavirus pandemic affected the issue of stillbirths?

DY: The world is currently scrambling to understand how the COVID-19 pandemic might be leading to disruptions in health services. Our analysis shows that the response to the pandemic could worsen the situation by potentially adding nearly 200,000 stillbirths to the global tally over a 12-month period in 117 low and middle-income countries in a scenario with severe health service disruptions (around 50 percent) due to the COVID-19 pandemic. This number may underestimate the additional stillbirth burden that could occur.

However, we were missing opportunities to prevent families from experiencing the pain of stillbirths even before the pandemic. Few women received timely and high-quality care to prevent stillbirths. In half of the 117 low and middle-income countries analysed, less than two to 50 percent of pregnant women received key interventions that could prevent stillbirths. For example, coverage for assisted vaginal delivery – a critical intervention for preventing intrapartum stillbirths – is estimated to reach less than half of pregnant women in low-and middle-income countries.

IPS: What are some challenges that remain with  gathering statistics on the issue?

DY: The targets specific to stillbirths were absent from the Millennium Development Goals (MDGs) and are still missing in the 2030 Agenda for Sustainable Development. Many countries do not have a defined stillbirth target. Among the 93 countries that have reported on their progress using the Every Newborn Action Plan tracking tool, only 30 have a defined stillbirth target, compared to 78 countries with a neonatal mortality target.

Stillbirths are largely absent in worldwide data tracking, rendering the true extent of the problem hidden. Sixty two countries had either no stillbirth data or insufficient quality data. While the causes of neonatal death are tracked globally by WHO, there are no such data for stillbirth.

IPS: What do you think is the way ahead?

DY: Progress is possible with sound policy, investment and programmes. For example, Southern Asia, which has the second highest stillbirth rate of all regions in the world, has reduced the stillbirth rate by 44 percent since 2000.

We must do better, faster, or 20 million babies will be stillborn by 2030. There is hope, but only if we act now, collectively, by raising voices, increasing awareness, reducing stigma, taboo and misconception.


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