The World Health Organization estimates some 2.6 million stillbirths occurred worldwide in 2009, the overwhelming majority in developing countries. This first comprehensive set of estimates appears as part of a series of articles on stillbirths published in the British medical journal, The Lancet.
Every day, the World Health Organization reports more than 7,200 babies are stillborn - ninety-eight percent of them occur in low and middle-income countries. But, WHO notes, high-income countries are not immune, with one in 320 babies stillborn. WHO says this rate has changed little in the past decade.
The lowest rates of stillbirth, two per 1,000 live births, are in Finland, followed by Singapore, Denmark and Norway. The highest rates, 47 per 1000, are in Pakistan followed by Nigeria, Bangladesh, Djibouti and Senegal.
The data show about two-thirds or 1.8 million stillbirths occur in just 10 countries. The highest numbers are found in sub-Saharan Africa and in Southeast Asia.
The new estimates show the number of stillbirths worldwide has declined by just over one percent per year, from three million in 1995 to 2.6 million in 2009. This is even slower than reductions for both maternal and child mortality in the same period.
Catherine d’Arcangues of WHO’s Department of Reproductive Health and Research says the causes are many.
"There are definitely causes during childbirth, such as obstructed labor. There are causes due to infections in pregnancy," she said. For example, it is quite a shame to think there are two million cases of congenital syphilis a year, a disease, which really should be eradicated…Other infections such as malaria, HIV also induce stillbirth. We also know that with advancing age, mothers tend to experience most stillbirth and also with their first child."
D’Arcangues notes almost half of all stillbirths happen when the woman is in labor. She says these 1.2 million deaths are directly related to the lack of skilled care at this critical time.
Department Director of the Norwegian Institute of Public Health, Frederik Froen, says many stillbirths go unrecorded, so they are not seen as a major public health problem.
He says the vast majority of these stillbirths are not given a name. They are not held or dressed by the mother. They do not have a funeral. He says they are disposed of in the simplest possible way.
"That invisibility at the personal level is also seen for the mothers," he said. "A large proportion of them are marginalized and there is significant stigma associated to having a stillbirth. One out of four stillbirths around the globe are thought to be - thought by community to be caused by the mother’s own sins by witchcraft and evil spirits. And, in sub-Saharan Africa, evil spirits and maternal sins are equally seen as causes as medical causes are."
The World Health Organization says there are a number of well-known interventions that, if universally applied, could avert more than one million stillbirths.
These include comprehensive emergency obstetric care, detection and treatment of syphilis, malaria prevention, detection and management of fetal growth restriction, of hypertension and diabetes during pregnancy.
WHO says strengthening family planning services also would save lives by reducing the numbers of unintended pregnancies.