How many lives are at stake? Assessing 2030 sustainable development goal trajectories for maternal and child health

Tthe article is nicely written but one thing that would have been worth mentioning or should have been discussed is that Still births, a massive segment of mortality, should have been included in sustainable developmental goals.

We point out certain facts about stillbirths as follows:

- According to WHO, any foetal deaths with >= 1000 g birthweight or >= 28 weeks of gestation or crown heel length of >35 cms, is still birth though different countries have different cut-offs. To put it simply, the definition recommended by WHO for international comparisons is a baby born with no signs of life at or after 28 weeks' gestation.1

- However, stillbirths are not included in the international measurements of mortality and morbidity.2 Zeshan Qureshi and colleagues emphasize that stillbirth should be given more importance and placed higher on the global health agenda.2

Global Situation:

The global rate of stillbirths was estimated to be 18.9 per 1000 births in 2009, coming to a total of 2.64 million stillbirths (with an uncertainty range of 2.08 million to 3.79 million), 1.2 million of which were during labour (intrapartum). 3,4,5

The burden is highest for women in low and middle income countries (98% of stillbirths) and among the most poor women in high income countries.5

Thus, occurrence of still births is related to socio-economic status and development which means that stillbirths are largely preventable. In 2009, 76·2% (three-fourths of stillbirths occurred in south Asia and sub-Saharan Africa.4 This corresponds to a similar distribution of maternal deaths and coincides well with areas of low-skilled birth attendants. The stillbirth rate in sub-Saharan Africa is approximately 10 times that of developed countries (29 vs. 3 per 1000 births).1

Ten countries (India, Pakistan, Nigeria, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Tanzania, and Afghanistan), which account for 54% of total global births, contributed to 67% of all stillbirths (1·76 million).4

References:

1. http://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en/ as accessed on 2/2/16
2. Qureshi ZU, Millum J, Blencowe H, Kelley M, Fottrell E, Lawn JE, Costello A,Colbourn T. Stillbirth should be given greater priority on the global health agenda. BMJ. 2015 Sep 23;351:h4620. doi: 10.1136/bmj.h4620.
3. Cousens S, Blencowe H, Stanton C, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 2011;377:1319-30.
4. Lawn JE, Blencowe H, Pattinson R, et al. Stillbirths: Where? When? Why? How to make the data count? Lancet2011;377:1448-63.
5. Lawn JE, Blencowe H, Oza S, et al. Every Newborn: progress, priorities, and potential beyond survival. Lancet2014;384:189-205.