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How The Lancet mobilized scientists to tackle a silent scandal

Highlighting the data behind stillbirths to bring about change

98 percent of stillbirths occur in low- and middle-income countries, with two-thirds in South Asia and Sub-Saharan Africa. (Image from The Lancet video <em>Ending Preventable Stillbirths</em>. Watch the video below.)
98 percent of stillbirths occur in low- and middle-income countries, with two-thirds in South Asia and Sub-Saharan Africa. (Image from The Lancet video Ending Preventable Stillbirths. Watch the video below.)

Numbers have a way of revealing truth without ambiguity.

  • 2.6 million babies worldwide are stillborn each year. The majority of these deaths are preventable.
  • 98 percent of stillbirths are concentrated in low- and middle-income countries, with two-thirds in South Asia and Sub-Saharan Africa. It is a tragedy that also features disproportionately in high-income countries.
  • In 2016, the United States experienced over 20,000 stillbirths.

With statistics like these, from recent Lancet reports, it’s surprising the world has not demanded more attention to the issue of stillbirths.

Richard Horton, FRCP, FMedSciIn January 2016, Dr. Richard Horton, Editor-in-Chief of The Lancet, set out to change the status quo. The Lancet is one of the world’s most prestigious scientific journals from Elsevier, an information analytics business known for combining smart technology with scientific and medical content. With this unique convening power, Dr. Horton decided to bring together scientists and experts from around the world to address this major public health issue.

The experts came from more than 100 organizations and 43 countries and were co-led by Prof. Joy Lawn, Director of the MARCH Centre at the London School of Hygiene & Tropical Medicine.

Prof. Joy Lawn, MPH, PhDThey published a series of five papers addressing fundamental issues related to stillbirths. This included analyzing where the biggest burden of stillbirths lies and which countries are most affected and, most importantly, translating this knowledge into a call to action to prevent stillbirths.

What Dr. Horton found particularly shocking was the figure of 1.3 million stillbirths that happen during labor per year. As he said at the time:

The idea of a child being alive at the beginning of labor and dying for entirely preventable reasons during the next few hours should be a health scandal of international proportions. Yet it is not. Our series aims to make it so.


Watch a video about The Lancet’s campaign to end preventable stillbirths


Following a dedicated campaign, including a conference and press launch, the series was reported in over 80 countries on television, radio and online, helping to publicize the compelling evidence that most stillbirths are preventable and instigating action from parents, healthcare professionals and politicians.

Raising public awareness of one of the world’s biggest health burdens sits within the mission of Elsevier and its parent company RELX Group, providing information and analysis to help people make better decisions. From The Lancet’s point of view, that means publishing the best science to improve the health of people worldwide.

A delivery room has been prepared for a stillbirth at Inselspital, Bern, Switzerland (Photo by Matthieu Zellweger for The Lancet)

Fast forward two years, and what has the Ending Preventable Stillbirths Series helped achieve?

  • In mid-2016, the World Health Organization announced they will ask countries to report stillbirths rate data.
  • So far 10 out of 51 priority countries tracked by UNICEF have set targets for stillbirth reduction by 2030. This compares to 43 out of 51 priority countries that have set targets for neonatal mortality reduction.
  • In November 2017, UK Minister of Health Jeremy Hunt announced that the UK government will bring forward the target to halve the UK stillbirth rate by 2025 rather than 2030. In addition, the UK government is planning to change the law so that coroners have the power to investigate stillbirths through inquests, providing additional accountability.
  • Including stillbirths when counting the burden of pregnancies affected by Group B Streptococcus has shown that the burden is almost doubled worldwide compared to only counting child deaths, making a stronger case for a maternal vaccine for Group B Streptococcus. This is an example of missing impact of interventions if stillbirths are not counted.

The results are encouraging, but more must be done. Reflecting on the impact of the series, Prof. Lawn said:

By working in partnership with The Lancet and so many organizations, we have undoubtedly raised awareness – more than any of us could have done on our own. This awareness, especially that most of the world’s 2.6 million stillbirths are preventable, is helping initiate policy change, but more practical change is required to accelerate change especially in the highest burden countries. Any stillbirth, anywhere, is a tragedy, and with The Lancet, we will continue our mission to improve data evidence and accountability for action.

Call to action for global health community, country leaders and citizens

  • Intentional leadership: Ensure efforts to address stillbirths are at the center of implementation plans for women’s, children’s and adolescents’ health.
  • Increased voice: Empower community groups, including women’s groups and affected families, to raise their voices to formulate plans to reduce stillbirths and hold decision-makers to account.
  • Implementation: Ensure stillbirth prevention is integrated into programming for women’s and children’s health with specific interventions on stillbirths to improve quality care in pregnancy and childbirth.
  • Indicators to measure impact: Address data gaps by tracking stillbirths and ensure effective coverage of quality care
  • Investigation: Invest in more research to end stillbirths and care for affected families.

Read the full Call to Action in the executive summary of the Ending Preventable Stillbirths Series.

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