Five unnamed babies around the world, 98% of them in the low and middlie-income countries, are laid to rest every minute. These babies are never recognized or acknowledged –they are born dead.

The Lancet’s recent series on stillbirths sheds much needed light on a truth that has largely gone ignored in the global community- that “7,300 stilbirths every day, or millions of stillbirths occur uncounted each year.
 
Most of these babies could be saved with access to quality care at birth and with solutions we know work. But when the global community does not count nor recognize these babies, how can we advocate for policies and programs that can save their lives and prevent needless deaths?
 
The Lancet identified the five major causes of stillbirths-- childbirth complications, maternal infections in pregnancy, maternal disorders, especially hypertension and diabetes, fetal growth restriction and congenital abnormalities. The series also identified ten interventions, which “if delivered at high coverage and quality, would substantially reduce the number of stillbirths worldwide at a very low cost.” Among these, care during childbirth by a skilled birth attendant who is equipped to address the major causes of death, focused antenatal care, and family planning offered as part of the package of interventions could significantly increase the likelihood of their survival.
 
When we do not recognize stillbirths we miss an opportunity to incorporate the care needed to save their lives into existing health service delivery packages for women and babies. The Millennium Development Goals (MDGs) and the Global Burden of Disease both omit stillbirths. And in many of the countries in which we work, it is the cultural standard to remain silent when a mother has given birth to a stillborn child. Sometimes the woman is even blamed and shunned from her community and considered “cursed” or enveloped by evil spirits. Both women and their babies deserve better.
 
Through household surveys, strengthening of routine vital registration and sentinel surveillance systems we can count stillbirths and begin collecting data on the cause of their deaths. Combined with improving access to quality health care services, this can help break the silence of stillbirths and truly save lives.
 
“Stillbirths are the last big invisible global health issues,” Joy Lawn of Saving Newborn Lives/Save the Children, a lead author of the series, is quoted as saying. “There are 2.65 million stillbirths a year- more than malaria and AIDS deaths combined- and yet they are never mentioned in global health data or policy.”
 
I applaud the Bill & Melinda Gates Foundation and Save the Children for funding this project and The Lancet Series for publishing its findings. It is because of studies like these that the global community can learn where we are failing mothers and their babies and can work to make sure we do our absolute best for them. And that starts with breaking the silence once and for all.
 
Koki Agarwal
Director
USAID’s flagship Maternal, Newborn and Child Health Integrated Program (MCHIP)