Early last month, UNICEF published a haunting, yet largely ignored, report on behalf of the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) on which it is represented along with the World Health Organisation (WHO), the World Bank Group and the United Nations Department of Economic and Social Affairs, Population Division. The report, “Never Forgotten – the situation of stillbirth around the globe”, revealed that in 2021, an estimated 1.9 million babies were stillborn at 28 weeks of pregnancy or later. It pegged the global stillbirth rate at 13.9 stillbirths per 1,000 total births. The top news agencies in the world, which tend to publish almost every brief issued by the WHO, seemingly could not be bothered with this one although it was emblazoned on that organisation’s website on January 10, the date the publication dropped.
It is possible that part of the reason for this is because although the figure represents the global picture, in reality, the majority of stillbirths occur in developing and underdeveloped countries. Another probable cause is that stillbirths are still generally seen as a women’s issue, rather than the universal health problem they really are. Both explanations indicate a bias on the part of those news agencies, which are for the most part, male dominated. They also almost render the report’s title null and void.
The data in the report further explained that the figure quoted above meant that every day in 2021, over 5,000 babies were stillborn at 28 weeks or more of gestation and that two in five were intrapartum stillbirths, which means they died during labour. What is even more staggering is that this figure only accounts for babies at 28 weeks of pregnancy or later; the stage at which premature infants in developed countries have about a 90% chance of survival. However, there are likely millions of others, between 21 to 27 weeks who were not counted, which would make the stillbirth figure much, much higher. It is worth noting here that the youngest premature babies to have survived were born at 21 weeks in the US.
The report noted that progress has been made in reducing the global stillbirth rate from 21.3 per 1,000 total births in 2000 to 13.9 in 2021. While that progress can be lauded, it still took 21 long years. Further, although the stillbirth rate in Europe, Northern America, Australia and New Zealand is around 2.9 per 1,000 total births, in parts of Africa it is 21.0. The stark differences in these figures underline why reaching targets, like the Sustainable Development Goals for instance, appear unattainable. They also do not augur well for the WHO’s Every Newborn Action Plan, instituted in 2014, which aims to achieve a global stillbirth rate of 9 per 1,000 total births by 2030.
Release of data aside, one of the main purposes of this report was to remind governments that very often stillbirths can be prevented if mothers receive high-quality care both during gestation and childbirth. At the very least, pregnant mothers should be monitored for those non-communicable diseases that pose a danger not only to their children’s, but their own lives, like hypertension or hypotension, as well as any that develop as a result of their condition, for example gestational diabetes. Education and awareness about nutrition and supplements are also critical and these are all factors that do not require the outlay of huge sums of money. Obviously there are other complications that could very well arise, but in too many places, Guyana included, the very basics appear to be ignored which often leads to dire consequences.
The last published data for stillbirths in Guyana was 13.8 per 1,000 total births in 2019. This is available on the WHO website. Despite many calls over the years, the Ministry of Health rarely produces data on any aspect of health for local public consumption. The exception is Covid-19 figures, which it has been trotting out like clockwork over the last year or so. However, late last year, there was a spate of stillbirths coupled with maternal deaths at public hospitals. They included Rashanna Dindayal, 31, and her unborn child on October 20; Navita Maraj and her unborn child on October 29; and two unnamed women aged 40 and 19 years old respectively on November 12 and 13. As usual certain actions were promised, but, as we have come to expect, there has been no follow through.
Perhaps, unlike UNICEF, the authorities here believe that these are incidents best forgotten. If so, they are sadly mistaken. The grieving loved ones remember. Always. Maybe someday attention will be given to this; someone will have the decency and fortitude to step up and say what went wrong, what will change and actually mean it.
