Editorial: The International Stillbirth Scandal

By Susan Yoshihara, Ph.D. | December 15, 2017

WASHINGTON, DC, December 15 (C-Fam) Every day somewhere in the world 800 women and 7000 children die in childbirth. This tragedy has rightfully garnered attention at the highest levels at the UN. Lurking in the shadows is a darker tragedy: 7100 additional children are stillborn every day yet their plight has been virtually erased from the international agenda.

At a conclave of maternal health experts last week in Washington the heads of the Guttmacher Institute, the White Ribbon Alliance, and senior staff from UNFPA and USAID were caught flatfooted when asked happened and what can be done.

The exception was Barbara Kwast, a petite, silver-haired Dutch midwife. Kwast, who served for decades in sub-Saharan African training midwives, helped WHO develop a simple chart to help birth attendants look for the signs of healthy babies in the early stages of labor. She said the “partograph” has fallen out of favor with those controlling the agenda. Many stillbirths go uncounted or misidentified.

Adding to the tragedy is the fact that just as stillbirth risks are knowable and manageable, its causes are too. A study released this year by the American College of Obstetricians and Gynecologists analyzed 512 stillbirths and found that testing the placenta identified a cause in about two-thirds of stillbirths, fetal autopsy helped in 40% of cases, and genetic testing helped in 12% of cases. But such tests are often out of reach from mothers and midwives in the developing world, whose work is woefully underfunded.

Ann Starrs, the head of Guttmacher, declined to answer if her organization might bring the same zeal to stillbirth that it brings to contraception and avoiding childbirth, the subject of her talk on maternal health.

Truth is, organizations like hers and UNFPA may not want to bring attention to the 2.6 million wanted children who die in utero every year. Their job is to keep the focus—and billions of dollars in annual funding—on averting so-called unwanted pregnancies. The United States doles out nearly half of this.

While it may not have been deliberate, the erasure of stillbirth was not a coincidence. A senior UNFPA official said at the advent of the Safe Motherhood Initiative in Nairobi thirty years ago there was a deliberate separation of the child from the rights of the mother. She admitted this was a “mistake.”

That “mistake” led to stillbirth’s eerie absence in the outcome document from the 1994 International Conference on Population and Development, the 1995 Fourth World Conference on Women, the 2000 Millennium Development Goals, and the 2015 Sustainable Development Goals. The latter will guide international funding priorities for decades to come.

And what about the treaty that obligates States Parties to reduce stillbirths? The committee that monitors compliance has only mentioned it once, to Chile in 1998, and only as an inquiry and not a recommendation for action. The same committee pressured countries to liberalize abortion 66 times, even though abortion is never mentioned in the treaty.

Meanwhile, the international coalition of maternal health practitioners from developing countries and activists from Western countries remains an uneasy one. The price of partnership seems to be accepting the diversion of billions of dollars every year to Western-based family planning organizations and away from more difficult, but lifesaving, tasks such as training and retaining midwives and giving them decent working conditions to deliver healthy babies to happy mothers and fathers.

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