Stillbirth losses affect at least 2.6 million families a year worldwide, but there are solutions, researchers say.
In Thursday's online issue of The Lancet, researchers from 50 organizations in 18 countries examine the unseen reality of stillbirth after 28 weeks or during the third trimester — "death just when a parent expects to welcome a new life," as the summary called it.
A map in the journal shows how most stillbirths —1.8 million or 66 per cent — happen in developing countries such as India, Pakistan, Nigeria, China, Bangladesh, Congo, Ethiopia, Indonesia, Afghanistan and Tanzania.
"It's a scandal there are so many stillbirths that can be prevented," said Joy Lawn, director of global evidence and policy at Save the Children in South Africa, who led the Lancet series.
She said the politics of public health has meant the stillbirths problem has been sidelined by maternal and child health programs, even though there are more stillbirths than children killed by AIDS and malaria combined.
Major causes of stillbirth include childbirth complications, maternal infections in pregnancy and disorders such as high blood pressure and diabetes in pregnancy, and fetal growth restriction, in which babies fail to grow at the proper rate.
In developing countries, better obstetric care, treatment of conditions such as syphilis and high blood pressure in women, and other strategies could save more than one million infants a year, the researchers concluded.
In developed countries such as Canada and Australia, an indigenous woman is about twice as likely as a non-indigenous woman to experience a stillbirth.
"The paper has pointed out significant risk factors, and a lot of these risk factors — smoking and obesity and dietary issues — all these would disproportionately affect Aboriginal women," said Dr. Malcolm King, scientific director of the Canadian Institutes of Health Research's Institute of Aboriginal People's Health in Edmonton.
"These would collectively account for a lot of the stillbirths reported," he added in a statement.
The vision is to offer culturally appropriate care and locally delivered services. Canada faces challenges of transporting women from the Arctic to southern centres when needed, which is disruptive and expensive, King noted.