Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done?

Lawn, Joy E.; Lee, Anne CC; Kinney, Mary; Sibley, Lynn; Carlo, Wally A.; Paul, Vinod K.; Pattinson, Robert; Darmstadt, Gary L.

doi:10.1016/j.ijgo.2009.07.016

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Volume 107, Supplement , Pages S5-S19, October 2009

Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done?

Joy E. Lawn
- Saving Newborn Lives/Save the Children-USA
- Corresponding author. Saving Newborn Lives/Save the Children USA, 11 South Way, Cape Town 7405, South Africa.
Anne CC Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Mary Kinney
- Saving Newborn Lives/Save the Children-USA
Lynn Sibley
- Nell Hodgson Woodruff School of Nursing and Rollins School of Public Health, Emory University, Atlanta, GA, USA
Wally A. Carlo
- University of Alabama at Birmingham, AL, USA
Vinod K. Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
Robert Pattinson
- MRC Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, Pretoria, South Africa
Gary L. Darmstadt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Integrated Health Solutions Development, Global Health Program, Bill & Melinda Gates Foundation

Abstract

Background

Intrapartum-related neonatal deaths (“birth asphyxia”) are a leading cause of child mortality globally, outnumbering deaths from malaria. Reduction is crucial to meeting the fourth Millennium Development Goal (MDG), and is intimately linked to intrapartum stillbirths as well as maternal health and MDG 5, yet there is a lack of consensus on what works, especially in weak health systems.

Objective

To clarify terminology for intrapartum-related outcomes; to describe the intrapartum-related global burden; to present current coverage and trends for care at birth; and to outline aims and methods for this comprehensive 7-paper supplement reviewing strategies to reduce intrapartum-related deaths.

Results

Birth is a critical time for the mother and fetus with an estimated 1.02 million intrapartum stillbirths, 904000 intrapartum-related neonatal deaths, and around 42% of the 535900 maternal deaths each year. Most of the burden (99%) occurs in low- and middle-income countries. Intrapartum-related neonatal mortality rates are 25-fold higher in the lowest income countries and intrapartum stillbirth rates are up to 50-fold higher. Maternal risk factors and delays in accessing care are critical contributors. The rural poor are at particular risk, and also have the lowest coverage of skilled care at birth. Almost 30000 abstracts were searched and the evidence is evaluated and reported in the 6 subsequent papers.

Conclusion

Each year the deaths of 2 million babies are linked to complications during birth and the burden is inequitably carried by the poor. Evidence-based strategies are urgently needed to reduce the burden of intrapartum-related deaths particularly in low- and middle-income settings where 60 million women give birth at home.

Keywords: Asphyxia neonatorum, Birth asphyxia, Intrapartum-related neonatal deaths, Low-income countries, Maternal mortality, Neonatal mortality, Perinatal mortality, Stillbirth