Stillbirths: recall to action in high-income countries

Vicki Flenady, Aleena M Wojcieszek, Philippa Middleton, David Ellwood, Jan Jaap Erwich, Michael Coory, T Yee Khong, Robert M Silver, Gordon C S Smith, Frances M Boyle, Joy E Lawn, Hannah Blencowe, Susannah Hopkins Leisher, Mechthild M Gross, Dell Horey, Lynn Farrales, Frank Bloomfield, Lesley McCowan, Stephanie J Brown, K S Joseph, Jennifer Zeitlin, Hanna E Reinebrant, Joanne Cacciatore, Claudia Ravaldi, Alfredo Vannacci, Jillian Cassidy, Paul Cassidy, Cindy Farquhar, Euan Wallace, Dimitrios Siassakos, Alexander E P Heazell, Claire Storey, Lynn Sadler, Scott Petersen, J Frederik Frøen, Robert L Goldenberg, Vicki Flenady, J Frederik Frøen, Mary V Kinney, Luc de Bernis, Joy E Lawn, Hannah Blencowe, Alexander Heazell, Susannah Hopkins Leisher, Jessica Ruidiaz, Andre Carvalho, Jane Dahlstrom, Christine East, Jane P Fox, Kristen Gibbons, Ibinabo Ibiebele, Sue Kildea, Glenn Gardener, Rohan Lourie, Patricia Wilson, Adrienne Gordon, Belinda Jennings, Alison Kent, Susan McDonald, Kelly Merchant, Jeremy Oats, Susan P Walker, Leanne Raven, Anne Schirmann, Francine de Montigny, Grace Guyon, Beatrice Blondel, Sabine de Wall, Sheelagh Bonham, Paul Corcoran, Mairie Cregan, Sarah Meany, Margaret Murphy, Stephanie Fukui, Sanne Gordijn, Fleurisca Korteweg, Robin Cronin, Vicki Mason, Vicki Culling, Anna Usynina, Karin Pettersson, Ingela Rådestad, Susanne van Gogh, Bia Bichara, Stephanie Bradley, Alison Ellis, Soo Downe, Elizabeth Draper, Brad Manktelow, Janet Scott, Lucy Smith, William Stones, Tina Lavender, Wes Duke, Ruth C Fretts, Katherine J Gold, Elizabeth McClure, Uma Reddy

Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19 439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.