Counting stillbirths and COVID 19—there has never been a more urgent time'
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We welcome the global stillbirth estimates published by UNICEF and WHO in October, 2020.1United Nations Inter-agency Group for Child Mortality EstimationA neglected tragedy: the global burden of stillbirths.https://data.unicef.org/resources/a-neglected-tragedy-stillbirth-estimates-report/Date accessed: October 23, 2020Google Scholar These data indicate that there are at least 1·9 million stillbirths globally each year. The heavy public health burden of stillbirth has long remained invisible, despite more than a decade of sustained effort to raise it on the global health agenda. Ironically, even the recent BMJ collection,2Leisher SH Kinney M Blencowe H et al.Rapid response to: reaching all women, children, and adolescents with essential health interventions by 2030. Leaving no one behind: where are 2.6 million stillbirths?.BMJ. 2020; 368l6986Google Scholar highlighting the UN guiding principle “Leave no one behind”, omitted any mention of the 26 million women and families who will experience a stillbirth by 2030. As the first stillbirth estimates to be generated by the UN Inter-Agency Group for Child Mortality Estimation, these data signal a long overdue shift towards global attention on stillbirth prevention. The new stillbirth report comes at a crucial point in time as we live through the most significant pandemic in over a century. COVID-19 will have a considerable impact on maternal and newborn health globally, directly and indirectly affecting the lives of millions of women and families.3Roberton T Carter ED Chou VB et al.Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study.Lancet Glob Health. 2020; 8: e901-e908Summary Full Text Full Text PDF PubMed Scopus (716) Google Scholar The report draws attention to the existing global inequalities, which are likely to be exacerbated by the global pandemic, potentially further increasing the risk of stillbirth. The direct impact of COVID-19 on mothers and babies is becoming clearer.4Khalil A Kalafat E Benlioglu C et al.SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis of clinical features and pregnancy outcomes.EClinicalMedicine. 2020; 25100446Summary Full Text Full Text PDF PubMed Scopus (210) Google Scholar Pregnant women with COVID-19 have generally had good pregnancy outcomes. However, the indirect impacts of COVID-19 will be substantial, including increased rates of stillbirth.5Khalil A von Dadelszen P Draycott T Ugwumadu A O'Brien P Magee L Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic.JAMA. 2020; 324: 705Crossref PubMed Scopus (302) Google Scholar, 6Kc A Gurung R Kinney MV et al.Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study.Lancet Glob Health. 2020; 8: e1273-e1281Summary Full Text Full Text PDF PubMed Scopus (255) Google Scholar Indirect effects of COVID-19 on perinatal outcomes are largely due to pandemic-related disruptions to reproductive, maternal, newborn, and child health care, and the effect of lockdown policies.2Leisher SH Kinney M Blencowe H et al.Rapid response to: reaching all women, children, and adolescents with essential health interventions by 2030. Leaving no one behind: where are 2.6 million stillbirths?.BMJ. 2020; 368l6986Google Scholar Restrictions could exacerbate the previously identified risks for stillbirth, including deferred births where women were sent home from the hospital by a health-care worker and asked to come back later to give birth.7Dandona R Kumar GA Akbar M Bhattacharya D Nanda P Dandona L Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all births.BMC Med. 2019; 17: 28Crossref PubMed Scopus (9) Google Scholar Supply-side bottlenecks, such as absence of clear guidelines during COVID-19 and sufficient personal protective equipment, have further affected care. Diverting experienced health-care workers, including midwives, to COVID-19 wards exposes them to a greater risk of contracting COVID-19, becoming ill themselves, and decreasing maternity unit staffing.7Dandona R Kumar GA Akbar M Bhattacharya D Nanda P Dandona L Deferred and referred deliveries contribute to stillbirths in the Indian state of Bihar: results from a population-based survey of all births.BMC Med. 2019; 17: 28Crossref PubMed Scopus (9) Google Scholar For all these reasons and more, it is likely that COVID-19 could undo improvements in rates of stillbirths that countries have managed to achieve.1United Nations Inter-agency Group for Child Mortality EstimationA neglected tragedy: the global burden of stillbirths.https://data.unicef.org/resources/a-neglected-tragedy-stillbirth-estimates-report/Date accessed: October 23, 2020Google Scholar Stillbirth increases might not be uniform or provide a complete pictur
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Emerging data link COVID-19 infection during pregnancy to an increased risk of stillbirths.
“There is emerging data available on the link between COVID-19 infection during pregnancy and an increase risk of stillbirths (Homer et al., 2021).”
From Stranger in a mask” midwives’ experiences of providing perinatal bereavement care to parents during the COVID-19 pandemic in Ireland: a qualitative descriptive study (2022) · cites this paper as Homer et al., 2021
Projections suggest rates of stillbirth are expected to double globally.
“For perinatal women receiving maternity care, we have already seen reports of devalued care [5], poor psycho-social outcomes [6, 24], and worrying projections suggesting rates of stillbirth are expected to double globally [25].”
From Preliminary findings on the experiences of care for parents who suffered perinatal bereavement during the COVID-19 pandemic (2021) · cites this paper as [25]
The reduction of face-to-face care and increased reliance on virtual care could contribute to the rise in perinatal mortality.
“which could contribute to the rise in perinatal mortality [25]”
From Preliminary findings on the experiences of care for parents who suffered perinatal bereavement during the COVID-19 pandemic (2021) · cites this paper as [25]
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- Leisher SH, Kinney M, Blencowe H, et al. Rapid response to: reaching all women, children, and adolescents with essential health interventions by 2030. Leaving no one behind: where are 2.6 million stillbirths? BMJ 2020; 368: l6986.
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ÓBITOS FETAIS EM BELÉM, PARÁ, BRASIL, 2014–2023: ESTUDO DE SÉRIE TEMPORAL
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- Authors
- Homer, C. S. E., Leisher, S. H., Aggarwal, N., Akuze, J., Babona, D., Blencowe, H., Bolgna, J., Chawana, R., Christou, A., Davies-Tuck, M., Dandona, R., Gordijn, S., Gordon, A., Jan, R., Korteweg, F., Maswime, S., Murphy, M. M., Quigley, P., Storey, C., Vallely, L. M., Waiswa, P., Whitehead, C., Zeitlin, J., & Flenady, V.
- Affiliations
- Burnet Institute (AU)
- The University of Queensland (AU)
- Post Graduate Institute of Medical Education and Research (IN)
- London School of Hygiene & Tropical Medicine (GB)
- University of the Witwatersrand (ZA)
- The University of Sydney (AU)
- University of Washington (US)
- University Medical Center Groningen (NL)
- Aga Khan University (PK)
- Martini Ziekenhuis (NL)
- University of Cape Town (ZA)
- University College Cork (IE)
- UNSW Sydney (AU)
- Makerere University (UG)
- Royal Women's Hospital (AU)
- Inserm (FR)
- Corresponding author
- Homer, Caroline S E
- ORCID
- Homer, Caroline S E
- Leisher, Susannah Hopkins
- Aggarwal, Neelam
- Babona, Delly
- Blencowe, Hannah
- Chawana, Richard
- Christou, Aliki
- Davies-Tuck, Miranda
- Dandona, Rakhi
- Gordijn, Sanne
- Gordon, Adrienne
- Maswime, Salome
- Murphy, Margaret M
- Quigley, Paula
- Storey, Claire
- Vallely, Lisa M
- Waiswa, Peter
- Whitehead, Clare
- Zeitlin, Jennifer
- Flenady, Vicki
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 9
- Issue
- 1
- Pages
- e10-e11
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC10011432
- OpenAlex
- W3098974746
- Cited by
- 59
- References
- 10
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 8 · 2023: 11 · 2022: 14 · 2021: 19
- FWCI
- 11.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Arrow@dit (Dublin Institute of Technology) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion, cc-by)
- HAL (submittedVersion, cc-by)
- Cork Open Research Archive (University College Cork, Ireland) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- UTS ePRESS (University of Technology Sydney) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion, cc-by)
- Greater South Information System
- Funders
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- stillbirth, COVID-19 pandemic, stillbirth prevention, maternal and newborn health, SARS-CoV-2 in pregnancy, global health disparities, leaving no one behind, low- and middle-income countries, health system disruption
- MeSH terms
- COVID-19, Female, Humans, Global Health, Stillbirth
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