Stillbirth: drawing back the veil
January 19, 2015by Betsy McCallon, Executive Director, White Ribbon Alliance
Betsy McCallon argues that we now have an opportunity to break the silence and make progress on this long hidden issue.
After a decade of remarkable progress in improving maternal and newborn health globally, there remains an extraordinary silence around the deeply sad and painfully common experience of stillbirth.
We know that better quality care could prevent the vast majority of the two and a half million stillbirths that happen every year. Yet at a time when quality of care is high on the agenda – and there is no clearer marker of it than stillbirth – most stillbirths remain uncounted.
In many communities, north and south, stillbirth is not even acknowledged as something women and their families can talk about, let alone mourn. Myths, taboos and multiple fears conspire to keep stillbirth in the shadows, wherever women live. But as long as the silence remains, citizens are not demanding change, no one is being held to account for failures in care, and policy makers can sit on their hands.
A standard ‘word cloud’ analysis of documents produced by the global health community shows how rarely the word ‘stillbirth’ comes up, a reflection of neglect. Even more powerful to me are the results of the 100 citizens’ hearings, which took place in 20 countries during 2015. The outcome reports do not mention stillbirth once, which means that families and midwives are dealing with these devastating losses in private. We cannot underestimate how hidden this issue is.
So how can we change this? We have some important opportunities. Firstly, recent evidence for investing in the global health workforce shows that more and better trained health workers – particularly in midwives - would dramatically reduce stillbirths. It’s also clear that health care professionals must be better supported to do their jobs, and this means more than ensuring equipment and supplies. Instead we must move on from the current narrative and talk about the painful experiences endured so often by health workers.
Imagine the effect on midwives in rural areas as they deliver dead baby after dead baby, and then also have to cope with the grief of parents in their care. How can we help them through this? If our efforts to grow the health workforce are to be sustainable, we must draw back the veil which surrounds stillbirth. We must take a holistic approach to promoting health care professionals – one that encompasses empowerment, personal safety, respect and dignity, as well as clinical skills.
Another opportunity has come with recognition of quality care as key to progress. Only a few years ago, no one was talking about disrespect and abuse of women in health facilities – and yet now there is a positive movement for Respectful Maternity Care. The new Quality of Care model from WHO values women’s experiences of their care as on a par with clinical interventions. We must now bring stillbirths into the Respectful Maternity Care agenda, while embedding clear accountability mechanisms for stillbirth which are backed by the global community.
We still have a big job to do in acknowledging women’s experiences of stillbirth and making their voices heard. This is critical if we are to mobilize communities. We also need to bring men’s voices into the conversation; not only are they often the decision makers, but they suffer immensely too. We must identify male champions, including political, religious and cultural leaders. This helped us get maternal mortality on the political agenda ten years ago; we can and must do the same again with stillbirth.
The collective progress we are making on accountability now also needs to tackle stillbirth – not only in the collection of data, but in terms of action and redress for communities. Similarly, the growing emphasis on rights must take in not only the rights of women as health service users, but the rights of midwives and others as health care providers.
As always, we must to work together – across geographies, across sectors, with communities, with media. In the past decade we have made maternal and newborn health and survival a matter for all people, everywhere, and this has been pivotal in increasing political will for change. Now it’s time for us to find the right words to talk with communities, and each other, about an issue that so far lies buried in all that we care about – rights, social justice, quality of care, equity, community empowerment. We know that the millions of stillbirths that happen each year can be prevented; it is high time.