Embargo: Hold for release until 6:30 p.m.

EST, April 13 th, 2011

New York Press Conference on April 13th at 10:30 a.m. at UNICEF House, 3 United Nations Plaza (at
44th Street, between First and Second Avenues), in the Danny Kaye Visitors Center, Ground Floor. No
security clearance required.
Interviews with experts are available by phone and in person in New York City and London.
For TV Producers: B-roll and interviews with stillbirth families are available on the Hoffman & Hoffman
website: http://www.hoffmanpr.com/world/Stillbirths/B-roll/
The Lancet’s Stillbirths Series papers are available under embargo for journalists preparing stories.
Contact: Marshall Hoffman, 703 533-3535, 703 801-8602 (mobile), marshall@hoffmanpr.com

Stillbirths: The Invisible Public Health Problem

New estimates place annual global toll at 2.6 million stillbirths
“Almost no burden affecting families is so big and yet so invisible in society”

Some 2.6 million third trimester stillbirths worldwide occur every year, according to the first
comprehensive set of stillbirth estimates, published today within a special series in the medical
journal The Lancet.

Every day more than 7,300 babies are stillborn. A death occurs just when parents expect to
welcome a new life.

Ninety-eight percent of stillbirths occur in low and middle-income countries. Wealthier nations
are not immune with 1 in 200 pregnancies resulting in a stillbirth - two thirds occurring in the
last trimester of pregnancy, a rate that has stagnated in the last decade.

The five main causes of stillbirths are childbirth complications, maternal infections in
pregnancy, maternal disorders (especially pre-eclampsia and diabetes), fetal growth restriction
and congenital abnormalities.

The number of stillbirths worldwide has declined by only 1.1 percent per year, from 3 million
per year in 1995 to 2.6 million in 2009. This is slower than reductions for child and maternal
mortality.

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“Stillbirths often go unrecorded, and are not seen as a major public health problem,” says Flavia
Bustreo, M.D., Assistant Director-General for Family and Community Health at the World
Health Organization. “Yet, stillbirth is a heartbreaking loss for women and families. We need to
acknowledge these losses and do everything we can to prevent them.”

If all causes of stillbirth are taken together, the new estimates would place stillbirths fifth on the
list of causes of deaths worldwide, according to The Lancet’s Stillbirths Series, authored by 69
experts from more than 50 organizations in 18 countries. The Series is comprised of six
scientific papers, two research articles, and eight linked comments.

Joy Lawn, M.D., PhD, Director of Global Evidence and Policy, Saving Newborn Lives/Save the
Children, a lead author of The Lancet’s Stillbirths Series
who coordinated the new estimates, emphasizes that “almost no burden affecting families is so
big and yet so invisible both in society and on the global public health agenda.”

The number of stillbirths can be slashed, say most experts. “Stillbirths need to be an integral
part of the maternal, newborn and child health agenda,” says Carole Presern, PhD, Director of
The Partnership for Maternal, Newborn & Child Health (PMNCH) and a midwife. “We do
know how to prevent most of them.”

Besides lacking visibility, stillbirths lack leadership both locally and internationally. “Parental
groups must join with professional organizations to bring a unified message on stillbirths to
government agencies and the UN,” says J. Frederik Frøen, M.D., PhD, an epidemiologist at The
Norwegian Institute of Public Health and member of the International Stillbirth Alliance.

Stillbirths - the new estimates in detail

Almost half of stillbirths, 1.2 million, happen when the woman is in labor. These deaths are
directly related to the lack of skilled care at this critical time for mothers and babies.
Before-labor stillbirths account for 1.4 million deaths.

“An African woman has a 24 times higher chance of having a stillbirth at the time of delivery
than a woman in a high-income country,” says Vicki Flenady, a perinatal epidemiologist, Chair
of the International Stillbirth Alliance, and author of the paper on stillbirths in high-income
countries for The Lancet’s Stillbirths Series.

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Two-thirds of stillbirths happen in rural areas, where skilled birth attendants, in particular
midwives and physicians, are not always available for essential care during childbirth and for
obstetric emergencies, including caesarean sections.

The stillbirth rate varies sharply by country, from the lowest rates of 2 per 1,000 births in
Finland and Singapore and 2.2 per 1,000 births in Denmark and Norway, to highs of 47 in
Pakistan and 42 in Nigeria, 36 in Bangladesh, and 34 in Djibouti and Senegal.

It is estimated that some 1.8 million stillbirths occur in ten countries — India, Pakistan, Nigeria,
China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and
United Republic of Tanzania. Half of all stillbirths occur in India, Pakistan, Nigeria, China and
Bangladesh alone. These same countries account for a high number of maternal and newborn
deaths.

Rates also vary widely within countries. In India, rates range from 20 to 66 per 1,000 births in
different states. In high-income countries, disadvantaged women still have very high stillbirth
rates. For example, indigenous women in Canada and Australia have stillbirth rates equal to
women living in some low and middle-income countries.

Comparing 1995 to 2009 stillbirth rates, the smallest declines were reported in Sub-Saharan
Africa and Oceania. Significant declines are reported for China, Bangladesh, and India, which
had a combined estimate of 400,000 fewer stillbirths in 2009 than in 1995.

“Stillbirth rates have halved in China and Mexico since 1995, demonstrating what can be
accomplished in middle-income countries,” says Dr. Lawn.

Well-known interventions for women and babies would also reduce stillbirths

“This Series shows that the way to address the problem of stillbirth is to strengthen existing
maternal, newborn, and child health programs by focusing on key interventions, which often
overlap with those interventions that benefit mothers and neonates,” says Gary L. Darmstadt,
M.D., Director, Family Health Division, Global Health Program, Bill & Melinda Gates
Foundation.

According to The Lancet’s Stillbirths Series, as many as 1.1 million stillbirths could be averted
with universal coverage of the following interventions:

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  Comprehensive emergency obstetric care 696,000
 Syphilis detection and treatment 136 000
 Detection and management of fetal growth restriction 107,000
 Detection and management of hypertension during pregnancy 57,000
 Identification and induction for mothers with >41 weeks gestation 52,000
 Malaria prevention, including bednets and drugs 35,000
 Folic acid fortification before conception 27,000
 Detection and management of diabetes in pregnancy 24,000

“An additional 1.6 million deaths of mothers and newborns could be averted if you add five
additional interventions beyond stillbirth interventions, such as antenatal steroids and neonatal
resuscitation,” says Professor Zulfiqar A. Bhutta, M.D., PhD, Chair, Department of Pediatrics
and Child Health, The Aga Khan University, Pakistan. “This is all highly doable and would
save 2.7 million lives -- a massive achievement.”

Such interventions could be provided to all women everywhere at an overall cost of US$10.9
billion per year, or $2.32 per person in the 68 highest burden countries, according to the
economic analysis by The Series team.

“This would provide a triple return for every dollar invested since these interventions can
prevent stillbirths as well as save mothers and newborns, ” explains Robert Pattinson, M.D. of
South Africa’s Medical Research Council, one of the team who developed the analysis using the
Lives Saved Tool modelling.

If all women gave birth in health facilities offering high-quality, comprehensive emergency
obstetric care, almost 700,000 stillbirths, 170,000 maternal deaths and nearly 600,000 neonatal
deaths could be averted.

“Ultimately, there’s a direct correlation between greatly increased coverage of these

interventions and the numbers of deaths averted,” says Carole Presern of PMNCH.

New funds

In September 2010, UN Secretary-General Ban Ki-moon announced the Global Strategy for
Women’s and Children’s Health, aimed at saving 16 million mothers and children over the next
five years.

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The initiative has drawn pledges totalling $40 billion in commitments from governments,
foundations, corporations and non-governmental organizations.

Besides the new funding, a special session on non-communicable diseases will be held at the
UN General Assembly this September. Two important topics connected to stillbirths will be
discussed: gestational diabetes (diabetes during pregnancy) and hypertension (high blood
pressure). Both these conditions are common in pregnant women in high-income countries.

Stillbirth stigma persists

In many parts of the world, taboos and evil spirits are held responsible or the woman is blamed
for the loss of a child.

Women who experience stillbirth suffer the most because of the stigma attached to it and their
perceived failure as a mother. Often they suffer depression, anxiety, and post-traumatic stress.

“By shining a spotlight on the tragic toll of stillbirths, we can prevent stigma, relieve suffering
and make greater progress to improve the health of every woman and every newborn,” says
Purnima Mane, Deputy Executive Director of United Nations Population Fund.

Stillbirths are overlooked

Despite the large numbers, stillbirths have been relatively overlooked as a global public health
problem. They are not included in the Millennium Development Goals for maternal and child
health set by the United Nations.

“WHO has taken the unprecedented step of working together with The Lancet’s Stillbirths
Series team to develop the first comprehensive, global set of stillbirth estimates by country,”
reports Dr. Bustreo.

These estimates underpin the Series analysis and will be included, for the first time, in WHO’s
World Health Statistics report for 2011. In addition to Dr. Lawn and WHO researchers,
Simon Cousens, Professor of Epidemiology and Medical Statistics at the London School of
Hygiene and Tropical Medicine, worked on the analysis for the new estimates.

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Authors of The Lancet’s Stillbirths Series call for action to reach these goals by 2020:
• For countries with a stillbirth rate of more than 5 per 1,000 births, at least a 50 percent
reduction from the current rate;
 For those nations with a current rate of under 5 per 1,000, to eliminate all preventable
stillbirths and close equity gaps.

Stillbirths: breaking the silence of a hidden grief

Steven’s story
Monday, May 3, 1993, 1040 h. That’s when my life changed, the exact time my third child, our second
daughter, Danielle, was stillborn. I’ve come a long way since then but never far enough. The emotions of
that day, the disbelief, confusion, pain, sadness, grief are less raw now but never completely gone.
I can remember the panic when the staff realized our baby was in distress, the rush to the delivery theatre,
the anxious wait in the small room next door, the silence after she was delivered. The consultant crying as
he told me she was dead; I’ll never forget his tears. I remember trying to tell my wife the awful news, being
asked if I’d like to see and hold my dead baby, my fear and revulsion at the very idea, the midwife who
handed me a beautiful little girl in a pink baby-grow, soft and warm in my arms—at least that’s how I
choose to remember that moment. I remember the mortuary technician who offered hand and footprints,
the curate who organized the funeral, the undertaker who placed her little coffin on the front seat beside
him. Burying her on my own, leaving the hospital with nothing, crying all day every day, not leaving the
house, people avoiding us in the street when we did go out. I remember it all.
I have moved on; I can talk about the day she died and not cry, sometimes. I am proud of the little girl we
lost. She has changed me from the shy insecure person I was then to the openly emotional, caring,
supportive, and strong man I am now. My living children will succeed or fail in their lives and I will love
them regardless. I love Danielle because she has inspired me to succeed or fail in her memory. Danielle
will be 18 this year; “will be” because she is always in my thoughts. To me she lives in the work I do to help
other parents bereaved as I was back then.
Steven Guy, UK
Malika’s story
No fetal heartbeat. These three words began the surreal journey of inducing labor and finally my
daughter’s stillbirth at dawn on Friday, Jan 3, 2003. I named her Iman (Faith) Bongiwe (Gratitude) and she
was buried at noon on that same day according to Islamic rites.
In the weeks that followed I waded through each day trying to keep my head above an ocean of sorrow. I
mostly hibernated. I slowed down to a routine of getting my two sons off to school and then returning to
bed where I spent most of the day. Family and friends showered me with all levels of support and comfort,
but still around 3 months later I did not want to go on. I just wanted to stop breathing, to stop time moving
me forward.
Being a writer, I had begun journaling on the very same day that we were told our baby was no longer
alive. I wrote for my own relief and sanity and to try to capture as much of her and her impact, for
remembrance as time passed by. It helped immensely to have a place to ventilate without censorship of
my thoughts and feelings. 6 years later a book* had emerged: a tribute to my daughter, made with
immeasurable love.
I have known from the start that she did not come to bring me sorrow. She is my greatest teacher and her
dying has intensified my living, deepening my gratitude for all that I have and strengthening my
compassion for others. Iman Bongiwe is fully present in our family memories and in the lives of those who
carried my family and me through the initial shock. She lives through us and through all those on whom her
story—our story—has made an impression. Through writing and speaking out about her, that circle widens
and the overwhelming silence and invisibility around her life and death, and many others like hers, is
penetrated.
Malika Ndlovu, South Africa

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Country stillbirth rates per 1000 total births for 2009

Stillbirth Stillbirth
Total rate per Total rate per
Country Total births stillbirths 1000 births Country Total births stillbirths 1000 births
1
FINLAND 59,540 120 2.0 49 KUWAIT 52,400 260 5.0
2
SINGAPORE 37,260 70 2.0 50 ARGENTINA 694,740 3,510 5.0
3
DENMARK 61,800 140 2.2 51 COSTA RICA 76,100 390 5.1
4
NORWAY 58,310 130 2.2 52 KAZAKSTAN 309,520 1,580 5.1
5
ICELAND 4,710 10 2.4 53 ALBANIA 46,950 250 5.3
6 GERMANY 660,790 1,610 2.4 54 COLOMBIA 715,450 3,950 5.5
7 SAN MARINO 290 0 2.5 55 MALAYSIA 553,410 3,290 5.9
8 SWITZERLAND 72,880 190 2.5 56 UZBEKISTAN 562000 3,540 6.3
BRUNEI
9 JAPAN 1,016,920 2,670 2.6 57 DARUSSALAM 7,850 50 6.4
CZECH
10 REPUBLIC 111,330 300 2.7 58 TFYR MACEDONIA 22,310 140 6.4
11 ITALY 544,120 1,470 2.7 59 OMAN 62,770 410 6.5
12 SWEDEN 108,340 300 2.7 60 BULGARIA 73,390 480 6.6
ANTIGUA AND
13 ANDORRA 950 0 2.8 61 BARBUDA 1,630 10 6.9
14 CYPRUS 10,080 30 2.8 62 SAUDI ARABIA 597,810 4,550 7.6
15 AUSTRALIA 270,360 780 2.9 63 CUBA 116,800 890 7.6
16 PORTUGAL 103,690 300 2.9 64 UKRAINE 471,730 3,920 8.3
17 USA 4,425,800 13,070 3.0 65 QATAR 15,790 130 8.4
TRINIDAD AND
18 GREECE 106,620 320 3.0 66 TOBAGO 20,080 170 8.5
19 CROATIA 42,610 130 3.0 67 LEBANON 66,720 570 8.6
20 LUXEMBOURG 5,520 20 3.0 68 IRAQ 957,320 8,240 8.6
21 MONACO 390 0 3.0 69 BAHAMAS 5,700 50 8.6
22 BELGIUM 120,070 370 3.1 70 BARBADOS 2,880 30 8.8
23 MALTA 3,710 10 3.1 71 SEYCHELLES 1,190 10 8.8
24 MONTENEGRO 7,560 20 3.2 72 CHILE 254,390 2,260 8.9
25 SPAIN 500,310 1,620 3.2 73 MAURITIUS 18,260 160 8.9
26 CANADA 359280 1,180 3.3 74 BAHRAIN 14,170 130 8.9
27 IRELAND 70,110 230 3.3 75 COOK ISLANDS 430 0 8.9
28 NETHERLANDS 183,490 610 3.3 76 TONGA 2,830 30 9.1
29 ISRAEL 157,310 530 3.4 77 MOLDOVA 45,480 420 9.2
30 SLOVENIA 19,820 70 3.4 78 URUGUAY 50,450 470 9.3
31 POLAND 416,440 1,420 3.4 79 BRAZIL 3,055,520 29,070 9.5
REPUBLIC OF RUSSIAN
32 KOREA 451,710 1,560 3.5 80 FEDERATION 1,574,100 15,040 9.6
UNITED SAINT KITTS AND
33 KINGDOM 751,370 2,630 3.5 81 NEVIS 960 10 9.7
34 NEW ZEALAND 58,790 210 3.5 82 CHINA 18,500,000 182,150 9.8
35 BELARUS 96,680 340 3.5 83 GUATEMALA 460,820 4,540 9.9
36 UAE 63,280 230 3.6 84 LIBYA 149,150 1,470 9.9
37 AUSTRIA 75,970 280 3.7 85 PERU 611,210 6,060 9.9
38 ESTONIA 16,380 60 3.7 86 TUNISIA 167,020 1,690 10.1
ST VINCENT/ THE
39 SLOVAKIA 55,730 210 3.7 87 GRENADINES 1,920 20 10.2
40 HUNGARY 99,190 370 3.8 88 SAMOA 4,130 40 10.2
41 FRANCE 747,440 2,890 3.9 89 KYRGYZSTAN 123,020 1,260 10.2
42 LITHUANIA 31,700 130 4.1 90 PANAMA 70,740 730 10.3
43 LATVIA 23,590 100 4.1 91 GRENADA 2,050 20 10.6
44 ROMANIA 212,800 890 4.2 92 DOMINICA 1,240 10 10.9
BOSNIA AND
45 HERZEGOVINA 34,340 140 4.2 93 VENEZUELA 606,300 6,610 10.9
46 THAILAND 980,820 4,270 4.4 94 TURKEY 1,361,500 15,260 11.2
47 MEXICO 2,636,110 11,940 4.5 95 ALGERIA 731,620 8,250 11.3
48 SERBIA 114,160 570 5.0 96 MONGOLIA 50,830 580 11.4

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 97 ECUADOR 282,250 3,330 11.8 155 BHUTAN 15,120 340 22.5
DOMINICAN
98 REPUBLIC 226,290 2,680 11.9 156 RWANDA 422,120 9,620 22.8
99 TAJIKISTAN 197,600 2,370 12.0 157 NIGER 834,400 19,080 22.9
100 TUVALU 210 0 12.0 158 YEMEN 881,580 20,380 23.1
101 NIUE 30 0 12.1 159 MALI 564,470 13,090 23.2
102 AZERBAIJAN 171,060 2,080 12.2 160 NEPAL 747,250 17,460 23.4
103 BELIZE 7,550 90 12.3 161 MALAWI 622,430 14,740 23.7
SYRIAN ARAB
104 REPUBLIC 603,170 7,470 12.4 162 GUINEA 406,710 9,660 23.7
105 PALAU 440 10 12.4 163 SUDAN 1,331,630 31,780 23.9
CENTRAL AFRICAN
106 JAMAICA 52,780 660 12.5 164 REPUBLIC 158,240 3,830 24.2
DEM. PEOPLE'S
107 REP. OF KOREA 330,870 4,180 12.6 165 BENIN 357,740 8,710 24.3
108 KIRIBATI 2,120 30 12.6 166 UGANDA 1,540,230 38,190 24.8
109 FIJI 17,730 220 12.7 167 TOGO 220,390 5,500 25.0
110 JORDAN 160,420 2,040 12.7 168 ANGOLA 804,590 20,210 25.1
111 VIET NAM 1,503,850 19,120 12.7 169 LESOTHO 60,710 1,530 25.3
112 TURKMENISTAN 112,350 1,430 12.7 170 ZAMBIA 563,240 14,380 25.5
113 VANUATU 7,240 90 12.9 171 CONGO 129,030 3,300 25.6
114 IRAN 1,408,750 18,380 13.0 172 TANZANIA 1,859,600 47,550 25.6
115 EGYPT 2,056,450 26,970 13.1 173 CAMEROON 729,780 18,660 25.6
116 MALDIVES 5,910 80 13.4 174 ETHIOPIA 3,214,640 82,370 25.6
117 NICARAGUA 142,260 1,930 13.6 175 GAMBIA 63,570 1,650 25.9
LAO PEOPLE'S
118 DEM REPUBLIC 174,060 2,450 14.1 176 BURKINA FASO 757,770 19,870 26.2
119 MICRONESIA 2,790 40 14.2 177 LIBERIA 152,680 4,110 26.9
120 EL SALVADOR 126,360 1,800 14.3 178 COMOROS 22,200 600 27.1
121 TIMOR-LESTE 46,210 660 14.3 179 COTE D'IVOIRE 749,090 20,520 27.4
122 ARMENIA 48,280 700 14.5 180 MAURITANIA 112,060 3,070 27.4
123 INDONESIA 4,236,610 62,290 14.7 181 BURUNDI 291,280 8,060 27.7
124 SAINT LUCIA 3,090 50 14.8 182 MOZAMBIQUE 902,400 25,660 28.4
PAPUA NEW DEM. REPUBLIC OF
125 GUINEA 211,600 3,140 14.8 183 THE CONGO 3,015,670 86,130 28.6
126 SURINAME 9,880 150 14.9 184 CHAD 522,990 15,260 29.2
127 NAMIBIA 59,840 900 15.1 185 AFGHANISTAN 1,341,210 39,310 29.3
MARSHALL
128 ISLANDS 1,340 20 15.1 186 GUINEA-BISSAU 67,930 2,010 29.6
129 HAITI 278,270 4,300 15.5 187 SIERRA LEONE 234,340 7,030 30.0
SOLOMON
130 ISLANDS 15,870 250 15.5 188 SOMALIA 414,220 12,450 30.1
131 CAPE VERDE 12,200 190 15.8 189 SENEGAL 493,010 16,660 33.8
132 PHILIPPINES 2,281,550 36,460 16.0 190 DJIBOUTI 25,040 850 33.9
133 BOTSWANA 48,290 780 16.1 191 BANGLADESH 3,529,710 128,550 36.4
134 GEORGIA 52,600 880 16.7 192 NIGERIA 6,345,150 264,390 41.7
EQUATORIAL
135 GUINEA 26,080 440 16.7 193 PAKISTAN 5,667,980 264,550 46.7
136 BOLIVIA 266,530 4,470 16.8
137 GUYANA 13,520 230 16.9
138 GABON 40,420 700 17.3
139 SRI LANKA 370,250 6,400 17.3
140 NAURU 220 0 17.4
141 HONDURAS 205,840 3,600 17.5
142 CAMBODIA 373,760 6,690 17.9
143 SWAZILAND 35,800 650 18.0
144 PARAGUAY 157,010 3,050 19.4
145 MOROCCO 664,350 12,960 19.5
146 MYANMAR 1,037,050 20,700 20.0
147 ZIMBABWE 387,210 7,740 20.0
148 SOUTH AFRICA 1,108,040 22,560 20.4
149 MADAGASCAR 709,260 14,590 20.6
150 ERITREA 188,720 4,000 21.2
151 KENYA 1,564,210 34,130 21.8
SAO TOME
152 AND PRINCIPE 5,250 110 21.9
153 GHANA 782,920 17,200 22.0
154 INDIA 27,400,000 605,230 22.1
Source: World Health Organization and Save the Children.