WHO & UNICEF Press Conference stillbirth estimates 07 October 2020

Hello everyone.

Thank you very much for joining this joint WTO UNICEF press briefing.

Greetings from WTO Headquarters here in Geneva.

[Other language spoken]

As most of you know me, we are happy to do this press briefing for our colleagues at Ballet Press Corps.

So, so you get this exclusive briefing on this report that is being launched by the United Nations Interagency Group for Child Mortality Estimation.

So just a few words about the group itself.

This is the first such a report and UN Integency group for child mortality estimation is including UNICEF, WHO, the World Bank Group, population, the the World Bank Group reported the population division of the United Nations Department of Economic and Social Affairs and the name of the report is a neglected tragedy.

The global burden of steel birds presence and we are presenting today the first joint global steel bird estimates.

We have sent to you the press release under embargo.

Embargo lifts tonight at midnight Geneva time.

So I hope you will all respect this embargo.

Also you should have been able to also to access the report itself.

If there are any issues, please let us know.

We will send everything including the audio file from this press conference to our global media list soon after this briefing.

So your colleagues from from other agencies can also prepare to report on this first report on global estimates of still birds.

But we wanted to do something special just just for you.

So let me just tell you who is online and who you you will hear from today.

So we have Mark Hereward, who is the associate director for data and analytics at UNICEF.

We have Doctor Anshu Banerjee, who is our director for the Department of Maternal, Newborn, Child and Adolescent Health and Ageing.

And we also have Susanna Hopkins Laser, who is the Chair of the International Stalbert Alliance and also Honorary Fellow Stilbert Centre for Research Excellence of the University of Queensland in Australia.

We also have here in the room Alice Alison Moran from WHO.

We also have online Danzen Yu from UNICEF, 2 experts who may be asked to compliment some answers if need be.

So this is for you to know if you see these names in Zoom that are not journalists and you don't know them.

So these are either our experts or some of our communication colleagues from WHO and and UNICEF.

So again, we we try to respect the embargo tonight at midnight Geneva time.

And I will first give the floor to Mark Hereward from UNICEF, WHO is the Director for Data Analytics to tell us more about this first joint global steel bird estimates.

Mark, thank you kindly and good morning from New York.

Good afternoon and good evening depending on where people are in the world.

So as Tarek said, we're just about to issue our first ever joint stillbirth report this week.

And this is the tragic eye-catching main point.

A stillbirth occurs every 16 seconds somewhere in the world.

This means that every year about 2 million babies are stillborn.

These are truly horrific data points for truly horrific experiences that mothers and fathers all over the world have to endure, and all too often endure in silence.

This traumatic loss of life remains A neglected issue.

Stillbirths have largely been absent in worldwide data tracking, rendering the true extent of the problem hidden.

And This is why we have worked together for almost 2 years to bring out this first ever publication on stillbirths by the UN Interagency Group for Child Mortality Estimation, which consists of UNICEF, the World Health Organisation, the World Bank and the UN Population Division.

And of course, we're bringing out this report when we see the compounding effects of the global pandemic on this global situation.

Our analysis shows that the response to the COVID-19 pandemic could worsen the situation by potentially adding more than 200,000 more stillbirths to the global tally over a 12 month period.

In 117 low and middle income countries that we could analyse if, if we see as we fear a 50% disruption in healthcare services.

And in 13 countries that could actually be a 20% increase or more in the number of stillbirths over a 12 month period.

I just have to say, as an old statistician, I'm just not used to talking about increases in mortality in this way.

There are a few trends that I'd like to highlight this morning.

First, our data analysis shows that inequities are a driving factor in the number of stillbirths.

3/4 of all stillbirths in the world occurred in sub-Saharan Africa or Southern Asia last year.

And the rates of stillbirths are 23 times higher in the worst affected countries than in those with the lowest rates.

Second, most stillbirths are preventable with known interventions and quality health care, and yet too few women are receiving the proper care.

Over 40% of all stillbirths occur during labour, and that rises to about half of all stillbirths in sub-Saharan Africa and central and southern Asia.

Yet in half of the 117 low and middle income countries we analysed, only two to 50% of pregnant women received key interventions that could prevent stillbirths.

Let's take an example of assisted vaginal delivery, a critical intervention for preventing intrapartum stillbirths.

That coverage is estimated to reach at least half of the pregnant women and less than half of the pregnant women that need it in low and middle income countries.

These lives could be saved if mothers were supported by a trained health worker at childbirth and timely emergency obstetric care.

3rd, we find that progress to reduce stillbirths is happening at a much slower rate than child and maternal mortality reduction.

Overall, between 2020 nineteen the global stillbirth rate reduced 35%, which is good, but the annual rate of reduction for stillbirths is almost half that of mortality for children under the age of five.

We should also note that in sub-Saharan Africa, although the stillbirth rate is going down, the number of stillbirths is rising.

But finally, stillbirth is an issue for every country, not just low and middle income countries.

Disparities continue to exist among vulnerable groups in **** income countries as well.

So we need action now.

Without it, without accelerated progress, there will be 20 million babies stillborn by 2030.

Thank you for your attention.

Thank you very much, Mark, for these opening remarks.

I'll just correct myself.

I said that embargo is midnight Geneva time.

In fact, it's a midnight GMT, so it's at 2:00 after midnight Geneva time.

But we still speak about it tonight.

So sorry for that.

Now, I'll give a floor to Doctor Anshu Banerjee, who is our Director for the Department of Maternal, Newborn, Child and Adolescent Health.

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And I would like to try to compliment what Mark has already highlighted.

But first of all, just to say that we're talking about an incredible tragedy here for many families who are losing on a daily basis their potentially loved ones.

And just to change the statistics a little bit, we're talking about 5000 families a day who are losing their their potential newborn child that would come and join their family.

And so we have seen that there has been some progress.

And that progress has been because countries have been able to strengthen their health systems and increase or improve the quality of care that has been provided.

And also the skilled birth attendants that have been there to, to support the deliveries.

But progress has been slow, as Mark has already highlighted.

And as already also highlighted by Mark, COVID will have an increase in reversing the gains that we have made.

However, we have seen that it is possible to make progress.

14 countries over the last decade have halved their still birth rate.

And out of those 14, three are actually low income countries, Mongolia, India and Cambodia to speak of.

So what do we need to do to prevent to preventable still birds?

First of all, I think it's very important that we reduce the stigma around this issue.

It's important that we look at the taboos that are out there in the community and the misconceptions in order to make this a topic that can be discussed, can be put on the health agenda and can be addressed.

It is often seen as inevitable in a number of communities and in other communities, stillbirths are seen as the fault of the mother with shame and stigma attached to it.

So this is the first thing that really we would have to try to highlight and, and break out of this, uh, uh, cocoon of taboos and stigma.

Secondly, once we are looking at this issue, it's important to better understand, uh, what we're talking about when we talk about steel birds.

We need a common definition across agencies, across countries with different ministries of health.

It's not defined in the same way as in every country, and therefore it's also often difficult to estimate the real figures that we're talking about.

And sometimes we have confusion amongst terms like miscarriage and steel birds, etcetera, and we need some more clarity around that.

So defining what a steel birth is, is going to be important.

Secondly, after that we need to set targets at national level as well as at sub national level.

And we have tried to, we have started doing this with the every newborn action plan that was launched a few weeks ago where we're looking at the target every country needs to achieve a still birth rate of 12 or below.

And and we have started looking also at making those targets at the sub national level.

Currently 56 countries would not reach the SDGS or the targets that we have set globally.

And of those 43 are in the African region.

And again, looking at countries that have set targets for amongst the top 20 highest risk countries, let's say we see that only actually 8 have set a target for still birth rates.

So a lot more needs to be done to get this onto the agenda because if countries don't set targets, they'll not be able to set, they'll not be able to sort of invest in this area.

And fourthly, then it would be to really strengthen health systems to provide **** quality care.

And this consists of a number of components.

First of all, to ensure continuum of care before, during and and during the pregnancy.

And this could also include preconception care.

One of the opportunities we have at country level is the shift of increasing the antenatal care physics from 4:00 to 8:00 antenatal care physics.

And that allows us to have more engagement with mothers during their pregnancy and to highlight risks or identify risk factors more often and more easily and to address those.

Secondly, to ensure that medicines, equipment are there available as well as electricity and running water.

We know that in many countries still there is there are a **** number of health facilities that don't have access to either of those.

Thirdly, to have adequate numbers of competent skilled health workers, including midwives and to also promote continuity, midwife continuity LED care.

And finally, I think also to ensure that there that we strengthen the confidence in the health system is that when a still birth occurs, there is supportive care for women and the family and the community.

Because these women will become pregnant again and they need to have trust in the health system so that the next time they do have proper care and deliver a life baby.

Just to highlight maybe some of the issues, some of the interventions that are important are in countries where there is endemic malaria is to provide inter prophylaxis for malaria during pregnancy.

We know that in Africa, in the sub-saharan African region, around 20% of the stilbirs are due to malaria in pregnancy.

It's making sure that we can diagnose gestational diabetes.

It's making sure that we can diagnose hypertension and preeclampsia.

It's making sure that we can treat pregnant women for syphilis so that we don't have congenital syphilis, which is also a large or big cause of major cause of stillbirths.

Supporting nutritional status during the pregnancy, providing advice around smoking and including second hand smoking that also has an impact and counselling around congenital anomalies and as well as making sure that a mother can have access to an assisted vaginal delivery or a caesarean section.

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Thank you very much Doctor Banerjee.

And now we will go to Susanna Hopkins Laser, who is the Chair of the International Stilbert Alliance and also honorary Fellow at Stilbert Centre for Research Excellence of the University of Queensland in Australia.

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Wilder Wilder Daniel is the name of my first child.

He was stillborn 21 years ago on July 13th, 1999.

I had a perfect pregnancy with no complications.

One Sunday, just 13 days before I was due, I realised my baby had stopped moving.

When the technician began an ultrasound to listen to the heartbeat, all we heard was static, a sound that I will never forget.

The technician said.

I see the legs, I see the heart.

The heart should be beating but it is not.

We began to cry.

Over the next two days, I was slowly induced.

Finally I went into labour.

[Other language spoken]

With most labourers you know you'll get a living baby at the end so it feels worth it.

But my baby was already dead and I wept about how pointless it was.

Finally, Wilder was born.

He had lots of brown hair.

He weighed about 6 lbs twelve oz.

Our bereavement nurse, Patty Campbell, helped me to hold him.

He was still warm from my body.

Patty asked what his name was and she took photographs, which we treasure.

I was afraid to open Wilder's eyes so I'll never know what colour they were.

Finally, Paddy took Wilder away.

We had consented to an autopsy and had decided to cremate him, so I knew I would never see my son again.

I knew nothing about still birth until it happened to me.

I expected that my baby would be born healthy.

Wilder's death was a guillotine that split my life in two.

We never found out why he died.

At first I thought I had just lost a baby, but today the person I lost would have been a 21 year old man.

What would have moved him?

Who would he have loved?

What would he have fought for?

I'll never know.

This is the devastation of stillbirth.

Wilder's death forced me into an enormous club of members of mothers and fathers from every country and every culture whose babies are stillborn.

As a result of his death, I changed my life.

Now I am honoured to be the Chair of the International Stillbirth Alliance.

ISA was founded by bereaved mothers who had a vision to breakdown barriers between clinicians, researchers and bereaved parents to work together as a united front for global action.

Today, ISA has members on every continent.

In addition to our research and our advocacy, we work to ensure bereaved families receive the support they deserve.

One of our current projects is the Parent Voices initiative to build an online registry of parent support organisations in every country in the world.

So what do you bereaved parents want?

We want recognition.

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Birth is not an adverse outcome.

It is the deaths of our babies who were loved.

Recognise us as mothers and fathers.

Recognise our losses as real babies who died.

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We are tired of hearing that sometimes these things happen.

No one says that when an adult dies, and no one should accept that when a baby dies before birth, there is always a reason.

Fund research on causes and include stillbirths in perinatal research.

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We are harmed when society refuses to acknowledge our loss, when clinicians lack the training to provide respectful care, when we are given no choice about whether to hold our babies after birth.

And so many parents continue to suffer from grief long after their babies were stillborn.

As this report shows, and as I know from my work, the world must take action to eradicate stigma and taboo around still birth and make sure clinicians are supported to provide appropriate care after death.

We also want partnership.

We are the experts on what it's like to suffer the deaths of our children and we need to be part of changes in policy and practise.

Treat us as allies, not afterthought.

And finally, we want urgency.

There can be no more dire health outcome than death.

Still, birth means the deaths of millions of babies every year, most of these preventable.

Each stillborn baby was loved by his or her family, just like Wilder.

This is a public health tragedy that does not need to happen.

We want policy makers to take action as if lives depended on it because they do.

On behalf of my son Wilder and the wonderful board at ISA, thank you so much.

Thank you very much, Susanna, for sharing this powerful personal story, but also for these words of hope.

We will now open the floor for for questions.

I will just remind the journalist that the the, the, the, the everything is under embargo, including this press briefing until.

Midnight GMT, that's 2:00 Geneva time.

And thanks Christiana for reminding me of that.

And we'll start with you, Christiana.

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And can we just help Christiana unmute the unmute?

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All right.

[Other language spoken]

OK, Nina, go ahead and we'll go back to Christian later.

[Other language spoken]

Thank you very much.

[Other language spoken]

You're talking about the possibility that 200,000 additional stillbursts could happen over 12 months.

Do you have sort of any idea of where specifically they'll be the biggest impact?

And also if you have some more information on the situation in the United States, I see that the US has, has not seen a very big decline in stillbursts.

If you could talk more specifically about that.

Thank you very much.

[Other language spoken]

So I will first ask Mark and then I'm sure as well who wants to to start.

I think I've been unleashed.

So I'm happy to to jump in.

So the, the effects of the effects of COVID on stillbirth are basically the effects on services that that have that were being provided, which can reduce the, the likelihood of of a still birth and the interruption of those services.

So it's a kind of a combination.

There are some countries which didn't have very many services anyway.

So the interruption from COVID is actually, you know, ironically less there because there's no services to interrupt or very few services to interrupt.

So the, the biggest effect happens in countries where there was a, a reasonably **** level of services and in which the COVID response for one reason or another has, has interrupted those services.

And in general, the, the the interruption to services has been much greater in in countries where where the services are are fragile anyway.

So less so in, in wealthier countries.

And in fact, we made the estimation for lower and middle income countries, not looking at the wealthier countries where services are continuing, albeit in, in modified form.

[Other language spoken]

Mark Anshu, would you like to add something?

Yeah, I wanted to highlight the issue of inequities.

We've seen that particularly families and and so mothers, pregnant women in rural areas with less education and the poorer section of the population let's say are more prone to have still birds.

This is because service delivery is maybe more difficult.

They're more remote, it's more difficult for them to have access.

It could be because of bias of how they're being treated etcetera.

And so in **** income countries, we also see that this could take place where we have different ethnicities.

So we see for example, in Canada that the Inuit population has maybe got less access to services.

And particularly also in in the US, we see that amongst African American populations, there are higher still birth rates than amongst the the the white Caucasian population.

And so this might be one of the reasons why maybe the trends, the decline in the US is also not going as quickly as as we would be hoping for.

And so it's because of systems issues, access to services, inequities in general that could explain these kind of trends within **** income countries.

Why the decline in **** income countries?

It's not as fast as we would hope for.

Thank you very much, Susanna.

Alison, Denzan, please, you're all unmuted.

If you want to add something, just jump in.

[Other language spoken]

I would just add, add to what Anshu has said.

I think that inequities are driving still birth rates and increases in still birth rates in COVID.

Of course, COVID is is widening the gaps that have already that already exist and that's just as true in the US as it is around the world.

Unfortunately, the US has a still birth rate among African American mothers that is twice as **** as that among white mothers and certainly COVID will exacerbate that, unfortunately.

[Other language spoken]

We will try again to get to get Christian Ulrich from DPA.

Christian, can you, can you hear us now?

Can you, can you, are you able to speak now maybe while you're working on that technical issue?

Yeah, just just to, to compliment my, my previous answers.

So in the study looking at the potential impact of COVID on Stillbus, I did mention that there were 13 countries which would likely see a 20% or more increase, which are Armenia, Dominican Republic, Jamaica, Paraguay, St.

Lucia, Suriname, Egypt, Iraq, Tunisia, Bangladesh, Pakistan, Namibia and South Africa.

So just to give a flavour of the kinds of places where the impact might be greater, these are scenario based.

Of course, you know, this is just a what if, but it's it's at least to give an idea of the kind of level of impact.

[Other language spoken]

So I'll let's let's try one more time with Christian.

Definitely there is a there is a there is a issue, but I got her question on on on on SMS.

So basically she is just trying to understand the figures.

You say every 16 seconds then 5000 a day and how many, how many per year?

Can you just clarify these numbers?

And so journalists can really report on different numbers, how much per day and per year Mark would you like to start?

Yeah, well, OK, so 16 seconds per day is is about 2 million a year.

So that that's just dividing the year by the number of seconds by, by sort of 2,000,000 by the number of seconds in a year.

And, and you know, and so that's how we make the calculation.

We just see the, the number in the year and then we divide it by, you know, assuming an equal distribution of, of deaths through the year.

So then we divide it by days or weeks or months or in this case seconds.

OK, Hope, Hope that answers the question of Christian.

And now we have Peter Kenny.

Peter, can you hear us?

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I think my question is direct to Doctor Hayward.

You just mentioned I think it was 15 or 16 countries where the incidents was likely to increase your projections.

And I'm a Southern African journalist and you mentioned South Africa and Namibia.

So I'm interested in if you perhaps know what this could be ascribed to and are there different factors in say South Africa and Namibia or would they be the same in terms of the information that you have?

[Other language spoken]

Thanks, Peter, and good question.

So what we did is what we used as a fairly blunt instrument.

So it's a model which looks at the relationship between different kinds of services and the, the, and the outcome in this case, the prevention of stillbirths and assumes different levels of interruption of those services either because of supply or because people don't want to go, because they're afraid to go or whatever it might be.

Umm, so we apply the same model.

So we're not looking at different models in different countries.

Umm, uh, so it comes out higher if the, if the likely, umm, uh, strength of the interruption of those services is higher in those countries.

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Mark Anshu, please, maybe just to compliment Mark.

And so, umm, the model shows the reduction in services and what the results will be.

And the reduction in services is either because the supplies are not there anymore and the supply chain has broken down because of COVID, either because health workers are not showing up or because people are afraid to go to services.

Either because the protective personal protective equipment is not in the facilities.

And so healthcare workers are not confident or comfortable to provide services, neither are is the population confident to come and benefit from potential.

So those are potential causes why these services might not be provided.

And also we know that a number of health workers have been repurposed in order to provide let's say more COVID directly direct services for COVID, so contact tracing or other things.

And so they have been basically taken away from the routine mother and child services that they would have provided.

So reasons can be varied and and that can even within a country vary, but overall they would be sort of similar.

[Other language spoken]

Anyone else?

Susanna Alison Denzen, would you like to add anything?

I guess I would just add that that in addition to repurposing clinicians towards COVID services, of course, the, the, the, the biggest impact on still birth is that that increased numbers of still births.

But in addition, after still birth does happen, there's the issue of bereavement care.

Unfortunately, in most of the world, there is really no bereavement care at all.

So there's nothing to interrupt.

But in places where there is even minimal care, there are fewer minutes in the day for every clinician to provide that care to to women who've suffered still birth.

And so there's definitely a follow on mental health impact that's at work here as well that's increasing as a result of COVID.

Thank you very much.

Peter, I see you have a follow up.

So this is the question concerning stigmatisation.

I'm just wondering if your research shows different attitudes to stigmatisation or different levels of stigmatisation between developed countries and lesser developed countries, and are they attributable to cultural reasons, religious reasons?

What sort of reasons are they attributed to?

If you have any research on this, thank you.

[Other language spoken]

I'll, I'll start by saying that unfortunately there is very limited, a very limited evidence base to answer your question.

So that's, that's the first thing.

There are some researchers who are working on the issue of stigma in Australia and elsewhere, but there's there's not a lot of evidence out there.

Certainly there are there are cultural differences that affect the the way that stigma is is is perceived in different different countries, driven by religion, culture, practise, etcetera.

However, there's also a commonality.

I think that you know the the case that the, the tragedy of the loss of Chrissy Teigen and John Legend's baby recently in the US unfortunately is an example of the stigma and taboo that surround the death of a baby even in a **** income country like the US.

And I think that shows the, the commonality of, of the issue.

In fact, it's also very difficult to for, for, for communities at every level from from the local on up to ****, **** level policy makers to talk about still birth and to show still birth.

And in fact, we're not able even to to show photographs of, of stillborn babies in this report.

And that unfortunately, is a situation that contributes to to challenges with with reducing the invisibility around still birth.

So I'd say that there are some things that are culturally driven and other things that are common.

[Other language spoken]

Susanna Anshu, would you like to to add something?

[Other language spoken]

Maybe to add that I mean, already looking at terminology and shame around that.

I mean, the word barren and that it's a barren woman, I think already highlights the the stigma around still birth and, and how the woman is perceived that, you know, it's almost, you know, it's her fault.

She So I think there are definitely cultural issues around that in many communities and marriages between two families and it's about progeny and to maintain the family lineage it has to be a male child in many communities etcetera, etcetera.

So there are definitely cultural issues around this.

But I think just the word Baron I think highlights the whole stigma around this whole issue of Steelboat.

Thank you very much.

Anshu, I understand a colleague from UNICEF, Denzen, you would like to add something.

Enrico, if you would be kind enough to unmute Denzen so she can add something.

And while that's happening, may I just put in another plug for for data, which is my passion and my life.

And it's precisely in situations where we have this kind of taboo or stigma or something like that, that is really important to be putting out publications that are jointly prepared and which which to put the situation in, you know, in a numerical and clear and compelling way because we have this extra hurdle to overcome that it's so difficult to to talk about by the individuals and at the community level.

So to help make that push and make that bridge to a conversation.

[Other language spoken]

I'll give the floor now to Dan Zen, call you from UNICEF.

Thank you Tarek and the colleagues.

Just want to add there in some **** income countries now there's some new practise in hospitals now to let the parents hold the baby and also take the photos.

And that helps a lot to support the families, also change them mind is that regarding stillborn babies.

So just want to highlight that, you know, this could be considered for many health facilities not only in the **** income countries, but you know, probably also in low and middle income country.

[Other language spoken]

Thank you very much, Denzen, for this.

I don't see any further questions from journalists who are online.

If that is the case, we will we will conclude here.

So I remind everyone, so you have a press release.

Normally when you click on the link that is in the press release, you will access the the report itself.

A neglected tragedy.

The global burden of steel birds and, and we would would be happy to to have you all respect the embargo that it's tonight at 22 after midnight Geneva time or midnight GMT.

If you have any additional questions, don't hesitate to contact us.

Our colleagues from UNICEF and from WHO will be happy to answer you.

I would like to thank our colleagues from United Nation Information Service for facilitating this this call and also to thank all of our all of our speakers.

Audio file will also be sent to Global Lists along with other documents including all of you in in the coming hours.

Thank you very much and have a nice evening.

Thanks very much Suzanne ask good to meet you.

Anshu, good to see you as always.

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