死产:看不见的公众健康问题
Some 2.6 million third trimester(晚期妊娠) stillbirths(死产) 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(停滞) 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(先天的) 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.
"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.