1. Callister, Lynn Clark PhD, RN, FAAN

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In 2015, there were 2.6 million stillbirths globally, with 1.3 million occurring during labor and birth (Froen et al., 2016). Twenty countries have the highest rates of stillbirths, accounting for 76% of those deaths occurring globally (United Nations International Children's Emergency Fund, 2016). Ninety-eight percent of stillbirths occur in low- and middle-income countries (Horton & Samarasekera, 2016). These are estimates, as reliable data are not available in some low- and middle-resource settings. For example, at least 38 countries had no stillbirth data in 2015. The global health agenda has been largely silent about stillbirth and the Sustainable Development Goals do not include targets and indicators related to this global tragedy. The 2016 Lancet series, Ending Preventable Stillbirths has brought this public health issue to the forefront in discussion in the global community (Froen et al.; Horton & Samarasekera).


In high-resource countries, most stillbirths occur during pregnancy and are difficult to prevent. In low- and middle-resource countries, the majority of stillbirths occur during labor and birth, mostly related to asphyxia. Small for gestational age fetuses are more at risk for asphyxia due to poor placental function. Stillbirths are significantly associated with adverse social and economic determinants of health and inadequate healthcare (Horton & Samarasekera, 2016). Fortunately, most stillbirths are preventable with appropriate care across the childbearing year. Interventions to prevent stillbirth are practical, feasible, and cost effective (Horton & Samarasekera). Such interventions are identified in the Global Investment Framework for Women's and Children's Health (Stenberg et al., 2014) and are outlined in the Lives Saved Tool Kit (Walker, Tam, & Friberg, 2013). They include prenatal folic acid administration, treatment of syphilis, management of maternal diabetes, management of preeclampsia, skilled birth attendants, induction of labor in pregnancies of more than 41 weeks, and treatment of maternal malaria (Heazell et al., 2016). The aim of this framework, as well as the Lancet series, is to end preventable stillbirths by 2030.


Giving voice to women experiencing stillbirth is one recommendation made by the Lancet series (Horton & Samarasekera, 2016). Exemplary attempts are being made to ameliorate the personal pain of stillbirth, including bereavement programs in healthcare facilities, educational initiatives to increase the sensitivity of nurses, and self-help groups for mourning mothers. This includes one initiative that began in Utah and has spread globally. Two mothers who experienced stillbirths worked together to form a nonprofit organization Teeny Tears ( that donates tiny clothing including miniature diapers for angel babies born at 14-18 weeks gestational age. The donation made by over 2,000 volunteers is provided in twos, with one for the child to be buried in and the other for the parents to keep as part of a memory box. This nonprofit organization serves more than 2,000 hospitals across the country in all 50 states as well as Canada, Belgium, England, Australia, Guatemala, Guam, and the Virgin Islands. Some volunteers who experienced this perinatal loss up to 50 years previously have found peace and healing through their participation in Teeny Tears. Working together across the globe, as professionals and mothers and volunteers, we can make a difference in reducing the incidence of this tragic challenge worldwide.




Froen J. F., Friberg I. K., Lawn J. E., Bhutta Z. A., Pattinson R. C., Allanson E. R., ..., Temmerman M.for the Lancet Ending Preventable Stillbirths Series study group. (2016). Stillbirths: Progress and unfinished business. Lancet, 387(10018). 574-586. [Context Link]


Heazell A. E., Siassakos D., Blencowe H., Burden C., Bhutta Z. A., Cacciatore J., ..., Downe S.for the Lancet Ending Preventable Stillbirths Series study group with the Lancet Ending Preventable Stillbirths investigator group. (2016). Stillbirths: Economic and psychosocial consequences. Lancet, 387 (10018). 604-616. [Context Link]


Horton R., Samarasekera U. (2016). Stillbirths: Ending an epidemic of grief. Lancet, 387 (10018). 515-516. doi:10.1016/S0140-6736(15)01276-3 [Context Link]


Stenberg K., Axelson H., Sheehan P., Anderson I., Gulmezoglu A. M., Temmerman M., ..., Bustreo F.for the Study Group for the Global Investment Framework for Women's Children's Health. (2014). Advancing social and economic development by investing in women's and children's health: A new Global Investment Framework. Lancet, 383 (9925). 1333-1354. doi:10.1016/S0140-6736(13)62231-X [Context Link]


United Nations International Children's Emergency Fund. (2016). State of the world's children 2015. Geneva: Author. [Context Link]


Walker N., Tam Y., Friberg I. K. (2013). Overview of the lives saved tool kit (LiST). BMC Public Health, 13(Suppl. 3), S1. doi:10.1186/1471-2458-13-S3-S1 [Context Link]