The forgotten perinatal mortality

Earlier this week, the Lancet published international estimates of stillbirth rates. The conclusion of the authors was that progress in reducing stillbirth is slow. This is especially true  in my home country of the United States where stillbirth is now more prevalent than infant death.

I don’t want to minimize the reality of the numbers; but I do want to acknowledge the importance of actually calculating these numbers.  Why? Because the deaths must be counted before action is taken.  It happened this way with neonatal mortality — it was ignored because there was an assumption that you couldn’t really count it.  Some brave advocates refused to accept this and progress accelerated for improved neonatal survival. It happened this way with maternal mortality.  So for me, the fact that fetal survival is being counted means fetal survival will finally be addressed.

I’ve built fetal mortality into my dissertation examining obstetrical levels of care.  Why? First, because I believe hospitals that are better equipped to care for sick mothers are able to improve fetal survival for those mothers.  But also because not counting fetal deaths biases results against the hospitals that can and do improve fetal survival when only neonatal deaths are counted.