Runa Akhter sat gloomily in the gynaecology ward of Dhaka Medical College Hospital. Four hours ago, her younger sister Asma Akhter (22) gave birth to a stillborn child. It was her very first child.
Runa told Prothom Alo, Asma has a cesarean section delivery. She had got admitted into the hospital six days ago with labour pains. Blaming her sister’s husband, Runa said, “He didn’t take her to see a physician even once during her pregnancy.”
Runa talked to this reporter in front of the gynaecology ward of Dhaka Medical College Hospital on 31 May afternoon.
According to the hospital’s register, Asma’s stillborn baby was 32 weeks or eight months. The infant died inside the womb.
On an average 37 infants, just like Asma’s child, have been stillborn in 586 government hospitals in seven months from January to July this year. The rate of stillbirth in the country is more than twice or about thrice higher than that of neonatal mortality.
Usually, when an infant dies after completing 28 weeks inside the womb it is defined as stillbirth. Loss of the child still inside the uterus prior to this stage is termed miscarriage. However, according to some definitions if a child is born dead after remaining inside the womb for 24 weeks it is considered a stillbirth.
Reasons of stillbirth
About the reasons behind stillbirth, Ferdousi Begum, president of Obstetrical and Gynecological Society of Bangladesh (OGSB), association of specialist gynecologists and obstetricians, told Prothom Alo if the expectant mother is younger than 16 years or older than 35 years, if the mother suffers from obesity, diabetes, high blood pressure and infection, if the pregnancy surpasses 42 weeks, if there’s a lack in prenatal care and nutrition during pregnancy and if proper steps are not taken at the time of delivery, there looms the risk of stillbirth.
Professor Fedousi said, taking 6 to 8 times more steps in maternal and child health safety than at present will reduce stillbirths, neonatal deaths and maternal mortality.
40 to 60 per cent of stillbirths occur at the very end of the labour process for not taking the mother to hospital at the time of the delivery and not taking proper measures for a safe delivery after arriving at the hospital.
33 stillbirths in a thousand
7,795 stillborn infants have been born in the first seven months of the running year at a total 586 government hospitals in the country including 430 health complexes, 33 medical college hospitals and 123 district level hospitals consisting 10 to 250 beds that fall under the jurisdiction of the health services directorate.
This is more than double the number of neonatal deaths in these seven months. Compared to the total number of infants born during that period, 33 stillbirths are occurring per thousand.
Analysing data from the directorate general of health services it was learnt that, among all the stillbirths 3,733 occurred at government medical colleges, 2,413 at district hospitals and 1,649 at upazila health complexes. Meanwhile, 15,753 stillbirths occurred in 2019, 14,255 in 2020 and 14,959 in 2021.
According to experts, this is the picture from 586 government hospitals. Beyond this, the highest numbers of childbirths take place at homes and at private hospitals. There is no record of the stillbirths happening there.
No records of stillbirths were found in the reports of three major government surveys, Bangladesh Demographic and Health Survey (BDHS) 2017-18, Multiple Indicator Cluster Survey 2019 and Bangladesh Sample Vital Statistics 2020.
According to BDHS’s latest report from 2017-18, only 50 per cent infants are born at hospitals. While only 14 per cent of them are born at government hospitals.
Md Shamsul Haque, line director (Maternal, Newborn, Child and Adolescent Health) at the directorate general of health services, speaking to Prothom Alo, said, “The stillbirth rate is somewhat high in our country. However it’s lower than that of many countries around the world. The reasons behind stillbirth have been identified.”
“Stillbirths, maternal mortality and neonatal deaths are interconnected with one another. So, these deaths can be prevented by strengthening the prenatal and pregnancy-time services along with the implementation of safe delivery procedures. The government is implementing ‘The Every New Born Action Plan’,” he added.
Bangladesh 7th in maternal mortality
A report titled ‘A Neglected Tragedy: The Global Burden of Stillbirth’, jointly published by UNICEF, World Bank Group and World Health Organization in 2020 stated, Bangladesh saw 24.3 per cent incidents of stillbirths per thousand in 2019.
Three organisations have set a target of reducing stillbirths below 12 per thousand by 2030 through the implementation of 'The Every New Born Action Plan'. The global stillbirth rate is now about 14 per thousand.
A report titled ‘Ending Preventable Stillbirth’ published in medical journal The Lancet in 2016 said, 83 thousand stillborn children are born in Bangladesh annually. In terms of numbers, Bangladesh ranks seventh among top ten countries of the world. India tops the list while Pakistan stands third.
There are six African countries and Indonesia among the seven remaining countries on that list. However Pakistan tops the list of top ten countries of stillbirth per thousand with 43 deaths per thousand. Other nine countries of the list are from Africa.
A report on stillbirths in rural areas of the country titled ‘Stillbirth Surveillance and Review in Rural Districts in Bangladesh’ published in BMC Pregnancy and Childbirth journal stated, about 54 per cent stillbirths in villages take place at homes.
15 per cent of the stillbirths occurred due to high blood pressure during pregnancy, 14 per cent due to blood loss, 11 per cent for oxygen deficiency and 9 per cent for infection during pregnancy. Reasons behind other stillbirths could not be figured out specifically. 48 per cent mothers gave birth to stillborn children, despite receiving maternal care from highly trained physicians.
Save the Children officer and public health expert Ishtiaq Mannan told Prothom Alo, most of the 83 thousand stillborn children being born in the country in a year could have lived if the existent maternal care programme functioned properly.
It is extremely difficult to collect an account of stillbirths, for the recording and management of healthcare data in the country is feeble and unreliable. Planning and implementation of stillbirth prevention is not possible unless these records are preserved in a systematic way.
*This report appeared in the print and online edition of Prothom Alo and has been rewritten in English by Nourin Ahmed Monisha