No Progress in Cutting Stillbirths in the United States

Health News -- November 14, 2022: A new study found that efforts to close the persisting disparity between the excess stillbirths suffered by
Black women and White women have stopped,

as have efforts to lessen the stillbirth rate in the United States.

"Over the last 40 years, we have reduced certain risk factors for stillbirth, such as smoking and alcohol use before and during pregnancy, but these gains have been countered by substantial increases in other risk factors, like obesity and structural racism," said Cande Ananth, chief of Epidemiology and Biostatistics in the Department of Obstetrics, Gynecology and Reproductive Sciences at the Rutgers Robert Wood Johnson Medical School and lead author of the study published in The Lancet Regional Health -- Americas.
"Our findings illustrate that past progress has now been offset by these newly identified risks," Ananth said.

According to a Rutgers-led study, progress in closing a lingering discrepancy in the excess stillbirths suffered by Black women compared with White women has stagnated, as has an endeavor to cut the stillbirth rate in the United States that has been ongoing for decades.

Ananth and a group of obstetricians from Rutgers University looked studied changes in stillbirth rates between 1980 and 2020 to understand how cultural and environmental factors affect stillbirths among Black and White mothers in the United States.

"The cohort is a new dimension to understanding these adverse outcomes," said Ananth. "To understand the paper's significance, you need to view it in a three-dimensional perspective. We have age of the mother, year of delivery and the birth cohort. All three factors are time-related and intertwined."

The researchers assessed the relationship between maternal age, year of death (indicating changes in prenatal and intrapartum care and other factors), and maternal birth cohorts (indicating social and environmental factors, such as socioeconomic status, education, nutrition, and substance use at the time of the women's birth). The data were compiled by the National Center for Health Statistics of the Centers for Disease Control and Prevention and covered all 50 states and the District of Columbia.

The analysis covered more than 157 million live births and roughly 711,000 stillbirths in the United States over the previous 40 years.

The researchers discovered that between 1980 and 2005, the overall stillbirth rate in the U.S. decreased consistently, supporting this finding with improvements in maternal and prenatal care. In 1980, 10 stillbirths occurred for every 1,000 deliveries made by women. By 2005, it had dropped to around 5 per 1,000 people.

The rate has since leveled out and is almost the same as it was more than ten years ago, the researchers discovered.

Additionally, despite initiatives to lessen institutional racism and improve access to healthcare for women of color, the difference between Black women's stillbirth rates and White women's nonetheless remained constant over the course of the 40-year period. In 1980, Black women's rate was around double that of White women's (17.4 against 9.2 per 1,000 births), and it remained double in 2020. (10.1 versus 5.0 per 1,000 births).

Ananth's study introduced a third component, the birth cohort, which is the year the mother was born, in contrast to most prior research, which has mostly concentrated on hazards like age at delivery and social and environmental factors.

The findings, according to Ananth, show a clear connection between birth cohort and the chance of stillbirth.

There are a number of factors that could be to blame for the stagnant drop in stillbirth rates. The researchers speculated that a national initiative to lower elective deliveries before 39 weeks in 2009 may have contributed to the problem. Additionally, it's possible that obstetrical intervention and medical advancements to detect or prevent stillbirth slowed down.

According to Ananth, the reasons for the persisting disparity in stillbirth disparities are more complex and include structural racism and bias, social inequality, and a higher prevalence of chronic disorders and sickness.

Ananth claimed that when these facts are combined, a grim picture of health care is painted that demands immediate response at the municipal, state, and federal levels.

"I am a firm believer that even one death is one too many," he said. "Delivering a stillbirth carries so much social and emotional trauma -- for the parents, and for the entire society."

WNCTIMES by Marjorie Farrington 

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