title: Stillbirths: economic and psychosocial consequences.
abstract: Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.
authors.affiliation: Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; International Stillbirth Alliance, New York, NY, USA. Electronic address: alexander.heazell@manchester.ac.uk.
authors.forename: Alexander E P
authors.initials: AEP
authors.lastname: Heazell
authors.affiliation: International Stillbirth Alliance, New York, NY, USA; Academic Centre for Women's Health, University of Bristol, Bristol, UK; Southmead Hospital, Bristol, UK.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Siassakos
authors.affiliation: Centre for Maternal Reproductive and Child Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Blencowe
authors.affiliation: Academic Centre for Women's Health, University of Bristol, Bristol, UK; Southmead Hospital, Bristol, UK.
authors.forename: Christy
authors.initials: C
authors.lastname: Burden
authors.affiliation: Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Arizona State University, Tempe, AZ, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Cacciatore
authors.affiliation: Institute for Reproductive and Family Health, Hanoi Vinmec International General Hospital, Hanoi, Vietnam.
authors.forename: Nghia
authors.initials: N
authors.lastname: Dang
authors.affiliation: Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Jai
authors.initials: J
authors.lastname: Das
authors.affiliation: International Stillbirth Alliance, New York, NY, USA; Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
authors.affiliation: International Stillbirth Alliance, New York, NY, USA; Department of Family Medicine and Department of Obstetrics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Gold
authors.affiliation: Krachi Midwifery Training School, Kete-Krach, Ghana.
authors.forename: Olivia K
authors.initials: OK
authors.lastname: Mensah
authors.affiliation: Clinical Center Department of Bioethics, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Millum
authors.affiliation: Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nuzum
authors.affiliation: Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland.
authors.forename: Keelin
authors.initials: K
authors.lastname: O'Donoghue
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Maggie
authors.initials: M
authors.lastname: Redshaw
authors.affiliation: Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Arjumand
authors.initials: A
authors.lastname: Rizvi
authors.affiliation: Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Tracy
authors.initials: T
authors.lastname: Roberts
authors.affiliation: Wellbeing Foundation Africa, Lagos, Nigeria.
authors.forename: H E
authors.initials: HE
authors.lastname: Toyin Saraki
authors.affiliation: International Stillbirth Alliance, New York, NY, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Storey
authors.affiliation: International Stillbirth Alliance, New York, NY, USA; Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Aleena M
authors.initials: AM
authors.lastname: Wojcieszek
authors.affiliation: ReaCH group, University of Central Lancashire, Preston, UK.
authors.forename: Soo
authors.initials: S
authors.lastname: Downe
mesh_terms: D003365:Costs and Cost Analysis; D005192:Family Health; D005260:Female; D005378:Financial Support; D006117:Grief; D017048:Health Care Costs; D005102:Health Expenditures; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D007182:Income; D010290:Parents / Q000523:psychology; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D012943:Social Security; D012944:Social Support; D013240:Stereotyping; D050497:Stillbirth / Q000191:economics* / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology