title: Stillbirths: recall to action in high-income countries.
abstract: Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19,439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.
authors.affiliation: Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA. Electronic address: vicki.flenady@mater.uq.edu.au.
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
authors.affiliation: Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA.
authors.forename: Aleena M
authors.initials: AM
authors.lastname: Wojcieszek
authors.affiliation: International Stillbirth Alliance, NJ, USA; Women's & Children's Health Research Institute, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Philippa
authors.initials: P
authors.lastname: Middleton
authors.affiliation: International Stillbirth Alliance, NJ, USA; Griffith University and Gold Coast University Hospital, Gold Coast, QLD, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ellwood
authors.affiliation: International Stillbirth Alliance, NJ, USA; University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Jan Jaap
authors.initials: JJ
authors.lastname: Erwich
authors.affiliation: International Stillbirth Alliance, NJ, USA; Murdoch Childrens Research Institute, Melbourne, VIC, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Coory
authors.affiliation: International Stillbirth Alliance, NJ, USA; SA Pathology, University of Adelaide, Adelaide, SA, Australia.
authors.forename: T Yee
authors.initials: TY
authors.lastname: Khong
authors.affiliation: International Stillbirth Alliance, NJ, USA; University of Utah Health Sciences Center, Salt Lake City, UT, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
authors.affiliation: National Institute for Health Research, Biomedical Research Centre and Cambridge University, Cambridge, UK.
authors.forename: Gordon C S
authors.initials: GCS
authors.lastname: Smith
authors.affiliation: School of Public Health, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Boyle
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Blencowe
authors.affiliation: Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA.
authors.forename: Susannah Hopkins
authors.initials: SH
authors.lastname: Leisher
authors.affiliation: Hannover Medical School, Hannover, Germany; Zurich University of Applied Sciences, Institute for Midwifery, Winterthur, Switzerland.
authors.forename: Mechthild M
authors.initials: MM
authors.lastname: Gross
authors.affiliation: Mater Research Institute, University of Queensland, Brisbane, QLD Australia; La Trobe University, Melbourne, VIC, Australia.
authors.forename: Dell
authors.initials: D
authors.lastname: Horey
authors.affiliation: International Stillbirth Alliance, NJ, USA; Still Life Canada: Stillbirth and Neonatal Death Education, Research and Support Society, Vancouver, Canada; University of British Columbia, Vancouver, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Farrales
authors.affiliation: Liggins Institute, Auckland, New Zealand.
authors.forename: Frank
authors.initials: F
authors.lastname: Bloomfield
authors.affiliation: International Stillbirth Alliance, NJ, USA; Liggins Institute, Auckland, New Zealand.
authors.forename: Lesley
authors.initials: L
authors.lastname: McCowan
authors.affiliation: Murdoch Childrens Research Institute and General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Brown
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
authors.affiliation: Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA.
authors.forename: Hanna E
authors.initials: HE
authors.lastname: Reinebrant
authors.affiliation: School of Social Work, Arizona State University, Phoenix, AZ, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Cacciatore
authors.affiliation: International Stillbirth Alliance, NJ, USA; CiaoLapo Onlus, Charity for High-Risk Pregnancies and Perinatal Grief Support, Prato, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ravaldi
authors.affiliation: International Stillbirth Alliance, NJ, USA; CiaoLapo Onlus, Charity for High-Risk Pregnancies and Perinatal Grief Support, Prato, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Vannacci
authors.affiliation: International Stillbirth Alliance, NJ, USA; Umamanita, Girona, Spain.
authors.forename: Jillian
authors.initials: J
authors.lastname: Cassidy
authors.affiliation: International Stillbirth Alliance, NJ, USA; Umamanita, Girona, Spain.
authors.forename: Paul
authors.initials: P
authors.lastname: Cassidy
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Cindy
authors.initials: C
authors.lastname: Farquhar
authors.affiliation: International Stillbirth Alliance, NJ, USA; Monash University, Melbourne, VIC, Australia.
authors.forename: Euan
authors.initials: E
authors.lastname: Wallace
authors.affiliation: International Stillbirth Alliance, NJ, USA; University of Bristol, Bristol, UK; Southmead Hospital, Bristol, UK.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Siassakos
authors.affiliation: International Stillbirth Alliance, NJ, USA; 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.
authors.forename: Alexander E P
authors.initials: AEP
authors.lastname: Heazell
authors.affiliation: International Stillbirth Alliance, NJ, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Storey
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Lynn
authors.initials: L
authors.lastname: Sadler
authors.affiliation: Mater Research Institute, University of Queensland, Brisbane, QLD Australia; Mater Health Services, Brisbane, QLD, Australia.
authors.forename: Scott
authors.initials: S
authors.lastname: Petersen
authors.affiliation: Mater Research Institute, University of Queensland, Brisbane, QLD Australia; Griffith University and Gold Coast University Hospital, Gold Coast, QLD, Australia; Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway.
authors.forename: J Frederik
authors.initials: JF
authors.lastname: Frøen
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
mesh_terms: D001294:Attitude to Health; D000068598:Data Accuracy; D003695:Delivery of Health Care / Q000592:standards; D019049:Developed Countries / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D014943:Global Health / Q000706:statistics & numerical data; D006291:Health Policy; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D017051:Hospice Care / Q000592:standards; D006801:Humans; D007182:Income; D007391:International Cooperation; D054238:Perinatal Mortality; D011181:Postnatal Care / Q000592:standards; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards; D012307:Risk Factors; D013240:Stereotyping; D050497:Stillbirth / Q000453:epidemiology* / Q000523:psychology