Elsevier

Women and Birth

Volume 33, Issue 6, November 2020, Pages 506-513
Women and Birth

Stillbirth in Australia 1: The road to now: Two decades of stillbirth research and advocacy in Australia

https://doi.org/10.1016/j.wombi.2020.09.005Get rights and content

Abstract

Stillbirth is a major public health problem with an enormous mortality burden and psychosocial impact on parents, families and the wider community both globally and in Australia. In 2015, Australia’s late gestation stillbirth rate was over 30% higher than that of the best-performing countries globally, highlighting the urgent need for action. We present an overview of the foundations which led to the establishment of Australia’s NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) in 2017 and highlight key activities in the following areas: Opportunities to expand and improve collaborations between research teams; Supporting the conduct and development of innovative, high quality, collaborative research that incorporates a strong parent voice; Promoting effective translation of research into health policy and/or practice; and the Regional and global work of the Stillbirth CRE. We highlight the first-ever Senate Inquiry into Stillbirth in Australia in 2018. These events ultimately led to the development of a National Stillbirth Action and Implementation Plan for Australia with the aims of reducing stillbirth rates by 20% over the next five years, reducing the disparity in stillbirth rates between advantaged and disadvantaged communities, and improving care for all families who experience this loss.

Introduction

Stillbirth, the birth of a baby without signs of life after 20 weeks’ gestation, remains a serious public health problem, with an enormous psychosocial impact on parents and care providers, and a wide-ranging economic impact on health systems and society [1].

In this first paper of the Stillbirth Series in Women and Birth, we present an overview of the research and advocacy leading to the establishment of the National Health and Medical Research Council (NHMRC) Centre of Research Excellence on Stillbirth (Stillbirth CRE), and the political processes leading to Australia’s first-ever Senate Inquiry into Stillbirth, which have ultimately led to the National Stillbirth Action and Implementation Plan for Australia.

Section snippets

The need for focussed attention on stillbirth in Australia

Globally, at least 2.6 million women experience stillbirth each year; 7000 women every day [2]. This statistic includes only stillbirths after 28 weeks’ gestation, which is the World Health Organization’s definition. With a lower limit of 20 weeks (a definition commonly used in high-income countries (HICs)), this figure would more than double. Most stillbirths could be prevented by improving health care [3]. While the global burden of stillbirths is largely in low- and middle-income countries [2

Laying the foundations for the first national stillbirth research program

There has been considerable activity in Australia and globally to lay foundations for the first Australian national stillbirth research program, led by the Stillbirth CRE. The first coordinated effort to address stillbirth at a national level in Australia was the establishment of the PSANZ Perinatal Mortality Special Interest Group in 2003, which later became the Stillbirth and Neonatal Death Alliance (PSANZ-SANDA). This group developed a clinical classification system in 2004 [21] to improve

Providing opportunities to expand and improve collaboration between research teams

The initial Stillbirth CRE partnership has grown to a network of 24 organizations including 12 academic institutions, departments of health, peak professional bodies (Royal Australian and New Zealand College of Obstetricians and Gynecologists and the Australian College of Midwives [36]) and the professional societies (Perinatal Society of Australia and New Zealand [37], Women’s Health Care Australasia [38]), and others including The Multicultural Centre for Women’s Health [39]. Parent advocacy

The National Stillbirth Action and Implementation Plan

The Stillbirth CRE and major parent-based advocacy organizations including Red Nose [41], Sands [42], Still Aware [56], Stillbirth Foundation Australia [40], Bears of Hope [43] and others, increasingly applied pressure for government attention to stillbirths in Australia. The key message was the urgent need to address the lack of progress in reducing stillbirth rates. In 2018 in her maiden speech to the Senate, Senator Kristina Keneally (whose baby Caroline was stillborn in 1999) called for a

Conclusion

For too long, the Australian population was reluctant to discuss and confront stillbirth and so it has remained a private tragedy. As a research and advocacy community, one of our most significant achievements has been to bring stillbirths out of the shadows, supporting women and families to talk about their stillborn child and their experiences, helping to address stillbirth collectively as a public health issue. The Australian stillbirth community, with government backing, is now driving a

Conflict of interest

VF is Co-Director for the Stillbirth CRE and receives salary support through an NHMRC Career Development Fellowship. DE is Co-Director of the Stillbirth CRE and has received funding from NHMRC and MRFF. PM is a chief investigator on the Stillbirth CRE and receives salary support through a NHMRC Investigator Grant. CH receives funding as an NHMRC Principal Research Fellow. Caroline Homer (CH), the Editor-in-Chief of Women and Birth, commissioned this series and is a co-author of this paper. The

Funding

This initiative falls within the work program of the Stillbirth CRE which is funded by an NHMRC Centre of Research Excellence grant APP1116640 and MRFF Accelerated Research Grant and Primary Health Care Development Program: The Stillbirth Education and Awareness (GO2536). We gratefully thank the Mater Foundation for their contribution.

Ethical statement

Not applicable to this commentary.

Author contributions

Vicki J. Flenady conceived the paper and worked with David A. Ellwood and Philippa Middleton to draft and revise the manuscript based on author feedback. Aleena M. Wojcieszek, Madeline Forbes, Susannah H. Leisher, Vicki J. Flenady and Hannah Blencowe prepared the Australian scorecard. All authors commented on the drafts and read and approved the final version prior to submission.

Acknowledgements

We thank the women and their families, maternity healthcare professionals, parent advocates, researchers and policy makers in Australia and globally for their contributions to stillbirth advocacy and research. We acknowledged Heidi and Ned Mules for their support over many years providing valuable insights for a parents’ perspective. We acknowledge Stillbirth Foundation Australia, Red Nose, Sands, Bears of Hope, Remembering Riley and other parent advocacy organizations across Australia for

References (58)

  • Z. Mullan et al.

    Bringing stillbirths out of the shadows

    Lancet

    (2011)
  • V. Flenady et al.

    Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis

    Lancet

    (2011)
  • A.E.P. Heazell et al.

    Stillbirths: economic and psychosocial consequences

    Lancet

    (2016)
  • L. de Bernis et al.

    Stillbirths: ending preventable deaths by 2030

    Lancet

    (2016)
  • J.E. Norman et al.

    Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial

    Lancet

    (2018)
  • M.L. Davies-Tuck et al.

    Maternal region of birth and stillbirth in Victoria, Australia 2000-2011: a retrospective cohort study of Victorian perinatal data

    PLoS One

    (2017)
  • M. Mozooni et al.

    Stillbirth in Western Australia, 2005-2013: the influence of maternal migration and ethnic origin

    Med. J. Aust.

    (2018)
  • Australian Institute of Health and Welfare

    Stillbirths and Neonatal Deaths in Australia 2015 and 2016

    (2019)
  • TuJ Kaitu’u-Lino et al.

    Circulating SPINT1 is a biomarker of pregnancies with poor placental function and fetal growth restriction

    Nat. Commun.

    (2020)
  • B.A. Winje et al.

    Analysis of’ count-to-ten’ fetal movement charts: a prospective cohort study

    BJOG

    (2011)
  • Australian Institute of Health Welfare

    Australia’s Mothers and Babies 2018—In Brief

    (2020)
  • V. Flenady et al.

    Clinical Practice Guideline for Care Around Stillbirth and Neonatal Death: Section 3 Respectful and Supportive Perinatal Bereavement Care

    (2020)
  • V. Flenady et al.

    Clinical Practice Guideline for Care Around Stillbirth and Neonatal Death: Section 4 Perinatal Autopsy Including Placental Assessment

    (2020)
  • V. Flenady et al.

    Clinical Practice Guideline for Care Around Stillbirth and Neonatal Death. Version 3

    (2018)
  • World Health Organisation

    Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths

    (2016)
  • P.A. Gardiner et al.

    Evaluation of an international educational programme for health care professionals on best practice in the management of a perinatal death: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE)

    BMC Pregnancy Childbirth

    (2016)
  • A. Chan et al.

    Classification of perinatal deaths: development of the Australian and New Zealand classifications

    J. Paediatr. Child Health

    (2004)
  • International Stillbirth Alliance

    (2020)
  • V. Flenady et al.

    Clinical Practice Guideline for Perinatal Mortality. Version 2.2: (PSANZ)

    (2009)
  • Cited by (0)

    View full text