Better statistics for better health

for pregnant women and their babies

Commentary on the Lancet Ending Preventable Stillbirths Series

by Jennifer Zeitlin, *

The Lancet Ending Preventable Stillbirths Series was published in January 2016 and includes five papers that develop a global agenda for ending preventable stillbirths in low, middle and high income countries [1]. The series builds on a previous set of articles published in 2011 and measures the effectiveness of actions since this first call to action [2]. One article specifically addresses the issue of stillbirths in high income countries, as in the original series [3, 4]. Euro-Peristat added to the information in this article by publishing a background paper showing that stillbirth rates are much higher among women in a lower socioeconomic position compared with women in a higher position and that routine data are available to monitor these inequalities [5].

The conclusions of the series are relevant for Euro-Peristat’s on-going work. First, the series highlights the importance of having more and better data on stillbirths and calls attention to the question of stillbirths among extremely preterm births. In our studies comparing stillbirth rates, we have removed stillbirths before 28 weeks of gestation to make sure that we are comparing “like with like”, but it is also important to investigate trends in this group, at least in countries where definitions have stayed the same over the years. Second, by emphasizing the importance of social inequalities in maternal and newborn outcomes, the series challenges countries to collect better and more comprehensive data on social characteristics. It may be possible in our future work to collect more of our current indicators, such as maternal age, smoking or body mass index, by our indicators of social position (mothers’ educational level and parents’ social class based on occupation), or to collect fetal and neonatal mortality by new indicators of social position (for instance, migration status). Third, the series identifies key risk factors for stillbirth that require further research, including fetal growth restriction. Being able to compare the proportions of small for gestational age babies between countries is a complex question which our group has recently started to tackle. Finally, Euro-Peristat advocates the improvement of stillbirth and infant mortality data by promoting the use of common definitions and by analysing the extent to which apparent differences in outcomes may arise from differences in recording practices. We hope that the momentum and interest generated by this series will increase awareness and concern about the shortcomings of current data and encourage investment in the high quality statistics needed to underpin effective national and international health policies.

*Research director, EPOPé Research Team, INSERM U1153, Coordinator Euro-Peristat


1. de Bernis L, Kinney MV, Stones W, Ten Hoope-Bender P, Vivio D, Leisher SH, Bhutta ZA, Gulmezoglu M, Mathai M, Belizan JM, Franco L, McDougall L, Zeitlin J, Malata A, Dickson KE, Lawn JE, Lancet Ending Preventable Stillbirths Series study g, Lancet Ending Preventable Stillbirths Series Advisory G, (2016) Stillbirths: ending preventable deaths by 2030. Lancet 387: 703-716


2. Goldenberg RL, McClure EM, Bhutta ZA, Belizan JM, Reddy UM, Rubens CE, Mabeya H, Flenady V, Darmstadt GL, (2011) Stillbirths: the vision for 2020. Lancet 377: 1798-1805


3. Flenady V, Wojcieszek AM, Middleton P, Ellwood D, Erwich JJ, Coory M, Khong TY, Silver RM, Smith GC, Boyle FM, Lawn JE, Blencowe H, Leisher SH, Gross MM, Horey D, Farrales L, Bloomfield F, McCowan L, Brown SJ, Joseph KS, Zeitlin J, Reinebrant HE, Ravaldi C, Vannacci A, Cassidy J, Cassidy P, Farquhar C, Wallace E, Siassakos D, Heazell AE, Storey C, Sadler L, Petersen S, Froen JF, Goldenberg RL, Lancet Ending Preventable Stillbirths study g, Lancet Stillbirths In High-Income Countries Investigator G, (2016) Stillbirths: recall to action in high-income countries. Lancet 387: 691-702

4. Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY, Neilson J, Ezzati M, Koopmans L, Ellwood D, Fretts R, Froen JF, Lancet's Stillbirths Series steering c, (2011) Stillbirths: the way forward in high-income countries. Lancet 377: 1703-1717

5. Zeitlin J, Mortensen L, Prunet C, Macfarlane A, Hindori-Mohangoo AD, Gissler M, Szamotulska K, van der Pal K, Bolumar F, Andersen AM, Olafsdottir HS, Zhang WH, Blondel B, Alexander S, Euro-Peristat Scientific C, (2016) Socioeconomic inequalities in stillbirth rates in Europe: measuring the gap using routine data from the Euro-Peristat Project. BMC pregnancy and childbirth 16: 15




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