years ago published a groundbreaking and taboo breaking

5 years ago, published a groundbreaking (and taboo-breaking) Series on stillbirths. Its powerful mix of advocacy and hard data attracted more media attention than perhaps any other Series, and made waves on numerous levels, from the individual to the intergovernmental. Working closely with countries and WHO, the Series authors fought to bring “out of the shadows” the unacceptable toll of intrapartum stillbirths in low-income countries, the addressable differences in stillbirth rates between countries with advanced health systems, and the deplorable absence of such devastating events from global tracking efforts such as those of the UN, the Millennium Development Goals, and the Global Burden of Disease. The Series brought home the injustice of ignoring these missing 2·6 million annual deaths, which result from the very same causes as those that kill newborn babies and pregnant women—ie, complications of childbirth, maternal infections, maternal disorders such as BLZ945 and diabetes, fetal growth restriction, and congenital abnormalities. Last week saw the publication of a follow-up Series that begins with a paper assessing progress and finishes with a call to end preventable stillbirths by 2030. In this month\'s issue of , we publish a linked Article in which the Stillbirth Series authors update the landmark 2011 paper that produced the estimate of 2·6 million deaths. In the updated Article, Hannah Blencowe and colleagues refine their methods by including more datapoints (almost twice as many as in 2011) and applying more stringent inclusion and exclusion criteria. Modelling was done for missing datapoints, of which there were sadly still many—only 32% of countries in southeast Asia had national data available. The authors find that the global estimate for 2015 is also 2·6 million, but the uncertainty range is narrower (2·4–3·0 million 2·14–3·82 million for the previous estimate). They compare this with an estimate of 3·25 million for 2000, corresponding to a 19·4% decrease (uncertainty range −1·8 to 36·9%) since that date. The slowest rate of decline was in sub-Saharan Africa and the fastest was in east Asia.
In , Hannah Blencowe and colleagues provide an important contribution to global health through a robust modelling effort to estimate the global stillbirth rates at 28 weeks or more on both a country and regional basis. Crucially, they use consistent methods and extensive data sources to determine stillbirth trends over time since 2000. With the improved modelling, the global stillbirth rate in 2015 is now estimated to be 18·4 per 1000 births, a 24% decrease from the estimated global stillbirth rate of 24·7 per 1000 births in 2000. These modelling methods are necessary to determine stillbirth trends because the regions with the highest stillbirth rates—low-income and middle-income countries (LMICs)—generally have poor registration systems. Historically, stillbirth rates have been absent altogether from registries in many regions. While many high-income countries use a lower gestational age limit of 20–24 weeks to define stillbirth, WHO has recommended 28 weeks (generally considered as the lower limit of viability in LMICs) for international comparisons. Because half of all stillbirths in the USA and Australia occur between 20 weeks and 28 weeks, the stillbirth estimates reported by Blencowe and colleagues using the 28 week cutoff are likely far lower than the rates had a 20–24 week cutoff been used. It is important not to forget the millions of stillbirths that occur worldwide at less than 28 weeks.
China accounts for about a fifth of the world\'s population. With an annual birth rate of 11–12%, or 16 million, as well as wide regional heterogeneity in demographic characteristics, socioeconomic development, and medical resource allocation, it is very difficult, if not impossible, to retrieve vital statistics on all Chinese neonates. Nonetheless, the past decade has witnessed a boom of data production focused on infant mortality and mortality of children younger than 5 years, by virtue of national surveillance systems that sample hospital birth data from cities and counties. However, the stillbirth rate—an indicator of the quality of neonatal and perinatal health care—has been underappreciated and remains largely unexplored.