Giving birth to a stillborn infant is a tragedy for any parent and their family. These babies die either in late pregnancy or during the process of giving birth; deaths earlier than 28 weeks are called miscarriages.
According to the latest statistics on stillbirths published in The Lancet medical journal on Tuesday, we are still a long way off: around 2.6 million pregnancies worldwide are estimated to have ended in stillbirth last year. Of these, 98% occurred in low- and middle-income countries.
The greater tragedy within these statistics, is that these deaths are often preventable - particularly in the case of malaria and syphilis which are responsible for more stillbirths than any other infections, around 420,000 per year collectively. In sub-Saharan Africa, three of every 10 stillbirths are due to these diseases.
Yet the flipside of this grim reading is the reason for hope: we know how to intervene.
Malaria
Currently, preventive treatment is provided to all pregnant women in moderate to high malaria transmission areas, in the form of antimalarial medication 'SP' (sulphadoxine-pyrimethamine). A course of SP costs just $0.20 and also helps safeguard against a range of associated problems including stillbirth, preterm birth, low birth weight, and neonatal death. This is coupled with using insecticide-treated bed nets at night to prevent the malaria-transmitting mosquitoes from biting women.
However, there is a need for an alternative solution in lower-transmission areas and where SP provision is not the norm; and because malaria parasites eventually lose sensitivity to SP. In particular, there is a need to develop diagnostic tests that are sensitive enough to detect the presence of the parasites in the placenta: those currently available aren't, meaning that a pregnant women may be considered 'malaria free' based on a blood test, while unknowingly carrying the disease.
Syphilis
As for syphilis, around 4-5% of pregnant women in East and Southern Africa are infected with it. A recent study in Tanzania showed 25% of pregnant women with untreated infection delivered a stillborn baby and 50% of all stillbirths were attributed to syphilis in women who had not been screened. A second study in the same setting showed that treatment with a single dose of penicillin before 28 weeks' of pregnancy cured maternal and congenital syphilis and prevented stillbirth and low birthweight attributable to the infection. The cost of intervention was just $1.4 per woman screened.
There is now an affordable solution to these problems. Point of care tests that are quick and easy to use, requiring only one drop of blood and no equipment, are available at a cost of $0.5. These tests can be used anywhere and will give a result within 15 minutes so that women can be screened and, if necessary, treated during the same visit.
To simplify HIV and syphilis screening during antenatal visits, a new point of care test has recently been shown to identify individuals who are infected with syphilis, HIV, or both. The first of these was awarded WHO pre-qualification in November last year, making it available for public sector procurement in resource-limited countries and/ or everywhere where laboratory facilities are not readily available for antenatal care.
There have been major efforts in recent years to mobilise the global health community, donors, policy makers and governments to address this disease through the uptake of dual elimination screening programmes, not least by the Global Congenital Syphilis Partnership (GCSP) a collaboration between Save the Children, the Bill & Melinda Gates Foundation, London School of Hygiene & Tropical Medicine and the U.S. Centers for Disease Control and Prevention among others which was launched in 2012.
Encouragingly, in June last year, the WHO/ PAHO reported that Cuba became the first country in the world to have eliminated the transmission of HIV and syphilis from mothers to children, rising to 17 countries across the Americas by November and a further number poised to follow suit. Elsewhere in the developing world however, the reality is that the political will to implement such programmes at a country level is often not matched by the necessary resources.
So what next?
While some causes of stillbirth are unknown, it is abundantly clear that we have the tools available for preventing those attributable to malaria and syphilis.
But additional resources are needed to catalyse and accelerate further progress: the WHO's 2014 Every Newborn action plan, sets a global target to reduce stillbirth rates to ten for every 1000 births by 2035.
This is where business can step into the breach: but to date, a scarce few industry players have come forward to lend their support to these efforts.
While global leaders from politics, business and civil society are gathered in Davos to future gaze on collaborative solutions for the seemingly insurmountable health challenges of the years ahead, I urge them not to lose sight of the immediate opportunity for - straightforward and proven cost effective - collective action today to prevent nearly half a million stillbirths this year.