Abstract
Previous studies from South Ethiopia have shown that interventions that focus on intrapartum care substantially reduce maternal mortality and there is a need to operationalize health packages that could reduce stillbirths. The aim of this paper is to evaluate if a programme that aimed to improve maternal health, and mainly focusing on strengthening intrapartum care, also would reduce the number of stillbirths, and to estimate if there are other indicators that explains high stillbirth rates. Our study used a “continuum of care” approach and focussed on providing essential antenatal and obstetric services in communities through health extension workers, at antenatal and health facility services. In this follow up study, which includes the same 38.312 births registered by community health workers, shows that interventions focusing on improved intrapartum care can also reduce stillbirths (by 46%; from 14.5 to 7.8 per 1000 births). Other risk factors for stillbirths are mainly related to complications during delivery and illnesses during pregnancy. We show that focusing on Comprehensive Emergency Obstetric Care and antenatal services reduces stillbirths. However, the study also underlines that illnesses during pregnancy and complications during delivery still represent the main risk factors for stillbirths. This indicates that obstetric care need still to be strengthened, should include the continuum of care from home to the health facility, make care accessible to all, and reduce delays.
Highlights
Between 1.7 and 2.5 million stillbirths occur every year, and most of them in developing countries [1]
The aim of this paper is to evaluate if a programme that mainly focused on strengthening intrapartum care would reduce the number of stillbirths, and to assess if there are other indicators that explain high stillbirth rates
The decrease occurred in areas with good access to Comprehensive Emergency Obstetric care (CEmOC) (Dirashe and Arba Minch Zuria woredas), but not in a district where only Basic Emergency Obstetric care (BEmOC) services was available (Bonke) (Table 1)
Summary
Between 1.7 and 2.5 million (median estimate 2.1 million) stillbirths occur every year, and most of them in developing countries [1]. Ethiopia was in 2009 among the ten countries in Asia and Sub-Saharan Africa that accounted for 67% of all stillbirths [2]. Many countries have managed to reduce stillbirths, Sub-Saharan African countries still have high stillbirth rates [1, 3], and even if the Millennium Development Goals focused on maternal and child health, the decline in stillbirths and neonatal deaths rates were slow [4, 5]. The true causes of stillbirths remain uncertain in most low-income countries [7]. Most of the earlier research on stillbirth rates in Ethiopia are based on institutional based
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