Background

There have been many advances in our understanding of the medical reasons for stillbirth in recent years and plans for prevention now in place. Less well understood is how to help reduce preventable stillbirths among women from particular social groups, geographical areas, or ethnic groups who are at higher risk of stillbirth.

The study

The research team searched and found over 13,500 sources of potentially relevant research to include in the review. Only 54 of those sources were actually included. The sources were from nine different research areas.

The review linked existing evidence about inequalities and stillbirth from Social Medicine, Epidemiology, Medical Sociology, Public Health, Spatial Epidemiology, Social Psychology, Audits, Reports and Confidential Enquiries, Fetal-Maternal Medicine, and Nursing and Midwifery. 

Findings

Evidence of links between social inequalities and stillbirth spanned 70 years. There was persistent evidence of social disadvantage and higher risk of stillbirth remaining constant or increasing. The review found repeated calls for action on inequalities across all research traditions, but less evidence of an effective response to these calls.

Data about socio-economic, area and ethnic differences were regularly collected, but not always recorded, monitored or reported.

Many studies stressed the interplay of socio-economic status, deprivation or ethnicity with aggregated factors including heritable, structural, environmental, and lifestyle factors. Most of these factors are already well known and have been for some time. Thus the challenge remains to move from evidence of associations between inequalities and stillbirth to the relationship between factors and how best to intervene to impact stillbirth prevention.

The review found no intervention studies.

What’s next?

This review connects insights from different research traditions into the complexities, challenges and opportunities surrounding inequalities and stillbirth. In so doing, it provides a starting point for a novel transdisciplinary response. Lobbying for policy and research leadership in this area is a priority. In addition, work is now underway to obtain funding for a series of studies to begin to target stillbirth reduction in disadvantaged families, which complement existing initiatives.

Recommendations

1. The number of babies that die before, during or shortly after birth is a useful marker of inequalities in health more generally and should be a consideration in public health programmes.
2. Living in impoverished circumstances and/or being from an ethnic minority group are markers that should be incorporated into routine assessments for the identification and management of women at “higher risk” of stillbirth.
3. Data pertaining to socio-economic, area and ethnic disparities should be more consistently recorded, monitored, reported and acted upon – this requires a national consensus to harmonise existing measures.  
4. Future research should incorporate methodological approaches that listen to women, families and health professionals to understand their values, beliefs and experiences, which are crucial mediators of the effectiveness of stillbirth prevention initiatives. 
5. A specific research forum is required to lead the development of research and policy in this area, which can harness the multiple relevant research perspectives and address the intersections between different policy areas.

The full research paper can be read here

Lead researcher: Dr Carol Kingdon, University of Central Lancashire

Sum awarded: £23,436