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Midwife-led research is helping to reduce stillbirths in Africa

A life-changing four-year research programme, funded by the NIHR’s Global Health Research Programme, is helping to tackle the stillbirth crisis in sub-Saharan Africa.

Globally, 2 million stillbirths occur every year. Sub-Saharan Africa accounts for 64% of these, with women eight times more likely to experience a stillbirth than those in high-income countries like the UK. 

The National Institute for Health Research (NIHR) Global Health Group on Stillbirth Prevention and Management in Sub-Saharan Africa, established in 2017, is the first programme of its kind aimed at reducing stillbirths. 

The Group is a midwife-led research partnership between Liverpool School of Tropical Medicine (University of Manchester until 2020) and the Lugina Africa Midwives Research Network (LAMRN). Its aims were to address a critical lack of research around stillbirth and identify best practice and support for families who endure stillbirths in Kenya, Malawi, Uganda, Tanzania, Zambia and Zimbabwe.

Families and midwives were involved in 12 studies that looked at the risk factors associated with stillbirth, the way the loss of a baby is communicated to families, and bereavement care and support.

Dame Tina Lavender, Professor of Maternal and Newborn Health and Director of the Liverpool School of Tropical Medicine’s Centre for Childbirth, Women’s and Newborn Health, led the programme. She said: “This was a challenging area of investigation, particularly because of the traditional taboos, myths and practices associated with stillbirth. However, it has been the most rewarding, as the small changes that are already being made in the 6 countries look to have set a life-changing impact for many generations to come.”

Research outcomes from the programme include a new clinic in Zimbabwe for women undergoing labour following stillbirth, private rooms for bereaved parents in facilities in Kenya and Tanzania, and a team of bereavement champions in hospitals in Uganda and Kenya. Audits of stillbirth have been embedded in 2 facilities in Malawi to improve childbirth care. 

The programme’s findings have also informed guidelines on maternal health and stillbirth in Uganda, Kenya and led to inquiries into high stillbirth rates in Tanzania. In Zambia, the group’s approach to design data collection is being used to provide better estimates of stillbirth numbers in other parts of the country. 

An impact report found through the programme, the teams shared a number of research outputs that raised the profile of stillbirth at a local level within hospitals and communities, at a country and regional level through events and conferences, and on a global scale through working groups. Midwifery, nursing and medical schools are developing the findings and work into course curriculums, to influence the training of nurses, midwives and doctors and improve care for women and families.

Patient and Public Involvement was found to be central to its success.