• Vicki Flenady, Aleena M Wojcieszek, Philippa Middleton, David Ellwood, Jan Jaap Erwich, Michael Coory, T Yee Khong, Robert M Silver, SmithGordon C SGCSNational Institute for Health Research, Biomedical Research Centre and Cambridge University, Cambridge, UK., Frances M Boyle, Joy E Lawn, Hannah Blencowe, Susannah Hopkins Leisher, Mechthild M Gross, Dell Horey, Lynn Farrales, Frank Bloomfield, Lesley McCowan, Stephanie J Brown, K S Joseph, Jennifer Zeitlin, Hanna E Reinebrant, Joanne Cacciatore, Claudia Ravaldi, Alfredo Vannacci, Jillian Cassidy, Paul Cassidy, Cindy Farquhar, Euan Wallace, Dimitrios Siassakos, HeazellAlexander E PAEPInternational Stillbirth Alliance, NJ, USA; Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; St Mary's Hospital, Central Manchester University Hospitals, NHS Foundation, Claire Storey, Lynn Sadler, Scott Petersen, J Frederik Frøen, Robert L Goldenberg, Lancet Ending Preventable Stillbirths study group, and Lancet Stillbirths In High-Income Countries Investigator Group.
• Mater Research Institute, University of Queensland, Brisbane, QLD Australia; International Stillbirth Alliance, NJ, USA. Electronic address: vicki.flenady@mater.uq.edu.au.
• Lancet. 2016 Feb 13; 387 (10019): 691-702.

AbstractVariation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19,439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.Copyright © 2016 Elsevier Ltd. All rights reserved.

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