24 June 2021

Life-changing research study led by African midwives is helping reduce stillbirths

A life-changing four-year research programme led by midwives in Africa is helping tackle the stillbirth crisis faced by over a million families 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 with an average of 29 stillbirths per 1,000 births. Responding to international targets the governments of Kenya, Malawi, Uganda, Tanzania, Zambia and Zimbabwe aim to reduce this rate to less than 12 per 1,000 women by 2030.

Midwives from the Lugina Africa Midwives Research Network (LAMRN) have been leading research around stillbirth since 2017, as part of a unique partnership with Liverpool School of Tropical Medicine in the UK, called the National Institute for Health Research (NIHR) Global Health Group on Stillbirth Prevention and Management in Sub-Saharan Africa.

Many families and midwives were involved in 12 studies that looked at the risk factors associated with stillbirth, the way stillbirth is communicated to families and their bereavement care and support.

Some of the many research outcomes include a new clinic in Zimbabwe for women in subsequent pregnancy following stillbirth, private rooms for bereaved parents in Kenya and Tanzania,  a cabinet to facilitate the viewing of the stillborn baby in Kenya, and a team of dedicated bereavement counsellors and champions in hospitals in Uganda and Kenya. Audit of stillbirth have been embedded in 2 facilities in Malawi to improve childbirth care.

An educational board game called ‘Dignity’ was developed to enhance health workers’ knowledge and skills to deliver respectful care which has been tested with health workers and students in Malawi and Zambia with really positive feedback. The findings of the programme have also informed national guidelines on maternal health and stillbirth in Uganda, Kenya and triggered inquiries into high stillbirth rates in hospitals in Tanzania. In Zambia, the MOH is using our approach to design data collection for better estimates of numbers of stillbirths in other parts of the country.

Over the course of the programme the teams has shared research outputs to raise the profile of stillbirth at a local level within hospitals and local 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 building the findings and work into course curriculums, influencing the training of nurses, midwives and doctors to give better care to women and families.

Angela Chimwaza, LAMRN Chair, said: “I am very proud of the work conducted in the six countries to develop best practice to support women and families. The research has had a huge impact on the lives of so many already. Most importantly the work has made important strides towards raising the profile of stillbirth across Africa, encouraging conversations and engagement with the topic.

“Although this programme of work was multi-disciplinary, it was developed, led and delivered by midwives. Taking on this work has been an empowering experience, giving midwives the confidence that they can make a real difference to women and their babies in the future.”

Dame Tina Lavender, Professor of Maternal and Newborn Health and Director of the Centre for Childbirth, Women’s and Newborn Health at Liverpool School of Tropical Medicine in the UK, who led the programme, said:

“Working with parents, health workers, communities and governments through our Community Engagement and Involvement groups was a real highlight. It allowed those most affected by stillbirth to have their voices heard, help us frame our research and questions in culturally sensitive ways and develop services that directly address their needs.”

Angela Chimwaza concluded:

“Reflecting on the last four years, I believe that midwives, as primary care givers, are well placed to address important healthcare issues, and as Chair of LAMRN want to thank everybody involved for their passion and commitment.”

This research was funded by the National Institute for Health Research (NIHR) (16/137/53), a major funder of global health research and training, using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.”