Combatting Air Pollution to Reduce Preventable Stillbirths

Stillbirths are a “neglected tragedy,” with one occurring every 16 seconds worldwide on average. A recent Nature Communications article suggests that almost one million stillbirths are associated with air pollution every year, reiterating the globally pervasive consequences that the climate crisis has on health.  

What is a Stillbirth? 

According to the World Health Organization, a stillbirth can be defined as “a baby who dies after 28 weeks of pregnancy, but before or during birth.” Annually, approximately 2.6 million babies die due to stillbirth, which also directly cause 303,000 maternal deaths, creating significant and long-lasting trauma for women and families. 

Air Pollution and Stillbirth 

99% of the world breathes polluted air, with low- and middle-income countries (LMICs) suffering most. Microscopic air pollutants are associated with a variety of health conditions, including a new hypothesis on how air pollutants cause lung cancer in non-smokers. 

The exact mechanism of how air pollution contributes to stillbirths remains unknown. Hypotheses acknowledged in the research article include exposure to air pollution reducing oxygen transport to the fetus; and causing dysfunction to the placenta itself. Despite this, there is growing evidence that air pollution plays a significant role in stillbirths worldwide. Across the 137 countries assessed (which are responsible for over 98% of all stillbirths annually), at least 25% of all stillbirths were associated with exposure to air pollutants during gestation.  

When compared to other causes of pregnancy loss (including miscarriage), stillbirth and exposure to air pollutants are most strongly associated. Furthermore, the research suggests that LMICs are particularly affected by stillbirths from exposure to air pollution during gestation. Therefore, reducing air pollution – particularly in LMICs that are disproportionately affected – may minimize preventable stillbirths worldwide. 

A Multi-Faceted Approach is Required 

It is important to recognize that there are additional approaches which must also be utilized to reduce preventable stillbirths, particularly in LMICs. To combat stillbirths, the Every Newborn Action Plan was launched in 2014, and explores four main indicators: increasing antenatal care contacts, increasing the number of births attended by a skilled health professional, early routine postnatal care, and care for small and sick newborns.  

While the plan will not completely prevent stillbirths, it aims to minimise all stillbirths that can be avoided, and includes global, national, and subnational targets. Additional approaches to reduce avoidable stillbirths include improving access to healthcare and improving service provision such as emergency obstetric care. Through the Every Newborn Action Plan, at least 45 countries now have national plans to improve their quality of care. By adopting these measures while tackling air pollution, this can help to provide a coherent response in tackling preventable stillbirths.