Article Text

Download PDFPDF
Stillbirths and neonatal deaths: a neglected global pandemic
  1. Carsten Krüger
  1. Friede Springer Endowed Professorship for Global Child Health, Department of Medicine, Witten/Herdecke University, Witten, Germany
  1. Correspondence to Dr Carsten Krüger, Friede Springer Endowed Professorship for Global Child Health, Department of Medicine, Witten/Herdecke University, Witten 58448, Germany; carsten.krueger{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


The SARS-CoV-2 pandemic has attracted unprecedented attention within the global health (GH) community, the public and in politics worldwide, overshadowing numerous, long-existing major threats to GH (box 1). While resembling several other pandemics, it is perceived and portrayed as an ultimate threat to GH and security. This view is promoted mainly by high-income countries (HICs),1 but ignores the long-existing challenges especially those affecting children, namely climate change, poverty and hunger.2 3

Box 1

Major threats to global health*

  • Climate change, environmental degradation, exploitation of natural resources.

  • Poverty, hunger, lack of education, inequality, impaired developmental potential.

  • Fragile and vulnerable settings, injury and violence, conflict and migration.

  • Non-communicable diseases, unhealthy lifestyles and diets.

  • Weak health systems, inadequate health service provision.

  • Infectious diseases (tuberculosis, HIV, malaria, dengue, influenza, Ebola, SARS-CoV-2, and other high-threat pathogens, neglected tropical diseases), antimicrobial resistance, vaccine hesitancy.

  • * -in-2019;

Some of these threats, for example, non-communicable diseases4 or tuberculosis, may equally qualify for being designated as a pandemic. The term ‘pandemic’ is usually applied to an infectious disease epidemic occurring in many countries on different continents and usually affecting large numbers of people,4 like the ongoing SARS-CoV-2 pandemic. Here, I shall argue that there are strong reasons to apply the term ‘pandemic’ to the global situation in perinatal and neonatal health (PNH). After a brief review of the epidemiology, I shall focus my deliberations on the four qualities which define the term ‘pandemic’: size of affected population, spatial distribution, temporal profile and ‘being contagious’.4 Finally, I shall explain why designating neonatal deaths and stillbirths as a ‘pandemic’ needs urgent consideration.


Each year, 135–140 million children are born worldwide, more than 85% of them in low and middle-income countries (LMICs).S1,S2 During the neonatal …

View Full Text


  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.