EA - Shallow Investigation: Stillbirths by Joseph Pusey

Link to original articleWelcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Shallow Investigation: Stillbirths, published by Joseph Pusey on March 13, 2023 on The Effective Altruism Forum.This topic has the potential to be deeply upsetting to those reading it, particularly to those who have personal experience of the topic in question. If you feel that I’ve missed or misunderstood something, or could have phrased things more sensitively, please reach out to me.Throughout the review, words like “woman” or “mother” are used in places where some people might prefer “birthing person” or similar. This choice reflects the language used in the available literature and does not constitute a position on what the most appropriate terminology is.This report is a shallow dive into stillbirths, a sub-area within maternal and neonatal health, and was produced as part of the Cause Innovation Bootcamp. The report, which reflects approximately 40-50 hours of research, offers a brief dive into whether a particular problem area is a promising area for either funders or founders to be working in. Being a shallow report, it should be used to decide whether or not more research and work into a particular problem area should be prioritised.Executive SummaryImportance: This problem is likely very important (epistemic status-strong)- stillbirths are widespread, concentrated in the world’s poorest countries, and decreasing only very slowly compared to the decline in maternal and infant mortality. There are more deaths resulting from stillbirth than those caused by HIV and malaria combined (depending on your personal definition of death- see below), and even in high-income countries stillbirths outnumber infant deaths.Tractability: This problem is likely moderately tractable (moderate)- most stillbirths are likely to be preventable, but the most impactful interventions are complex, facility-based, expensive, and most effective at scale e.g. guaranteeing access to high-quality emergency obstetric careNeglectedness: This problem is unlikely to be neglected (less strong)- although still under-researched and under-counted, stillbirths are the target of some of the largest organisations in the global health and development world, including the WHO, UNICEF, the Bill and Melinda Gates Foundation, and the Lancet. Many countries have committed to the Every Newborn Action Plan, which aims- amongst other things- to reduce the frequency of stillbirths.Key uncertaintiesKey uncertainty 1: Accurately assessing the impact of stillbirths, and therefore the cost-effectiveness of interventions aimed at reducing stillbirths, depends significantly on to what extent direct costs to the unborn child are counted. Some organisations view stillbirths as having negative effects on the parents and wider communities but do not count the potential years of life lost by the unborn child; others use time-discounting methods to calculate a hypothetical number of expected QALYS lost, and still others see it as completely equivalent to losing an averagely-long life. Differences in the weighting of this loss can alter the calculated impacts of stillbirth by several orders of magnitude and is likely the most important consideration when considering a stillbirth-reducing interventionKey uncertainty 2: Interventions which reduce the risk of stillbirth tend to be those which also address maternal and neonatal health more broadly; therefore, it is very difficult to accurately assess the cost-effectiveness of these interventions solely in terms of their impact on stillbirths, and more complex models which take into account the impacts on maternal, neonatal, and infant health are likely more accurate in assessing the overall cost-effectiveness of interventions.Key uncertainty 3: A large proportion of the data around interventions to reduce stillbirths comes from high-income countries, but most still...