EA - [Cause Exploration Prizes] Preventing stillbirths by Denise Melchin

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: [Cause Exploration Prizes] Preventing stillbirths, published by Denise Melchin on August 29, 2022 on The Effective Altruism Forum. This essay was submitted to Open Philanthropy's Cause Exploration Prizes contest. If you're seeing this in summer 2022, we'll be posting many submissions in a short period. If you want to stop seeing them so often, apply a filter for the appropriate tag! Author's note: This cause area exploration is far from the depth and clear conclusions I would want and is in parts clearly in draft mode. Open Phil encouraged me to submit regardless and publish properly later. I will do this to encourage myself to actually finish it at a later date and not forget the post in the drawer. This submission might change focus later: I could imagine improved antenatal and labour care to have wider benefits on child health than reducing stillbirths. Summary Two million babies are stillborn every year. A baby is called stillborn if they die after 28 weeks of pregnancy. Most charitable interventions focus on children already born despite babies being much more vulnerable in the last trimester. Almost half of all stillborn babies were still alive until labour started, passing away hours or mere minutes before they were born. Stillbirths are usually not given a DALY weighting so are ignored in cost-effectiveness analysis. Interventions reducing maternal and child deaths often reduce stillbirths as well, so they are more cost-effective than they first appear. Intragovernmental bodies as well as philanthropists have shown much less interest in reducing stillbirths compared to maternal and child deaths. This gives philanthropists the opportunity to save more lives by focusing on stillbirths. To a first approximation, children become less vulnerable as they get older. Adjusting for the length of the time period, the stillbirth rate is much higher than the infant mortality rate which in turn is much higher than the under 5’s mortality rate. Although birth is the riskiest period. As philanthropists we have already noticed that focusing on young children is often most cost-effective. All recommended GiveWell charities above the GiveDirectly bar are focusing on the lives of young children. Trying to reduce stillbirths by improving care of pregnant women would just be going one step further in this direction. Uncertainties Major This submission primarily discusses stillbirths. But the potential interventions to reduce stillbirths have wider benefits. I do not know what fraction of the benefits of the interventions actually accrue as stillbirth prevention. Therefore it is possible a later publication will pivot into antenatal interventions and/or labour care more widely. As of now, his post is missing plenty of potential interventions, instead just giving a cursory overview, as well as lacking cost-effectiveness estimates. Therefore it is hard to say whether it is a plausible competitive cause area candidate. Minor Some data is a bit outdated. This seems particularly risky due to geographic shift in stillbirths. I have not paid enough attention to different risk factors by geography. Importance Two million babies are stillborn every year. A baby is called stillborn if they die after the 28th week of pregnancy but before they are born. If born in a rich country, most of these babies would live. In the UK, a baby born at 28 weeks is around 90% likely to survive up to virtually a hundred percent if full-term. This is especially true for the almost half of all stillbirths in which the baby only dies after labour has already started. A sharp discontinuity in health cost-effectiveness analysis such that a baby passing away minutes after birth should be given the full QALY weighting while a baby passing away minutes before should be ignored seems hard to defend.Babies passing away...