Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment

Abstract

Summary Background Stillbirths are a major public health issue and a sensitive marker of the quality of care around pregnancy and birth. The UN Global Strategy for Women's, Children's and Adolescents’ Health (2016–30) and the Every Newborn Action Plan (led by UNICEF and WHO) call for an end to preventable stillbirths. A first step to prevent stillbirths is obtaining standardised measurement of stillbirth rates across countries. We estimated stillbirth rates and their trends for 195 countries from 2000 to 2019 and assessed progress over time. Methods For a systematic assessment, we created a dataset of 2833 country-year datapoints from 171 countries relevant to stillbirth rates, including data from registration and health information systems, household-based surveys, and population-based studies. After data quality assessment and exclusions, we used 1531 datapoints to estimate country-specific stillbirth rates for 195 countries from 2000 to 2019 using a Bayesian hierarchical temporal sparse regression model, according to a definition of stillbirth of at least 28 weeks’ gestational age. Our model combined covariates with a temporal smoothing process such that estimates were informed by data for country-periods with high quality data, while being based on covariates for country-periods with little or no data on stillbirth rates. Bias and additional uncertainty associated with observations based on alternative stillbirth definitions and source types, and observations that were subject to non-sampling errors, were included in the model. We compared the estimated stillbirth rates and trends to previously reported mortality estimates in children younger than 5 years. Findings Globally in 2019, an estimated 2·0 million babies (90% uncertainty interval [UI] 1·9–2·2) were stillborn at 28 weeks or more of gestation, with a global stillbirth rate of 13·9 stillbirths (90% UI 13·5–15·4) per 1000 total births. Stillbirth rates in 2019 varied widely across regions, from 22·8 stillbirths (19·8–27·7) per 1000 total births in west and central Africa to 2·9 (2·7–3·0) in western Europe. After west and central Africa, eastern and southern Africa and south Asia had the second and third highest stillbirth rates in 2019. The global annual rate of reduction in stillbirth rate was estimated at 2·3% (90% UI 1·7–2·7) from 2000 to 2019, which was lower than the 2·9% (2·5–3·2) annual rate of reduction in neonatal mortality rate (for neonates aged <28 days) and the 4·3% (3·8–4·7) annual rate of reduction in mortality rate among children aged 1–59 months during the same period. Based on the lower bound of the 90% UIs, 114 countries had an estimated decrease in stillbirth rate since 2000, with four countries having a decrease of at least 50·0%, 28 having a decrease of 25·0–49·9%, 50 having a decrease of 10·0–24·9%, and 32 having a decrease of less than 10·0%. For the remaining 81 countries, we found no decrease in stillbirth rate since 2000. Of these countries...

Effect of Elevated Ambient Temperature on Maternal, Foetal, and Neonatal Outcomes: A Scoping Review

“…In addition, LBW (live births under 2500g) is associated with prenatal mortality and morbidity and increases the risk of non-communicable diseases later in life [25]. Stillbirth is a birth following foetal death before labour or during labour, accounting for 2.0 million deaths globally in 2019 [26].…”

“Too much, too late”: data on stillbirths to improve interpretation of caesarean section rates

“…Like many deaths that are largely preventable, the 2 million stillbirths occurring worldwide every year are inequitably distributed. 1 Low- and middle-income countries carry the largest burden, accounting for up to 98% of stillbirths. Of the estimated 1 966 000 stillbirths per year worldwide, only 38 000 occur in high-income countries.…”

“…Of the estimated 1 966 000 stillbirths per year worldwide, only 38 000 occur in high-income countries. 1 In the past decade, awareness of the high burden of stillbirths has increased, as the global health community has highlighted their impact on the lives of affected parents and communities. 2 …”

“…Stillbirth rates are increasingly regarded as an important indicator of the quality of maternity care. 1 , 3 Nevertheless, many low- and middle-income countries lack accurate and timely data about stillbirths because of limited coverage of civil registration and vital statistics. Instead, national – and therefore global – estimations of stillbirths rely, for the most part, on population-based household surveys such as Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys.…”

“…Instead, national – and therefore global – estimations of stillbirths rely, for the most part, on population-based household surveys such as Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys. 1 To date, these surveys do not capture data pertaining to antenatal and intrapartum care received by women reporting stillbirths, including data regarding mode of birth. Lack of such data leaves an important knowledge gap regarding the impact of interventions on maternal and newborn outcomes.…”