Stillbirths: Global Causes, Disparities and the Need for Better Reporting

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By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

An estimated 2.6 million stillbirths occur every year across the globe, but many of them are not counted, reviewed or reported. The Every Newborn Action Plan proposed a target for reducing global stillbirths during the Sustainable Development Goal period from 18.4 stillbirths per 1,000 births to 12 or fewer stillbirths per 1,000 births by 2030. However, inaccurate reporting and inconsistencies with definitions are key challenges for tracking progress and achieving this target.

In a recent systematic review, Reinebrant and colleagues examined the reported causes of stillbirth globally, revealing substantial data gaps.

What are the causes of stillbirth?

The authors reviewed 85 reports—28 from low-income countries (LICs), 20 from middle-income countries (MICs) and 37 from high-income countries (HICs)—containing data on nearly 490,000 stillbirths.

Based on a subset of 33 nationally representative reports classifying roughly 250,000 stillbirths, the most commonly reported cause across all settings was categorized as “unexplained,” and many were listed as “other unspecified condition.” Other leading reported causes included antepartum hemorrhage, infection and hypoxic peripartum death. The relative proportions of these causes varied across high-, middle- and low-income countries.

Data discrepancies

Classification systems and definitions for stillbirth varied substantially among regions. For example, while most LICs used 28 weeks’ gestation as a parameter for stillbirth, the majority of HICs used 20-24 weeks. This discrepancy makes it difficult to compare stillbirth rates across countries.

The authors added,

“Many countries, particularly those where the majority of stillbirths occur, do not report any information about these deaths. Where there are reports, the quality is often poor. It is important to improve the investigation and reporting of stillbirth using a standardized system so that policymakers and health care workers can develop effective stillbirth prevention programs. All stillbirths should be investigated and reported in line with the World Health Organization standards.”

Identifying specific areas for improvement and interventions to address the global burden of stillbirth requires reliable data. Accurate, consistent and comprehensive reporting of stillbirths is essential for reaching the stillbirth target under the SDGs and is a reflection of a strong health information system.

Explore The Lancet series on ending preventable stillbirths.

Learn about the World Health Organization’s efforts to help countries improve data collection on stillbirths.

Are you working on preventing stillbirth globally? We want to hear from you!