Maternal, newborn, child and adolescent health

Stillbirths

Definition

The definition recommended by WHO for international comparison is a baby born with no signs of life at or after 28 weeks' gestation.

Incidence

In 2015 there were 2.6 million stillbirths globally, with more than 7178 deaths a day. The majority of these deaths occured in developing countries. Ninety-eight percent occurred in low- and middle-income countries. About half of all stillbirths occur in the intrapartum period, representing the greatest time of risk. Estimated proportion of stillbirths that are intrapartum varies from 10% in developed regions to 59% in south Asia.

Distribution

Three-forths of the stillbirths occured in south Asia and sub-Saharan Africa and 60% occurred in rural families from these areas. This reflects a similar distribution of maternal deaths and correlates with areas of low-skilled health professional attendants at birth. The stillbirth rate in sub-Saharan Africa is approximately 10 times that of developed countries (29 vs. 3 per 1000 births).

Trends

Worldwide, the number of stillbirths has declined by 19.4% between 2000 and 2015, representing an annual rate of reduction (ARR) of 2%. This reduction noted for stillbirths is lower than that noted for maternal mortality ratio (AAR=3.0 %) and under 5 mortality rate (ARR= 3.9 %), for the same period.

Causes of stillbirth

The major causes of stillbirth include:

  • child birth complications
  • post-term pregnancy
  • maternal infections in pregnancy (malaria, syphilis and HIV)
  • maternal disorders (especially hypertension, obesity and diabetes)
  • fetal growth restriction
  • congenital abnormalities.

Almost half of stillbirths happen when the woman is in labour.

The majority of stillbirths are preventable, evidenced by the regional variation across the world. The rates correlate with access to maternal healthcare. The every newborn action plan (ENAP) to end preventable deaths has a set stillbirth target of 12 per 1000 births or less by 2030. Global ARR needs to more than double the present ARR of 2% to accomplish this target for reduction in stillbirth.