Press release: Stillbirths - The invisible public health problem

Stillbirths - the new estimates in detail

Almost half of stillbirths, 1.2 million, happen when the woman is in labor. These deaths are directly related to the lack of skilled care at this critical time for mothers and babies. Before-labor stillbirths account for 1.4 million deaths.

“An African woman has a 24 times higher chance of having a stillbirth at the time of delivery than a woman in a high-income country,” says Vicki Flenady, a perinatal epidemiologist, Chair of the International Stillbirth Alliance, and author of the paper on stillbirths in high-income countries for The Lancet’s Stillbirths Series.

Two-thirds of stillbirths happen in rural areas, where skilled birth attendants, in particular midwives and physicians, are not always available for essential care during childbirth and for obstetric emergencies, including caesarean sections.

The stillbirth rate varies sharply by country, from the lowest rates of 2 per 1,000 births in Finland and Singapore and 2.2 per 1,000 births in Denmark and Norway, to highs of 47 in Pakistan and 42 in Nigeria, 36 in Bangladesh, and 34 in Djibouti and Senegal.

It is estimated that some 1.8 million stillbirths occur in ten countries — India, Pakistan, Nigeria, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and United Republic of Tanzania. Half of all stillbirths occur in India, Pakistan, Nigeria, China and Bangladesh alone. These same countries account for a high number of maternal and newborn deaths.

Rates also vary widely within countries. In India, rates range from 20 to 66 per 1,000 births in different states. In high-income countries, disadvantaged women still have very high stillbirth rates. For example, indigenous women in Canada and Australia have stillbirth rates equal to women living in some low and middle-income countries.

Comparing 1995 to 2009 stillbirth rates, the smallest declines were reported in Sub-Saharan Africa and Oceania. Significant declines are reported for China, Bangladesh, and India, which had a combined estimate of 400,000 fewer stillbirths in 2009 than in 1995.

“Stillbirth rates have halved in China and Mexico since 1995, demonstrating what can be accomplished in middle-income countries,” says Dr. Lawn.