Stillbirths: rates, risk factors, and acceleration towards 2030

This is the second of five articles published in the 2016 Lancet Series on Ending Preventable Stillbirths.  This article reviews the status of stillbirths worldwide and assesses the progress made since the Lancet Stillbirth Series in 2011.  The paper describes how stillbirth rates have declined more slowly than either maternal death rates or death rates in children younger than 5 years since 2000. As noted, both maternal and child survival were explicitly targeted in the Millennium Development Goals (MDGs), however stillbirths were not included the in MDGs and have not been tracked by the United Nations (UN) or Global Burden of Disease. The Every Newborn Action Plan (ENAP) has the target of 12 or fewer stillbirths per 1000 total births in every country by 2030.The authors performed the following analyses to help inform the actions needed to meet this target:

1. Stillbirth estimates for 195 countries, showing trends from  2000 to 2015
2. The first published analysis of global risk factors, to help identify priority action areas
3. Improvements and remaining gaps in national stillbirth data since the 2011 Lancet Stillbirth Series 

Key findings

• An estimated 2.6 million stillbirths occurred in 2015
• The global stillbirth rate was 18 stillbirths per 1,000 total births in 2015
• Sub-Saharan African has the highest stillbirth rate (28.7 stillbirths per 1,000 total births) and slowest rates of progress worldwide, especially in conflict areas and emergency states
• 98% of stillbirths occur in low- and middle-income countries
• Nigeria has the second highest number of stillbirths worldwide.  Tanzania has the ninth highest number
• Over 60% of stillbirths in sub-Saharan African occur in rural areas 

When do stillbirths occur?The paper indicates that half of stillbirths occur during labour (1.3 million), despite the fact that two-thirds of births worldwide now take place in health facilities.  The authors highlight that improvements in access to high quality care during pregnancy and childbirth is essential to reducing preventable stillbirths and also contributes to improvements in maternal and newborn survival and improved child development. Why do stillbirths occur?Various classification systems for stillbirths limited the authors’ ability to estimate cause of stillbirths.  However, for the 18 countries with reliable data, only 7% of stillbirths are due to congenital abnormalities (also known as birth defects).  Many disorders associated with stillbirths could be modified. For example, in sub-Saharan Africa, 20% of stillbirths are associated with malaria and 11% are associated with syphilis, both of which could be prevented and treated during pregnancy. Counting stillbirthsThe paper finds that less than 5% of newborn deaths and even fewer stillbirths have death registration.  As noted, improved data on stillbirths could help target interventions to prevent stillbirths. Conclusion and recommendationsMany stillbirths could be prevented by treating infections during pregnancy (e.g malaria and syphilis) and improving access to quality family planning services and care during pregnancy and labour.  The authors call for improved data collection systems and systematic recording of stillbirths and review of these data at a local and national level. To read the Lancet Ending Preventable Stillbirths Series, click here. To download stillbirth estimates for Evidence for Action (E4A)-MamaYe countries, click here.To read the article for free, click here. Lawn, J. E., Blencowe, H., Waiswa, P., Amouzou, A., Mathers, C., Hogan, D., Flenady, V., Frøen,J.F., Qureshi, Z.U., Calderwood, C., Suhail, B.M., & Cousens, S. (2016). Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet, 6736(15), 1–17.