A stillbirth occurs every 16 seconds somewhere in the world. This means that every year, about 2 million babies are stillborn – a loss that reaches far beyond the loss of life. It has a traumatic long-lasting impact on women and their families around the world, who often endure profound psychological suffering as well as stigma from their communities, even in high-income countries. Perhaps even more tragically, the majority of these deaths could have been avoided with high-quality care antenatally and during birth. Over 40 per cent of all stillbirths occurred during labour – a loss that could be prevented with improved monitoring and access to emergency obstetric care when required.
Being in the same room with other mothers holding their babies was unbearable. In the neighborhood, hearing dehumanizing words toward my baby and myself was the worst.
— Sabine Uwizeye, mother, Rwanda
This tragic loss of life remains a neglected issue, as worldwide data on stillbirths are largely absent. A Neglected Tragedy: The Global Burden of Stillbirths, the first-ever stillbirth report by the UN Inter-Agency Group for Child Mortality Estimation (UN-IGME), is a critical milestone in improving the availability of these data globally and driving political and public recognition of the issue. The report finds that despite progress being made since 2000, stillbirths have not declined as rapidly as maternal and newborn mortality, and if current trends continue, an additional 19 million stillbirths will take place before 2030. More than 200,000 additional stillbirths could also occur over the next 12 months in 117 low- and middle-income countries due to severe COVID-related disruptions in health care services.
⟩ Global inequities
In 2019, an estimated 1.9 million babies were stillborn at 28 weeks of pregnancy or later, with a global stillbirth rate of 13.9 stillbirths per 1,000 total births. These losses, however, are not experienced uniformly. The report reveals huge differences in stillbirth rates across the globe, with a risk that is up to 23 times higher in the worst affected countries. Stillbirths were concentrated in a few countries, with the greatest number found in India, followed by Pakistan, Nigeria, the Democratic Republic of the Congo, China and Ethiopia. These six countries accounted for half of the estimated global number of stillbirths and 44 per cent of global live births.
The unequal burden of stillbirths is also observed within countries, as access to health care, maternal education and other socioeconomic factors differs. For example, in high- and low-income countries alike, higher stillbirths rates are reported in rural areas than in urban areas. These wide discrepancies reiterate the need for all countries to take action and understand who carries the heaviest burden so that we can end preventable stillbirths for all women and families.
The burden of stillbirths is highest in sub-Saharan Africa and South Asia, with the two regions accounting for three quarters of all stillbirths. In sub-Saharan Africa, the stillbirth rate of 21.7 per 1,000 total births was seven times higher than the lowest regional rate of 3.1 found in the Europe, Northern America, Australia and New Zealand region. More worryingly, sub-Saharan Africa’s portion of the global number of stillbirths has increased from 27 per cent in 2000 to 42 per cent in 2019 as population growth has outpaced decreases in stillbirth rates.
⟩ Progress since 2000
Over the past two decades, substantial progress has been made in reducing the stillbirth rate globally, which declined from 21.4 stillbirth per 1,000 total births in 2000 to 13.9 in 2019 – a 35 per cent reduction. The total number of stillbirths also decreased by 32 per cent, from 2.9 million to 2.0 million. However, these reductions have not kept pace with other indicators such as under-five mortality.
Compared to the annual rates of reduction for other mortality indicators, the gains made in stillbirths have been much slower, with progress lagging behind across all regions since 2000. The reduction in mortality for children aged 1–59 months, for example, was almost double the reduction in stillbirths (4.3 to 2.3, respectively). Progress in preventing stillbirths has also not accelerated over the past decade, instead maintaining similar rates of reduction to the period 2000–2009.
⟩ Lives that could be saved
Without urgent action, millions of families will experience the tragic stillbirth of a baby in the next decade. The Every Newborn Action Plan (ENAP) calls for each country to achieve a rate of 12 stillbirths or fewer per 1,000 total births by 2030 and to close equity gaps. Fifty-six countries would need to accelerate their progress in order to meet the ENAP target – this means investment in quality antenatal and delivery care. More ambitiously, if each country’s stillbirth rate reached or fell below the current average rate in high-income countries (3 stillbirths per 1,000 total births) by 2030, an additional 6.6 million lives could be saved (scenario 4 below). Although this scenario is aspirational, it shows what is possible with strong health systems and high-quality care. Without continued investments in health care and effort to close equity gaps, the progress of the past two decades will diminish, and many more lives will be lost.