Their names are Ashley, Everett and Shayen. They are among the 53 million babies that have been stillborn since 2000. Yet many of these children did not have to die. Many would be alive today had their mothers had access to proper care during pregnancy and labour. Instead of mourning them, their families would be celebrating birthdays, first steps and first words. Though these children’s lives have been cut tragically short, their parents will never forget them, nor the trauma of their death.
Every day in 2021, over 5,000 babies were stillborn at 28 weeks or more of gestation. That’s a staggering 1.9 million babies stillborn in just one year. Two in five of these babies died during labour – what is known as intrapartum stillbirth. The estimates in this publication, the second report to address stillbirth by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), are derived from the most up-to-date data from 195 countries and provide a picture of late gestation stillbirth, or deaths that occur at 28 weeks or more of gestation. They highlight the immense and continued annual burden of stillbirths and the women in the world at greatest risk of having a stillbirth. They also call attention to the fact that when pregnant women have access to quality care, most stillbirths can be prevented.
In 2021, 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 20 times higher in the country with the highest stillbirth rate compared to the country with the lowest stillbirth rate. Stillbirths were concentrated in a few countries, with the greatest number found in India, followed by Pakistan, Nigeria, the Democratic Republic of the Congo, Ethiopia and Bangladesh. These six countries accounted for almost half of the estimated global number of stillbirths and 36 per cent of global live births in 2021.
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 Southern Asia, with the two regions accounting for three quarters of all stillbirths. In sub-Saharan Africa, the stillbirth rate of 21.0 per 1,000 total births was seven times higher than the lowest regional rate of 2.9 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 26 per cent in 2000 to 45 per cent in 2021 as population growth has outpaced decreases in stillbirth rates.
Over the past two decades, substantial progress has been made in reducing the stillbirth rate globally, which declined from 21.3 stillbirth per 1,000 total births in 2000 to 13.9 in 2021 – a 35 per cent reduction. Similarly, the total number of stillbirths also decreased by 35 per cent, from 2.9 million to 1.9. million. However, these reductions have not kept pace with other indicators such as under-five mortality.
Compared to the annual rates of reduction (ARR) for other mortality indicators, the gains made in stillbirths have been much slower, with progress lagging behind across all regions since 2000. The ARR 2000-2021 in mortality for children aged 1–59 months, for example, was double the ARR in stillbirths for the same period (4.0 per cent to 2.0 per cent, respectively).
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. If all countries met or exceeded the ENAP stillbirth target, 2.6 million stillbirths could be averted before 2030 compared to continuing the current trends. 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, 8.4 million lives could be saved (scenario 4 below) compared to the continuing current trends scenario. 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.