Global, Regional, and National Estimates and Trends in Stillbirths From 2000 to 2019: A Systematic Assessment

Abstract

Stillbirths are a public health issue as well as an example of the inequality of care during pregnancy and birth. Groups such as the UN Global Strategy for Women's, Children's, and Adolescents' Health and the Every Newborn Action Plan aim to prevent stillbirths. The first step toward this end is to gather standardized stillbirth rates across countries, although the rates of stillbirth are not often recorded in lower-and middle-income countries. This article gathers data from across countries to estimate stillbirth rates and their trends for 195 countries from the years 2000 to 2019 based on data from the UN Inter-agency Group for Child Mortality Estimation.To develop a systematic assessment, the researchers created a data set of 2833 country-year data points of their stillbirth rates from 171 countries. They then incorporated data on registration and health information systems, household-based surveys, and population-based studies. Stillbirth rates were extracted from nationwide administrative registration systems. Following this, the researchers used a Bayesian hierarchical temporal sparse regression model using 1531 data points to estimate country-specific stillbirth rates. Stillbirth rates were measured by at least 28 weeks' gestation. Estimated stillbirth rates were compared with previously reported mortality estimates in children younger than 5 years old.Through this research, the authors found that, in 2019, an estimated 2 million babies (90% uncertainty interval [UI], 1.9-2.2) were stillborn at 28 weeks or more of gestation, with a global stillbirth rate of 13.9 stillbirths (90% UI, 13.5-15.4) per 1000 total births. The greatest decrease in stillbirth rate was estimated in east Asia and the Pacific, with a 50.8% (45.1-55.9) decrease in rate, followed by Eastern ) and South ). In 2019, stillbirth rates differed among various regions, from 22.8 stillbirths (19.8-27.7) per 1000 total births in West and Central Africa to 2.9

Factors associated with peri-neonatal mortality in Sao Tome & Principe: a prospective cohort study

“…From stillbirths in this study, 69% occurred during the intrapartum period, in accordance with other studies from LMICs [5]. These intrapartum stillbirths mean that intrauterine death occurred after the onset of labor and before birth (fresh stillbirth).…”

“…Ending preventable stillbirths and neonatal deaths does not necessarily require new or innovative interventions. Most modifiable risk factors identified in this study can be addressed and prevented with timely, quality care during childbirth, including ongoing intrapartum monitoring and opportune intervention in case of complications [72]. Some interventions, such as computerized cardiotocography to monitor a baby’s well-being in the womb by measuring contractions, are estimated to reduce the rate of infant deaths around the time of birth by 80% when compared with traditional cardiotocography [73].…”

“…Globally, perinatal mortality accounts for three-fourths of deaths during the neonatal period [3,4]. More than half of the cases of stillbirths occur when pregnant women are in labor, and these deaths are directly related to the lack of skilled care at this critical time [5,6]. On the other hand, the largest contributors to neonatal mortality (ENND plus LNND) are complications of preterm birth, birth asphyxia, infection, and congenital malformations although they can differ depending on the country context [7].…”

“…Where? Why?” [8], attention started to be given to the neonatal period in developing countries although stillbirths are still invisible and missing from the Sustainable Development Goals (SDG) agenda [5,9,10]. It urges to highlight that stillbirths and newborn deaths account for twice as many deaths as malaria and human immunodeficiency virus (HIV) infection combined but have received much less awareness and funding in these resource-constrained countries [8,9].…”

Fetal movement trials: where is the evidence in settings with high-burden of stillbirths?

“…Antenatal clinics are often overcrowded, understaffed, and lack essential supplies and clinical guidelines including for investigating and managing high risk pregnancies and abnormal FMs (2). Recent estimates show stillbirth rates as high as 22 per 1000 per total births in the Sub-Saharan African region, compared to less than 3 per 1000 in HICs (6). We propose for consideration that these trials may be demonstrating a lack of evidence rather than a lack of effectiveness and we hypothesise that in LMICs, a similar RCT with a low-cost, low-tech strategy would be likely to demonstrate a positive effect.…”