Global, Regional, and National Levels and Trends in Stillbirths from 2000 to 2019: A Systematic Assessment

Background: Stillbirths are a major public health issue and a sensitive marker of the quality of care around pregnancy and birth. The UN Global Strategy for Women’s, Children’s and Adolescents’ Health and the Every Newborn Action Plan (ENAP) call for ending preventable stillbirths. A first step to prevent stillbirths is obtaining standardized measurement of stillbirth levels and trends across countries. We estimated levels and trends in stillbirth rates at 28 weeks or more of gestation from 2000 to 2019 and assessed progress over time. Methods: Our dataset contained 2,800 country-year datapoints from 171 countries relevant to stillbirth rates, including data from registration systems, household-based surveys and population-based studies. We estimated country-specific stillbirth rates for all countries from 2000 to 2019 using a Bayesian hierarchical temporal sparse regression model. Our model combined covariates with a temporal smoothing process such that estimates were informed by data in country-periods with high-quality data and covariate-based for country-periods with limited or no data on stillbirth rates. Bias and additional uncertainty associated with observations using alternative stillbirth definitions, source types and observations that were subject to non-sampling errors were included in the model. Results: In 2019, an estimated 2.0 [90 percent uncertainty interval: 1.9, 2.2] million babies were stillborn at 28 weeks or more of gestation, with a global stillbirth rate of 13.9 [13.5, 15.4] stillbirths per 1,000 total births. Stillbirth rates varied widely across the world from 22.8 [19.8, 27.7] per 1,000 total births in West and Central Africa to 2.9 [2.7, 3.0] per 1,000 total births in Western Europe, with West and Central Africa, Eastern and Southern Africa and South Asia having the highest stillbirth rates in 2019. The global annual rate of reduction in the stillbirth rate was estimated at 2.3 [1.7, 2.7] per cent from 2000 to 2019, lower than the 2.9 [2.5, 3.2] percent reduction in the neonatal mortality rate and the 4.3 [3.8, 4.7] percent reduction in the mortality rate among children aged 1–59 months over the same period. Based on point estimates, 14 countries halved their stillbirth rate since 2000, and 115 countries reduced the stillbirth rate by more than 25 per cent. The remaining 80 countries for which we made estimates reduced their stillbirth rate by less than 25 percent since 2000, with the majority located in Sub-Saharan Africa. Interpretation: in reducing the stillbirth rate has been slow compared with declines in the mortality rate among children under 5 years of age. Accelerated improvements are most needed in the regions and countries with high stillbirth rates, particularly in sub-Saharan Africa where the increases in number of births has outpaced modest progress and declines in stillbirth rates, leading to a stagnation in the number of stillbirths since 2000. Increased efforts are needed to raise public awareness of stillbirths, to improve data collection and to prevent stillbirths. It’s not possible to assess progress going forward or understand public health priorities locally unless there is investment in gathering information about stillbirths. Funding Statement: UNICEF’s stillbirth estimation work was supported by the Bill & Melinda Gates Foundation (OPP1180460 OP190601 and INV-001395). We also acknowledge the Foreign, Commonwealth & Development Office (United Kingdom) for helping to initiate this work. Declaration of Interests: We declare that we have no conflicts of interest.