• Nearly 2 million babies die in the late stages of pregnancy and during birth every year, according to a new report from a UN inter-agency group.
  • A majority of these deaths are preventable.
  • Women in developing economies are most at risk, especially in sub-Saharan Africa, which has the highest stillbirth rate in the world.
  • Improving care during pregnancy, birth and after delivery will be fundamental to reducing the high number of stillbirths.

Every 16 seconds an expectant mum loses her baby in the late stages of pregnancy or during labour.

On top of the acute loss, social stigma attached to stillbirth means that women’s suffering remains largely hidden – even in developed countries.

Add to this the lack of international data on the occurrence of stillbirth, and you have the makings of a “neglected tragedy” that affects women and their families across the globe. That is the verdict of a new report released by a UN inter-agency group including Unicef, the World Health Organization (WHO) and the World Bank Group.

For the first time, A Neglected Tragedy – The global burden of stillbirths provides estimates of the occurrence of stillbirth worldwide.

Particularly tragic is the finding that the majority of stillbirths are preventable with better care during pregnancy and birth.

Stillbirths stillborn international health child mortality
2 million stillbirths occur on an annual basis.
Image: UN Inter-agency Group for Child Mortality Estimation, 2020

The invisibility of stillbirth

While the stillbirth rate globally has declined by 35% over the past 20 years, the report estimates that almost 2 million babies are stillborn every year. This means they die in the later stages of gestation, at or after 28 weeks. But a lack of data means cases are likely under-reported.

Moreover, based on the existing data compiled by the UN inter-agency group, progress has slowed rather than accelerated between the first and the second decade of the century.

In the past 20 years, the world suffered a total of 48 million stillbirths. If the current trajectory continues, expectant mothers will have to go through another 20 million losses before 2030. Not only does this dramatically impact the health and mental well-being of women and their families, but it also places a great strain on society.

But the invisibility of stillbirth in terms of worldwide data tracking means that there has not been adequate intervention to reduce its occurrence. There are no specific targets on stillbirths included in the Sustainable Development Goals (SDGs=, nor were they in the Millennium Development Goals previously, the report points out.

There is a great variation in the incidence of stillbirths across the globe.

Low- and lower-middle-income countries bear the brunt of the burden, accounting for 84% of all stillbirths. Women in sub-Saharan Africa and Southern Asia are affected by three-quarters of stillbirths - and half happen in just six countries: India, Pakistan, Nigeria, the Democratic Republic of Congo, China and Ethiopia.

What is more, while other regions have seen a small decline (or no significant change) in the incidence of stillbirth, rates in low-income countries have increased by an average of 9% since 2000. Sub-Saharan Africa has seen a rise of 15% over the past two decades, making it the region with the highest occurrence of stillbirth in the world.

That many countries in this region have a well-documented lack of healthcare infrastructure, services and qualified personnel goes some way towards explaining this trend.

Stillbirths stillborn international health child mortality.
The percentage of still births occurring in Africa has increased from 27% to 42%.
Image: UN Inter-agency Group for Child Mortality Estimation (UN IGME), 2020

The vast majority of these losses in the late stages of pregnancy could be avoided, according to A Neglected Tragedy.

While maternal health is a big factor throughout – ranging from infections such as malaria and HIV to obesity, diabetes and high blood pressure – the report finds that more than 40% of stillbirths occur during labour itself.

Again, the regional differences are stark: in Sub-Saharan Africa and Central and Southern Asia, just under half of stillborns are lost during the birthing process, compared with 6% in Europe, Northern America, Australia and New Zealand.

Stillbirths stillborn international health child mortality
The share of antepartum and intrapartum still births are almost a 50-50 split in Sub-Sahran Africa.
Image: UN Inter-agency Group for Child Mortality Estimation (UN IGME), 2020

The report suggests that these deaths could be avoided by improving monitoring and emergency obstetric care, as well as prenatal care.

Stronger healthcare systems

Unicef’s Every Newborn Action Plan (ENAP) has a target of 12 or fewer stillbirths per 1,000 total births by 2030. This means many countries – especially in the developing world – will need to take systematic action to close the significant existing gaps.

The programme aims to ensure that every expecting mother has a minimum number of antenatal appointments and that births are supervised by skilled health practitioners.

Strengthening health systems and providing high-quality care will be critical to achieving these outcomes for pregnant women and infants, and will require strong political dedication and financial investment. The growth of digital health in developing regions like sub-Saharan Africa may also contribute to boosting access and quality of care.