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Stillbirth 2010-2018: a prospective, population-based, multi-country study from the Global Network
Elizabeth M McClure1, Sarah Saleem2, Shivaprasad S Goudar3
1Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA. mcclure@rti.org.
Reproductive Health
|December 1, 2020
Summary
Stillbirth rates remain high in low-resource countries, with birth asphyxia and infections being major causes. Improvements were seen in Pakistan and India, but overall progress is slow, highlighting the need for better antenatal and obstetric care access.
Area of Science:
- Obstetrics and Gynecology
- Global Health
- Perinatology
Background:
- Stillbirth remains a significant contributor to under-5 mortality in low and middle-income countries (LMICs).
- Population-based studies on stillbirth causes and trends in LMICs are scarce.
- This study addresses the need for data on stillbirth rates and contributing factors in diverse low-resource settings.
Purpose of the Study:
- To document stillbirth rates and trends over time in multiple low-resource settings.
- To identify risk factors and causes of stillbirth in a large, multi-country cohort.
- To inform interventions aimed at reducing stillbirth globally.
Main Methods:
- A prospective, population-based study enrolled pregnant women across 7 sites in LMICs (Kenya, Zambia, DRC, India, Pakistan, Guatemala).
- Demographic, healthcare, and delivery outcome data were collected for over 573,000 women from 2010-2018.
- Stillbirth causes were assigned using an algorithmic approach.
Main Results:
- A total of 15,604 stillbirths occurred among 552,547 births, yielding a stillbirth rate of 28.2 per 1000 births.
- Stillbirth rates varied by region, with Asian sites (33.3/1000) higher than African sites (23.8/1000) and Guatemala (19.3/1000).
- Significant decreases in stillbirth rates were observed in Pakistan and Nagpur (India), while other sites showed minimal change. Key fetal causes included birth asphyxia (44.0%) and infections (22.2%). Increased risk was associated with lower education, older maternal age, limited antenatal care, and assisted vaginal delivery.
Conclusions:
- Stillbirth rates persist at high levels across most Global Network sites.
- Significant reductions in stillbirth rates were primarily noted in Pakistan and Nagpur, India.
- Lower maternal education and reduced access to antenatal and obstetric care are linked to the highest stillbirth burden.
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