Stillbirth

A baby who dies after 28 weeks of pregnancy, but before or during birth, is classified as a stillbirth.

There are nearly 2 million stillbirths every year – one every 16 seconds. Over 40% of all stillbirths occur during labour – a loss that could be avoided with improved quality and respectful care during childbirth including routine monitoring and timely access to emergency obstetric care when required.

Experiencing a stillbirth during pregnancy or childbirth is a tragedy insufficiently addressed in global agendas, policies and funded programmes. There are psychological costs, especially to women and their families, such as maternal depression, financial consequences and economic repercussions, as well as stigma and taboo.

In 2014, the World Health Assembly endorsed the Every Newborn Action Plan (ENAP), which includes a global target of 12 or fewer third trimester (late) stillbirths per 1,000 total births in every country by 2030. In 2021, 139 mainly high-income and upper middle-income countries had met this target, but 56 countries will not each the ENAP target by 2030 if further efforts are not made. If current trends continue, 15.9 million babies will be stillborn; nearly half of these (7.7 million, 48%) will occur in sub-Saharan Africa.

With quality health care throughout pregnancy and childbirth, most stillbirths are preventable.

The major causes of stillbirth include pregnancy and childbirth-related complications, prolonged pregnancy, maternal infections such as malaria, syphilis and HIV, maternal conditions especially hypertension, and diabetes, and fetal growth restriction (when an unborn baby is unable to achieve its growth potential and therefore smaller than it should be). Congenital abnormalities are responsible for less than 10% of stillbirths reported nationally in high-income countries and the exact proportion in low-income settings is unknown due to limitations in diagnostics. Factors related to age of the mother and practicing smoking can also increase the risk of maternal disease and stillbirth.

Stillbirths can be prevented through family planning to avoid unwanted pregnancies, good health and nutrition prior to and during pregnancy, quality and respectful antenatal and childbirth care including adequate skilled health personnel including midwives.

Syphilis treatment in pregnancy could also prevent an estimated 200 000 stillbirths, while fetal heart rate monitoring and labour surveillance and prompt interventions when needed are crucial for preventing 832 000 intrapartum stillbirths and reducing neonatal deaths.

Stillbirths are strongly linked to adverse social and economic determinants of health. Prevention and responsive care need to be integrated across the continuum of maternal health care, and beyond. This includes respectful and supportive care in the event of a death.

Listening to the experiences and voices of women and their communities is essential to help address issues of stigma associated with stillbirth.

More needs to be done to integrate stillbirth prevention within global and national agendas for high quality health care for women, adolescents, and babies.

Through the Global Strategy for Women's, Children's and Adolescents Health 2016–2030 and implementing the recommendations of the Every Newborn Action Plan (2014), WHO is working to end preventable stillbirths, as part of efforts to improve maternal, newborn, child and adolescent health.

Most stillbirths do not receive a birth certificate and are not registered. Improving systems for reporting births and neonatal deaths is a matter of human rights and a prerequisite for reducing stillbirths. In addition, there is a need to strengthen routine health information systems to accurately capture and report stillbirths for monitoring and improving the quality of care.

WHO provides tools to help countries improve their data on both stillbirths and neonatal deaths. WHO also has guidance to help countries review and investigate individual deaths so they can recommend and implement solutions to prevent similar ones in the future and a standard classification system for perinatal deaths (ICD-PM).

WHO and UNICEF are supporting a call for collective action to end preventable stillbirths by:

• increasing awareness and reducing stigma
• supporting bereaved women and families
• strengthening health systems to provide high-quality care
• nationalizing and localizing stillbirth targets
• improving measurement of stillbirths to enhance evidence and knowledge.