Key messages
What is happening to stillbirth rates?
At the end of the Millennium Development Goal era, 2·6 million (uncertainty range 2·4–3·0 million) third trimester stillbirths occurred annually. Stillbirth rates have declined more slowly since 2000 than either maternal mortality or mortality in children younger than 5 years. Better data are essential to accelerate progress towards the target of 12 or fewer stillbirths per 1000 births in every country by 2030.
Where geographically to focus attention?
Ten countries account for two-thirds of stillbirths and most neonatal (62%) and maternal (58%) deaths estimated in 2015. 56 countries, many of these in Africa, need to at least double present progress in the reduction of stillbirths. The highest stillbirth rates are in conflict and emergency areas. About 60% of stillbirths are in rural areas. Marked disparities remain between and within countries.
When and where in the health system to focus attention?
In 2015, an estimated 1·3 million intrapartum stillbirths (deaths during labour) occurred, despite two-thirds of births worldwide now being in health facilities. High coverage of good quality care during labour and birth gives a quadruple return on investment by preventing maternal and neonatal deaths and also stillbirths and disability with improvements in child development. Improved quality of antenatal care and family planning are also important to maximise maternal and fetal wellbeing.
What to focus on to end preventable stillbirths?
The opinion that most stillbirths are inevitable is a myth. Congenital abnormalities account for a median of only 7·4% of all stillbirths, some of which are also preventable, notably neural tube defects. Modifiable disorders with the highest estimated population attributable fraction (PAF) at a global level include: maternal age of older than 35 years (PAF 6·7%), maternal infections (malaria 8·2% and syphilis 7·7%), non-communicable diseases, nutrition and lifestyle factors, such as obesity (many of which coexist, each contributing to about 10%), and prolonged pregnancy (14·0%).
Which priority data are required to accelerate progress towards 2030?
Two-thirds of the world's newborns have a birth certificate but death and stillbirth certificate coverage is much lower, with many missed opportunities, especially in health facilities. Ending preventable stillbirths, as well as neonatal and maternal deaths, needs ambitious milestones and investment for data improvement, notably for counting births and deaths, tracking programme coverage and quality, and advancing accountability—eg, through audit.