Two Million Stillbirths Occur Annually; Pandemic Add To Risks In Coming Year, Says First UN Report On The Neglected Issue
Mother practices breast feeding her baby in the hospital maternity room in Ethiopia.

One stillbirth occurs every 16 seconds worldwide with approximately 2 million stillborn babies a year, says the first UN-wide report to document the global scale of the issue.

And COVID-19 related interruptions in maternal and child care services, particularly emergency obstetric care, could lead to an additional 60,000 to 200,000 stillbirths over the next 12 months, warns the report that was jointly produced by UNICEF, the World Health Organization, the World Bank and the Population Division of the United Nations Department of Economic and Social Affairs.  

“COVID will have an increase, reversing the gains that we have made,” said Anshu Banerjee, Director of the Department of Maternal, New born, Child and Adolescent Health and Ageing at the WHO, speaking at a press briefing on the report, which was released today. “However, we have seen that it is possible to make progress,” by strengthening health systems, improving the quality of care, and increasing the skills of birth attendants.” 

The WHO defines a stillbirth as babies born with no signs of life at 28 weeks of pregnancy. Approximately 2 million babies are stillborn every year. Often, these are deaths that lead to long-lasting psychological and financial consequences for women and their families.

In the majority of cases, stillbirths could have been avoided with high-quality care antenatally and during birth. The global issue of stillbirths is largely neglected in terms of research, data collection, and funding for interventions – although there is increasing recognition of the issue as a critical global health problem. 

Losing a child at birth or during pregnancy is a devastating tragedy for a family, one that is often endured quietly, yet all too frequently, around the world,” said Executive Director of UNICEF Henrietta Fore. 

The report finds several reasons for these preventable deaths, including: absence of or poor quality of care during pregnancy and birth, lack of investment in preventable interventions, absence of global and national leadership on the issue, and few established global targets. 

Access to Emergency Obstetric Care Could Reduce Scale Of Problem

With over 40 percent of stillbirths occurring during labour, access to emergency obstetric care and improved monitoring could reduce their scale, the report finds.  

“The tragedy of stillbirth shows how vital it is to reinforce and maintain essential health services, and how critical it is to increase investment in nurses and midwives,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. 

84 percent of stillbirths occur in low- and middle-income countries, with 3 in 4 stillbirths taking place in sub-Saharan Africa or Southern Asia, according to the report. In sub-Saharan Africa, 1 in 46 babies are stillborn, compared to the global average of 1 in 72 or the European and Northern American average of 1 in 321. 

Stillbirth rates globally per 1,000 births in 2019.

There are substantial disparities in stillbirths between income groups. And strikingly, one-half of all stillbirths occur across six countries – India, Pakistan, Nigeria, Democratic Republic of the Congo, China, and Ethiopia. The risk of a stillbirth is 23 times higher in the worst affected countries compared to countries with the lowest stillbirth rates. 

Access to health care, maternal education, socioeconomic status, and ethnicity are other factors that contribute to the variations in stillbirth rates. Notably, higher rates are observed in rural areas, among women without post-secondary education, in groups on the lower end of the socioeconomic spectrum, and among ethnic minorities. 

Over the past two decades there has been slow progress on preventing stillbirths. Although the global stillbirth rate declined by 35 percent since 2000, progress has lagged in comparison to achievements in reducing maternal and under-five mortality rates. 

The Every Newborn Action Plan (ENAP) was launched in 2014 to provide evidence-based solutions to prevent newborn deaths and stillbirths. It established a target rate of 12 stillbirths per 1,000 total births to be achieved by 2030 and issued guidelines for national steps to achieve this goal, which includes investing in quality antenatal and delivery care. 

Projected number of stillbirths by different scenarios from 2020 to 2030.

Currently, 56 countries are at risk of missing the ENAP target by 2030, 34 countries are at risk of missing it by 2050, and eight countries will not meet the target by the end of the century, according to the report. 

Projections for the next decade estimate that 20 million babies will be stillborn by 2030, of which 2.9 million could be prevented. In order to curtail the current trend, the new report calls for increased political will, smart policies, and targeted investment in antenatal and delivery care to accelerate progress towards the ENAP aims and Sustainable Development Goals. 

COVID-19 Exacerbates Existing Stillbirth Trends

The COVID-19 pandemic has disrupted health systems and services globally, including antenatal and labor care. The report projects that these disruptions could lead to 60,000 to 200,000 additional stillbirths over 12 months, increasing the global number of stillbirths by 3.2 to 11 percent. The impact is expected to be greatest in Armenia, the Dominican Republic, Jamaica, Egypt, Iraq, Pakistan, and South Africa, among others. 

“COVID-19 has triggered a devastating secondary health crisis for women, children and adolescents due to disruptions in life-saving health services,” said Muhammad Ali Pate, Global Health Director for Health, Nutrition and Population at the World Bank. 

The collective action plan provided by the report emphasizes the importance of reducing stigma, supporting bereaved families, strengthening health systems, nationalizing and localizing stillbirth targets, prioritizing equity through investment, and improving the measurement of stillbirth data. 


Image Credits: Flickr – UNICEF Ethiopia, UNICEF.

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