Abstract:
Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible—not
counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics.
At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008
(≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries,
and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and
Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where
skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated
1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are
associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal
growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classifi cation systems
impede international comparison. Immediate data improvements are feasible through household surveys and facility
audit, and improvements in vital registration, including specifi c perinatal certifi cates and revised International
Classifi cation of Disease codes, are needed. A simple, programme-relevant stillbirth classifi cation that can be used
with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the
time of birth is crucial to inform programmatic investment.
