Trends and determinants of stillbirth in developing countries: results from the Global Network's Population-Based Birth Registry

Sarah Saleem, Shiyam Sunder Tikmani, Elizabeth M McClure, Janet L Moore, Syed Iqbal Azam, Sangappa M Dhaded, Shivaprasad S Goudar, Ana Garces, Lester Figueroa, Irene Marete, Constance Tenge, Fabian Esamai, Archana B Patel, Sumera Aziz Ali, Farnaz Naqvi, Musaku Mwenchanya, Elwyn Chomba, Waldemar A Carlo, Richard J Derman, Patricia L Hibberd, Sherri Bucher, Edward A Liechty, Nancy Krebs, K Michael Hambidge, Dennis D Wallace, Marion Koso-Thomas, Menachem Miodovnik, Robert L Goldenberg, Sarah Saleem, Shiyam Sunder Tikmani, Elizabeth M McClure, Janet L Moore, Syed Iqbal Azam, Sangappa M Dhaded, Shivaprasad S Goudar, Ana Garces, Lester Figueroa, Irene Marete, Constance Tenge, Fabian Esamai, Archana B Patel, Sumera Aziz Ali, Farnaz Naqvi, Musaku Mwenchanya, Elwyn Chomba, Waldemar A Carlo, Richard J Derman, Patricia L Hibberd, Sherri Bucher, Edward A Liechty, Nancy Krebs, K Michael Hambidge, Dennis D Wallace, Marion Koso-Thomas, Menachem Miodovnik, Robert L Goldenberg

Abstract

Background: Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations' Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries.

Methods: From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births of which 12,181 were stillbirths.

Results: The mean stillbirth rates for the sites were 21.3 per 1000 births for Africa, 25.3 per 1000 births for India, 56.9 per 1000 births for Pakistan and 19.9 per 1000 births for Guatemala. From 2010 to 2016, across all sites, the mean stillbirth rate declined from 31.7 per 1000 births to 26.4 per 1000 births for an average annual decline of 3.0%. Risk factors for stillbirth were similar across the sites and included maternal age < 20 years and age > 35 years. Compared to parity 1-2, zero parity and parity > 3 were both associated with increased stillbirth risk and compared to women with any prenatal care, women with no prenatal care had significantly increased risk of stillbirth in all sites.

Conclusions: At the current rates of decline, stillbirth rates in these sites will not reach the Every Newborn Action Plan goal of 12 per 1000 births by 2030. More attention to the risk factors and treating the causes of stillbirths will be required to reach the Every Newborn Action Plan goal of stillbirth reduction.

Trial registration: NCT01073475 .

Keywords: Low-middle income countries; Rates of decline; Stillbirth.

Conflict of interest statement

Ethics approval and consent to participate

This study was reviewed and approved by all sites’ ethics review committees (Francisco Marroquin University, Guatemala; University of Zambia, Zambia; Moi University, Kenya; Aga Khan University; KLE University’s Jawaharlal Nehru Medical College, Belagavi; Lata Medical Research Foundation, Nagpur), and the institutional review boards at each U.S. partner university and the data coordinating center (RTI International). All women provided informed consent for participation in the study, including data collection and the follow-up visits.

Consent for publication

The article was approved for publication by NICHD through its clearance mechanism.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Subject Flow Diagram for Global Network Stillbirth Study, 2010–2016
Fig. 2
Fig. 2
Overall stillbirth rate, Global Network sites 2010–2016. n = number of stillbirths

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