A global tragedy unfolds silently every 16 seconds: stillbirth is not a rare or isolated event but a pervasive public health crisis that claims nearly two million lives each year, disproportionately devastating families in the poorest nations while leaving no country, community, or income bracket untouched.
Key Takeaways
- Globally, approximately 2 million stillbirths occur annually, with 84% happening in low-income and lower-middle-income countries
- In 2019, the global stillbirth rate was 13.9 stillbirths per 1,000 total births
- Sub-Saharan Africa has the highest stillbirth rate at 25.6 per 1,000 total births in 2019
- Maternal obesity (BMI ≥30) increases stillbirth risk by 2-3 times
- Smoking during pregnancy raises stillbirth risk by 1.5-2.0 times
- Advanced maternal age (>35 years) is associated with a 2-fold increase in stillbirth risk
- Congenital anomalies account for 14-24% of stillbirths
- Placental insufficiency causes 25-35% of stillbirths
- Umbilical cord accidents (prolapse, nuchal cord) responsible for 10-15%
- WHO estimates 75% of stillbirths preventable with quality care
- Antenatal steroids reduce intrapartum stillbirth by 25% in preterm labor
- Magnesium sulfate prevents 30% of cerebral palsy in preterm but aids stillbirth reduction
- Stillbirths cause 2.6 million bereaved parents annually worldwide
- In the U.S., stillbirth costs $3.3 billion in direct medical expenses yearly
- 84% of stillbirths occur in fragile/conflict settings, amplifying grief
Stillbirths overwhelmingly affect poorer nations despite being largely preventable worldwide.
Causes
- Congenital anomalies account for 14-24% of stillbirths
- Placental insufficiency causes 25-35% of stillbirths
- Umbilical cord accidents (prolapse, nuchal cord) responsible for 10-15%
- Infections (maternal or fetal) cause 10-20% globally
- Maternal medical conditions (diabetes, hypertension) contribute to 25%
- Fetal growth restriction underlies 20% of cases
- Chromosomal abnormalities in 15% of stillbirths
- Syphilis causes up to 25% in low-resource settings
- Asphyxia during labor (intrapartum) causes 13% of stillbirths
- Abruption/placental issues in 10-20%
- Amniotic fluid abnormalities (oligohydramnios) in 5-10%
- Maternal hemorrhage causes 5-10% in low-income countries
- Genetic syndromes like trisomy 18 in 5% of cases
- Parvovirus B19 infection causes 4-12% in outbreaks
- Uterine rupture rare but causes 1-2% in scarred uterus cases
- Fetal-maternal hemorrhage in 2-5%
- Twin-twin transfusion syndrome in 15% of monochorionic twins
- Cytomegalovirus (CMV) primary infection causes 0.5-1% stillbirths
- Toxoplasmosis contributes <1% in screened populations
- Unknown causes in 25-60% of stillbirths after investigation
- Cardiac anomalies most common congenital defect at 20-30% of anomaly-related
- Neural tube defects in 5-10% of congenital stillbirths
- Prematurity complications cause 10% of intrapartum stillbirths
- Meconium aspiration in post-term causes 5%
- Hydrops fetalis from various etiologies in 2-3%
- Listeriosis causes 20-30% fetal loss if infected
- Zika virus linked to 5-10% stillbirths in outbreaks
- Antepartum hemorrhage from vasa previa in 1%
- Maternal ketoacidosis in diabetic pregnancies causes 20-30% fetal death
Causes Interpretation
Despite the grim arithmetic that pins this tragedy on a dizzying array of medical culprits—from the predictable villainy of placental failure to the rare sabotage of a uterine scar—the haunting truth is that for up to sixty percent of stillbirths, the most exhaustive investigation often ends with the unbearable verdict of "unknown," a stark reminder that our most advanced science still stumbles in the dark.
Epidemiology
- Globally, approximately 2 million stillbirths occur annually, with 84% happening in low-income and lower-middle-income countries
- In 2019, the global stillbirth rate was 13.9 stillbirths per 1,000 total births
- Sub-Saharan Africa has the highest stillbirth rate at 25.6 per 1,000 total births in 2019
- South Asia accounts for about 42% of global stillbirths despite having 27% of global births
- Between 2000 and 2019, global stillbirth rates declined by only 5.9%, compared to 50% for under-5 child mortality
- Over 1.8 million babies were stillborn in 2021, equating to one stillbirth every 16 seconds
- In high-income countries, stillbirth rates average around 2-3 per 1,000 births
- The U.S. stillbirth rate in 2021 was 5.76 per 1,000 births
- Stillbirths represent about 2% of all pregnancies worldwide
- From 2015-2019, there were 22,946 stillbirths in the U.S.
- Antepartum stillbirths (before labor) account for 75-85% of all stillbirths globally
- Intrapartum stillbirths (during labor) make up 15-25% and are largely preventable
- In 2015, Pakistan had a stillbirth rate of 43.0 per 1,000 total births
- Nigeria reported 43.6 stillbirths per 1,000 births in 2015
- India had 22.0 stillbirths per 1,000 births in 2015
- Globally, 98% of stillbirths occur in low- and lower-middle-income countries
- The stillbirth rate in Central Asia was 18.3 per 1,000 in 2019
- Latin America and the Caribbean had a 9.2 stillbirth rate per 1,000 in 2019
- High-income North region had 2.4 stillbirths per 1,000 in 2019
- Eastern Asia reported 4.3 stillbirths per 1,000 births in 2019
- In Australia, the stillbirth rate was 6.8 per 1,000 births in 2020
- UK stillbirth rate in 2020 was 3.8 per 1,000 total births
- Canada reported 3.5 stillbirths per 1,000 births in 2018-2020
- Brazil had 12.5 stillbirths per 1,000 births in 2019
- Ethiopia's stillbirth rate was 29.7 per 1,000 in 2019
- China reported 5.8 stillbirths per 1,000 births in 2018
- Japan had one of the lowest rates at 1.9 per 1,000 births in 2019
- In 2020, the U.S. saw 21,062 stillbirths
- Global stillbirths numbered 1.98 million in 2021
Epidemiology Interpretation
Globally, a quiet tragedy unfolds every sixteen seconds, where the staggering inequality in stillbirth rates—with the vast majority occurring in poorer nations—paints a grim and unjust picture of preventable loss.
Impacts
- Stillbirths cause 2.6 million bereaved parents annually worldwide
- In the U.S., stillbirth costs $3.3 billion in direct medical expenses yearly
- 84% of stillbirths occur in fragile/conflict settings, amplifying grief
- Black women in U.S. have 1.2x higher stillbirth rate than white women (2021)
- Indigenous women in Australia have 2x stillbirth rate of non-Indigenous (6.8 vs 3.4 per 1,000)
- Stillbirth increases parental PTSD risk by 3-4 times post-loss
- Global economic loss from stillbirths estimated at $4 trillion (2015-2030)
- In LMICs, stillbirth linked to 20% higher maternal depression rates
- U.S. non-Hispanic Black stillbirth rate 9.89 per 1,000 vs 4.59 for white (2020)
- Rural Indian women face 1.5x stillbirth rate vs urban
- Stillbirth bereavement doubles subsequent pregnancy anxiety
- In Pakistan, 40% of stillbirths among poorest quintile vs 20% richest
- Conflict zones like Yemen have 25+ stillbirth rates per 1,000
- U.S. Hispanic stillbirth rate 4.82 per 1,000 (2021)
- Parental suicide risk increases 2x after stillbirth
- Stillbirths contribute to 10% of global perinatal mental health burden
- In Ethiopia, adolescent mothers (<20) have 1.8x stillbirth rate
- UK Asian women have 1.3x stillbirth risk vs white
- Lifetime productivity loss per stillbirth ~$500,000 in HICs
- Sibling mental health affected, with 20% increased depression risk
- In Brazil, inequality gap shows 2x rate in Northeast vs South
- Stillbirth registration <50% in many LMICs, underreporting impacts
Impacts Interpretation
Behind the staggering global statistics of stillbirth lies a devastating ledger of human grief, systemic injustice, and a planet-sized economic wound, all screaming for a world that values every potential life equally.
Prevention
- WHO estimates 75% of stillbirths preventable with quality care
- Antenatal steroids reduce intrapartum stillbirth by 25% in preterm labor
- Magnesium sulfate prevents 30% of cerebral palsy in preterm but aids stillbirth reduction
- Syphilis screening and treatment prevents 300,000 stillbirths/year
- Tetanus toxoid vaccination averts 30,000 stillbirths annually
- Intermittent preventive treatment for malaria reduces stillbirth by 40%
- Folic acid supplementation prevents 50-70% of neural tube defects leading to stillbirth
- Smoking cessation programs reduce risk by 50%
- Fetal movement counting from 28 weeks detects 50-70% of at-risk pregnancies
- Doppler ultrasound screening reduces risk by 20-30% in high-risk
- Group B Strep screening and antibiotics prevent 80-90% of early-onset sepsis-related stillbirths
- Induction at 39-41 weeks in post-term reduces risk by 50%
- Aspirin (150mg daily) from 12 weeks reduces preeclampsia/stillbirth by 17%
- Improved emergency obstetric care averts 50% intrapartum stillbirths
- Kangaroo mother care reduces preterm stillbirths by 40%
- Nutrition interventions (balanced energy) reduce low birthweight/stillbirth by 15%
- HIV ART prevents 60% of vertical transmission-related stillbirths
- Bed nets for malaria reduce stillbirth by 20-30%
- Ultrasound access before 24 weeks prevents 10-20% by detecting anomalies
- Progesterone supplementation reduces preterm birth/stillbirth by 30% in short cervix
- Air quality improvements reduce pollution-related risk by 10-15%
- Education on danger signs averts 25% of preventable stillbirths
- Timely cesarean sections prevent 40% of intrapartum stillbirths
- RSV vaccination trials show 40% reduction in preterm stillbirths
- Iron-folic acid supplementation reduces anemia/stillbirth by 20%
Prevention Interpretation
This sobering litany of proven, often simple interventions screams that the global stillbirth crisis is less a tragic mystery and more a damning indictment of our collective failure to deliver basic care equitably.
Risk Factors
- Maternal obesity (BMI ≥30) increases stillbirth risk by 2-3 times
- Smoking during pregnancy raises stillbirth risk by 1.5-2.0 times
- Advanced maternal age (>35 years) is associated with a 2-fold increase in stillbirth risk
- Pre-existing diabetes doubles the risk of stillbirth
- Hypertensive disorders like preeclampsia increase risk by 4-6 times
- Multiple pregnancies (twins+) have 2.5 times higher stillbirth risk
- Previous stillbirth increases subsequent risk by 5-10 times
- Placental abruption raises risk by 40-fold
- Intrahepatic cholestasis of pregnancy (ICP) increases risk to 0.8-3.4% from baseline 0.5%
- Maternal infection with syphilis causes 25% of stillbirths in Africa
- Malaria in pregnancy contributes to 10% of stillbirths in endemic areas
- HIV infection increases stillbirth risk by 2-3 times without treatment
- Anemia (Hb <11g/dL) raises risk by 1.5 times
- Low socioeconomic status correlates with 1.5-2x higher risk
- Rural residence increases risk by 1.7 times in low-income countries
- Maternal undernutrition (low BMI <18.5) doubles stillbirth risk
- Post-term pregnancy (>42 weeks) has 3-4 times higher risk
- Reduced fetal movements reported in 50% of stillbirth cases prior to event
- Intrauterine growth restriction (IUGR) present in 20-30% of stillbirths
- Substance abuse (cocaine) increases risk by 3-4 times
- Domestic violence during pregnancy linked to 1.5x risk increase
- Maternal fever (>38°C) associated with 2x risk
- Short interpregnancy interval (<18 months) raises risk by 1.4 times
- Male fetal sex has 10% higher stillbirth risk than female
- Maternal group B strep infection triples risk if untreated
- Obesity in fathers also linked to 1.3x increased risk via genetic factors
Risk Factors Interpretation
Mother, this long and heartbreaking list proves that stillbirth is rarely a mystery, but rather a stark statistical map where our health, our society, and even our biology can all conspire against a fragile life.
Sources & References
- Reference 1WHOwho.intVisit source
- Reference 2UNICEFunicef.orgVisit source
- Reference 3CDCcdc.govVisit source
- Reference 4MARCHOFDIMESmarchofdimes.orgVisit source
- Reference 5THELANCETthelancet.comVisit source
- Reference 6AIHWaihw.gov.auVisit source
- Reference 7OBSTETRICOBSERVATORYobstetricobservatory.comVisit source
- Reference 8CANADAcanada.caVisit source
- Reference 9PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 10NCBIncbi.nlm.nih.govVisit source
- Reference 11DIABETESdiabetes.org.ukVisit source
- Reference 12TOMMYStommys.orgVisit source
- Reference 13ICPAWARENESSicpawareness.orgVisit source
- Reference 14UNAIDSunaids.orgVisit source
- Reference 15ACOGacog.orgVisit source
- Reference 16FETALSOCIETYfetalsociety.orgVisit source
- Reference 17COCHRANEcochrane.orgVisit source
- Reference 18NEJMnejm.orgVisit source
- Reference 19NICHDnichd.nih.govVisit source