Global, Regional, and National Stillbirths at Greater than 20 Weeks’ Gestation for 204 Countries and Territories, 1990–2021: Findings from the Global Burden of Disease Study 2021

Haley Comfort, University of Washington - IHME
Theresa McHugh, University of Washington IHME
Austin E. Schumacher, University Of Washington
Nicholas Kassebaum, University of Washington - IHME

Monitoring stillbirth trends is imperative for continuing progress in pregnancy loss reduction. This study, part of GBD 2021, estimates all stillbirths >=20, 22, and 28 weeks’ gestation for 204 countries and territories from 1990-2021. We extracted data from 11,412 sources for 11 different definitions which were adjusted to match the three gestational age thresholds. We modelled the ratio of stillbirth rate / neonatal mortality rate using spatiotemporal Gaussian process regression and used fertility and all-cause neonatal mortality estimates to calculate total stillbirths. The global stillbirth rate at >=20 weeks was 23·0 stillbirths (95% UI 19·7–27·2]) per 1000 births in 2021, compared to 16·1 (13·9–19·0) at >=28 weeks. There were 3·04 million (2·61–3·62) stillbirths in 2021, a 39·8% (31·8–48·0) reduction from 1990. Approximately 30·5% of stillbirths occurred at gestational ages between the >=20 weeks and >=28 weeks thresholds. Counting all stillbirths is paramount to progress, as close to 1 million in total are left uncounted at the >=28 weeks threshold. Our findings draw attention to differential progress in reducing stillbirths, with high burden concentrated in countries with low development status. Addressing inequities in universal maternal health coverage and care and improving data system robustness are urgently needed to reduce stillbirths.

Keywords: Sexual and Reproductive Health and Rights, Data and Methods

See paper.