title: Stillbirths: rates, risk factors, and acceleration towards 2030.
abstract: An estimated 2.6 million third trimester stillbirths occurred in 2015 (uncertainty range 2.4-3.0 million). The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan has the target of 12 or fewer stillbirths per 1000 births in every country by 2030. 94 mainly high-income countries and upper middle-income countries have already met this target, although with noticeable disparities. At least 56 countries, particularly in Africa and in areas affected by conflict, will have to more than double present progress to reach this target. Most (98%) stillbirths are in low-income and middle-income countries. Improved care at birth is essential to prevent 1.3 million (uncertainty range 1.2-1.6 million) intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development. Estimates for stillbirth causation are impeded by various classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7.4% of stillbirths. Many disorders associated with stillbirths are potentially modifiable and often coexist, such as maternal infections (population attributable fraction: malaria 8.0% and syphilis 7.7%), non-communicable diseases, nutrition and lifestyle factors (each about 10%), and maternal age older than 35 years (6.7%). Prolonged pregnancies contribute to 14.0% of stillbirths. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour, or both. Two-thirds of newborns have their births registered. However, less than 5% of neonatal deaths and even fewer stillbirths have death registration. Records and registrations of all births, stillbirths, neonatal, and maternal deaths in a health facility would substantially increase data availability. Improved data alone will not save lives but provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.
authors.affiliation: Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA. Electronic address: joy.lawn@lshtm.ac.uk.
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
authors.affiliation: Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Blencowe
authors.affiliation: Maternal and Newborn Centre of Excellence, Makerere University and INDEPTH Maternal Newborn Working Group, School of Public Health, Kampala, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
authors.affiliation: Division of Data, Research, and Policy, United Nations Children's Fund, New York, NY, USA.
authors.forename: Agbessi
authors.initials: A
authors.lastname: Amouzou
authors.affiliation: Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Colin
authors.initials: C
authors.lastname: Mathers
authors.affiliation: Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Dan
authors.initials: D
authors.lastname: Hogan
authors.affiliation: Mater Hospital, Brisbane, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Flenady
authors.affiliation: Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway.
authors.forename: J Frederik
authors.initials: JF
authors.lastname: Frøen
authors.affiliation: Institute of Global Health, University College London, London, UK.
authors.forename: Zeshan U
authors.initials: ZU
authors.lastname: Qureshi
authors.affiliation: William Harvey Research Institute, Queen Mary University of London, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Calderwood
authors.affiliation: Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Suhail
authors.initials: S
authors.lastname: Shiekh
authors.affiliation: Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Fiorella Bianchi
authors.initials: FB
authors.lastname: Jassir
authors.affiliation: Division of Data, Research, and Policy, United Nations Children's Fund, New York, NY, USA.
authors.forename: Danzhen
authors.initials: D
authors.lastname: You
authors.affiliation: Research Triangle Institute, Durham, NC, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
authors.forename: Matthews
authors.initials: M
authors.lastname: Mathai
authors.affiliation: Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
mesh_terms: D000013:Congenital Abnormalities / Q000453:epidemiology; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data; D006292:Health Priorities; D006801:Humans; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration / Q000592:standards; D011314:Preventive Health Services / Q000458:organization & administration; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*