National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis

Hannah Blencowe, Simon Cousens, Fiorella Bianchi Jassir, Lale Say, Doris Chou, Colin Mathers, Dan Hogan, Suhail Shiekh, Zeshan U Qureshi, Danzhen You, Joy E Lawn, Jun Zhu, Juan Liang, Yi Mu, Xiaohong Li, Anthony Costello, Tim Colbourn, Edward Fottrell, Audrey Prost, David Osrin, Carina King, Melissa Neuman, Neena Shah More, Kishwar Azad, Dharma Manandhar, Nirmala Nair, Prasanta Tripathy, Rajesh Kumar, Ariarathinam Newtonraj, Manmeet Kaur, Madhu Gupta, LK Dhaliwal, Neelam Aggarwal, Venkateshashan, Deepak Chawla, Anju Hurja, Poonam Shivkumar, Manish Jain, Geeta Gathwala, Smiti Nanda, Shashi Gupta, Sangeeta Singal, Raj Kumar, Sujata Sharma, Manjit Mohi, Santish Minhas, Rajendra Prasad, Suresh Verma, Neena Raina, Aimable Musafi Li, Beena Varghese, Robert Pattison, Jane Hirst, Peter Waiswa, Daniel Kadobera, Sanni Kujala, Anna Bergstrom, Tambosi Phiri, Jennifer A Hall, Louise T Day, Stacy L Saha, Shafi Ul Alam, Anisur Rahman, Shams El-Arifeen, Sayed Rubayet, Ahmed Ali Hassan, Lucy Smith, Bradley N Manktelow, Elizabeth S Draper, Nanbert Zhong, Jans Langhoff-Roos, Vicki Flenady, Kärt Allvee, Mika Gissler, Nicholas Lack, Sonam Wangdi, Jan Cap, Zuzana Podmanicka, Katarzyna Szamotulska, Chantal Hukkelhoven, Joyce Dijs-Elsinga, Theopisti Kyprianou, Kari Klungsøyr, Flor de Maria Herandez, Ala Curteanu, Henrique Barros, Sofia Correia, Shorena Tsiklauri, Ellen Lundqvist, Tinga Fulbert Ilboudo, Abdouli Bah, Lamin Jawara, Jennifer Zeitlin, Jelena Isakova, Olav Poppe

Previous estimates have highlighted a large global burden of stillbirths, with an absence of reliable data from regions where most stillbirths occur. The Every Newborn Action Plan (ENAP) targets national stillbirth rates (SBRs) of 12 or fewer stillbirths per 1000 births by 2030. We estimate SBRs and numbers for 195 countries, including trends from 2000 to 2015. We collated SBR data meeting prespecified inclusion criteria from national routine or registration systems, nationally representative surveys, and other data sources identified through a systematic review, web-based searches, and consultation with stillbirth experts. We modelled SBR (≥28 weeks' gestation) for 195 countries with restricted maximum likelihood estimation with country-level random effects. Uncertainty ranges were obtained through a bootstrap approach. Data from 157 countries (2207 datapoints) met the inclusion criteria, a 90% increase from 2009 estimates. The estimated average global SBR in 2015 was 18·4 per 1000 births, down from 24·7 in 2000 (25·5% reduction). In 2015, an estimated 2·6 million (uncertainty range 2·4-3·0 million) babies were stillborn, giving a 19% decline in numbers since 2000 with the slowest progress in sub-Saharan Africa. 98% of all stillbirths occur in low-income and middle-income countries; 77% in south Asia and sub-Saharan Africa. Progress in reducing the large worldwide stillbirth burden remains slow and insufficient to meet national targets such as for ENAP. Stillbirths are increasingly being counted at a local level, but countries and the global community must further improve the quality and comparability of data, and ensure that this is more clearly linked to accountability processes including the Sustainable Development Goals. Bill & Melinda Gates Foundation through Save the Children's Saving Newborn Lives programme to The London School of Hygiene & Tropical Medicine.