Background

Stillbirths are a major public health issue and a sensitive marker of the quality of care around pregnancy and birth. The UN Global Strategy for Women's, Children's and Adolescents’ Health (2016–30) and the Every Newborn Action Plan (led by UNICEF and WHO) call for an end to preventable stillbirths. A first step to prevent stillbirths is obtaining standardised measurement of stillbirth rates across countries. We estimated stillbirth rates and their trends for 195 countries from 2000 to 2019 and assessed progress over time.

Methods

For a systematic assessment, we created a dataset of 2833 country-year datapoints from 171 countries relevant to stillbirth rates, including data from registration and health information systems, household-based surveys, and population-based studies. After data quality assessment and exclusions, we used 1531 datapoints to estimate country-specific stillbirth rates for 195 countries from 2000 to 2019 using a Bayesian hierarchical temporal sparse regression model, according to a definition of stillbirth of at least 28 weeks’ gestational age. Our model combined covariates with a temporal smoothing process such that estimates were informed by data for country-periods with high quality data, while being based on covariates for country-periods with little or no data on stillbirth rates. Bias and additional uncertainty associated with observations based on alternative stillbirth definitions and source types, and observations that were subject to non-sampling errors, were included in the model. We compared the estimated stillbirth rates and trends to previously reported mortality estimates in children younger than 5 years.

Findings

Globally in 2019, an estimated 2·0 million babies (90% uncertainty interval [UI] 1·9–2·2) were stillborn at 28 weeks or more of gestation, with a global stillbirth rate of 13·9 stillbirths (90% UI 13·5–15·4) per 1000 total births. Stillbirth rates in 2019 varied widely across regions, from 22·8 stillbirths (19·8–27·7) per 1000 total births in west and central Africa to 2·9 (2·7–3·0) in western Europe. After west and central Africa, eastern and southern Africa and south Asia had the second and third highest stillbirth rates in 2019. The global annual rate of reduction in stillbirth rate was estimated at 2·3% (90% UI 1·7–2·7) from 2000 to 2019, which was lower than the 2·9% (2·5–3·2) annual rate of reduction in neonatal mortality rate (for neonates aged <28 days) and the 4·3% (3·8–4·7) annual rate of reduction in mortality rate among children aged 1–59 months during the same period. Based on the lower bound of the 90% UIs, 114 countries had an estimated decrease in stillbirth rate since 2000, with four countries having a decrease of at least 50·0%, 28 having a decrease of 25·0–49·9%, 50 having a decrease of 10·0–24·9%, and 32 having a decrease of less than 10·0%. For the remaining 81 countries, we found no decrease in stillbirth rate since 2000. Of these countries, 34 were in sub-Saharan Africa, 16 were in east Asia and the Pacific, and 15 were in Latin America and the Caribbean.

Interpretation

Progress in reducing the rate of stillbirths has been slow compared with decreases in the mortality rate of children younger than 5 years. Accelerated improvements are most needed in the regions and countries with high stillbirth rates, particularly in sub-Saharan Africa. Future prevention of stillbirths needs increased efforts to raise public awareness, improve data collection, assess progress, and understand public health priorities locally, all of which require investment.

Funding

Bill & Melinda Gates Foundation and the UK Foreign, Commonwealth and Development Office.

中文翻译：

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2000 年至 2019 年全球、区域和国家死产估计和趋势：系统评估

 背景

死产是一个重大的公共卫生问题，也是妊娠和分娩护理质量的敏感标志。联合国全球妇女、儿童和青少年健康战略（2016-30）和每个新生儿行动计划（由联合国儿童基金会和世界卫生组织领导）呼吁结束可预防的死产。预防死产的第一步是对各国死产率进行标准化测量。我们估计了 2000 年至 2019 年 195 个国家的死产率及其趋势，并评估了一段时间内的进展。

 方法

为了进行系统评估，我们创建了来自 171 个国家的 2833 个与死产率相关的国家/地区年数据点的数据集，包括来自登记和健康信息系统、基于家庭的调查和基于人口的研究的数据。经过数据质量评估和排除后，我们根据胎龄至少 28 周的死产定义，使用贝叶斯分层时间稀疏回归模型，使用 1531 个数据点估计了 2000 年至 2019 年 195 个国家/地区特定国家的死产率。我们的模型将协变量与时间平滑过程相结合，以便根据具有高质量数据的国家时期的数据进行估计，同时基于很少或没有死产率数据的国家时期的协变量。模型中包含了与基于替代死产定义和来源类型的观察结果相关的偏差和额外的不确定性，以及受非抽样误差影响的观察结果。我们将估计的死产率和趋势与之前报告的 5 岁以下儿童死亡率估计值进行了比较。

 发现

2019 年，全球估计有 2·0 百万婴儿（90% 不确定性区间 [UI] 1·9–2·2）在妊娠 28 周或以上死产，全球死产率为 13·9 名死产（90% UI 13·5–15·4) 每 1000 名新生儿。 2019 年，各地区的死产率差异很大，西非和中非每 1000 名新生儿中有 22·8 名死产 (19·8–27·7)，而西欧则为 2·9 (2·7–3·0)。 2019 年，继西非和中非之后，东部和南部非洲以及南亚的死产率位居第二和第三。全球死产率年下降率估计为 2·3%（90% UI 1·7–2· 7）2000年至2019年，新生儿死亡率（<28天新生儿）年下降率低于2·9%（2·5-3·2）和4·3%（3·2）年下降率。 8–4·7) 同期1–59月龄儿童死亡率的年下降率。根据 90% UI 的下限，自 2000 年以来，估计有 114 个国家的死产率下降，其中 4 个国家下降至少 50·0%，28 个国家下降 25·0–49·9% ，下降10·0~24·9%的有50个，下降小于10·0%的有32个。对于其余 81 个国家，我们发现自 2000 年以来死产率没有下降。其中 34 个位于撒哈拉以南非洲，16 个位于东亚和太平洋地区，15 个位于拉丁美洲和加勒比地区。

 解释

与 5 岁以下儿童死亡率的下降相比，降低死产率的进展缓慢。死产率高的地区和国家，特别是撒哈拉以南非洲地区，最需要加速改善。未来预防死产需要加大力度提高公众意识、改进数据收集、评估进展并了解当地公共卫生优先事项，所有这些都需要投资。

 资金

比尔及梅琳达·盖茨基金会和英国外交、联邦和发展办公室。