Hidden tragedy: Nigeria accounts for one of the highest stillbirth rates in Africa

One stillbirth occurs every 16 seconds, according to first-ever joint UN estimates

UNICEF Nigeria
A baby in Nigeria
UNICEF Nigeria
23 November 2020

Almost 2 million babies are stillborn every year – or 1 every 16 seconds – according to a recently released report by UNICEF, the World Health Organization (WHO), the World Bank Group and the Population Division of the United Nations Department of Economic and Social Affairs.

The vast majority of stillbirths, 84 per cent, occur in low- and lower-middle-income countries, according to the report, A Neglected Tragedy: The Global Burden of Stillbirths. In 2019, 3 in 4 stillbirths occurred in sub-Saharan Africa or Southern Asia.

Nigeria accounts for one of the highest stillbirth rates in the African continent. It is one of six countries that bears the burden of half of all stillbirths globally, together with India, Pakistan, the Democratic Republic of the Congo, China and Ethiopia. 

Between 2000-2019 Nigeria reported a 15 percent increase in the number of stillbirths. It is estimated that the total number of stillbirths in Nigeria in 2019  was 171,428 .  A stillbirth is defined in the report as a baby born with no signs of life at 28 weeks of pregnancy or more.

At a global conference in October on “Ending preventable stillbirths: A renewed call to action”, the Federal Minister of Health, Dr Osaghie Ehanire, said: “The need for awareness of stillbirths in Nigeria cannot be over emphasised...Stillbirths have been overlooked as a global public health challenge, despite the fact that useful preventive measures could easily augment maternal and newborn health interventions to limit their occurrence. Nigeria, unhappily, has the second highest rate of stillbirths in the world with 42.9 per 1,000 births. The government has set a target of reducing it to 27 per 1000 live births by 2030."

The Minister said that this would require a multipronged approach and multisectoral collaboration - including with the education sector, whose role relates to the health seeking behaviour of women and adolescents.

“Losing a child at birth or during pregnancy is a devastating tragedy for a family, one that is often endured quietly, yet all too frequently, around the world,” said Henrietta Fore, UNICEF Executive Director. “Every 16 seconds, a mother somewhere will suffer the unspeakable tragedy of stillbirth. Beyond the loss of life, the psychological and financial costs for women, families and societies are severe and long lasting. For many of these mothers, it simply didn’t have to be this way. A majority of stillbirths could have been prevented with high quality monitoring, proper antenatal care and a skilled birth attendant.”

The global stillbirth report warns that the COVID-19 pandemic could worsen the global number of stillbirths. A 50 per cent reduction in health services due to the pandemic could cause nearly 200,000 additional stillbirths over a 12-month period in 117 low- and middle-income countries, including Nigeria. This corresponds to an increase in the number of stillbirths by 11.1 per cent. According to modeling done for the report by researchers from the Johns Hopkins Bloomberg School of Public Health, 13 countries could see a 20 per cent increase or more in the number of stillbirths over a 12-month period.

Most stillbirths are due to poor quality of care during pregnancy and birth. Lack of investments in antenatal and intrapartum services and in strengthening the nursing and midwifery workforce are key challenges, the report says. 

“While the high number of stillbirths in Nigeria is a huge loss, we must remember that every single one is an individual tragedy, and one that reaches far beyond the loss of life for the family concerned,” said Peter Hawkins, UNICEF Representative in Nigeria.

“Each stillbirth has a traumatic and long-lasting impact on women and their families, who often endure profound psychological suffering and often stigma in their communities. Perhaps even more tragically, the majority of these deaths could have been avoided with high-quality care before and during birth. More than 40 per cent of all stillbirths occurred during labour – a loss that could be prevented with improved monitoring and access to emergency obstetric care, when needed,” said Peter Hawkins.

Around half of stillbirths in sub-Saharan Africa and Central and Southern Asia occur during labour, compared to 6 per cent in Europe, Northern America, Australia and New Zealand. In Nigeria more than 50 per cent of stillbirths occur during the intrapartum and delivery period.

Even before the pandemic caused critical disruptions in health services, few women in low- and middle-income countries received timely and high-quality care to prevent stillbirths. Half of the 117 countries analyzed in the report have coverage that ranges from a low of less than 2 per cent to a high of only 50 per cent for 8 important maternal health interventions such as C-section, malaria prevention, management of hypertension in pregnancy and syphilis detection and treatment. Coverage for assisted vaginal delivery - a critical intervention for preventing stillbirths during labour – is estimated to reach less than half of pregnant women who need it.

As a result, despite advances in health services to prevent or treat causes of child death, progress in lowering the stillbirth rate has been slow. From 2000 to 2019, the annual rate of reduction in the stillbirth rate was just 2.3 per cent, compared to a 2.9 per cent reduction in neonatal mortality, and 4.3 per cent in mortality among children aged 1–59 months. Progress, however, is possible with sound policy, programmes and investment.

The report also notes that stillbirth is not only a challenge for poor countries. In 2019, 39 high-income countries had a higher number of stillbirths than neonatal deaths and 15 countries had a higher number of stillbirths than infant deaths. A mother’s level of education is one of the greatest drivers of inequity in high-income countries, in terms of stillbirth rates. According to Nigeria Health and Demographic survey 2018, stillbirths are more prevalent in the North West and North Central geopolitical zones - regions where adult female literacy is low, ranging from 4.5 percent in the North West to 6.2 in the North East and 20.4 percent in the South West.

Download the report and data here.