By Sharon Atieno
Stillbirths- babies born with no sign of life- remain a major yet under-prioritized public health concern, with an estimated 1.9 million cases occurring globally each year—most in low- and middle-income countries. Despite this burden, stillbirth data collection, classification, and use vary widely across countries, undermining effective response.
In Africa, particularly, where routine health information systems, such as District Health Information System (DHIS2) or perinatal death surveillance linked to maternal death surveillance and response (MPDSR), and Civil Registration and Vital Statistics (CRVS) platforms, are still at initial stages of development and implementation, data is scanty.
In collaboration with Africa CDC, UNICEF, the London School of Hygiene and Tropical Medicine, and the University of Cape Town, conducted a survey across African Union (AU) member states to assess the status of stillbirth data systems, including definitions, policies, data practices, and use.
A cross-sectional online survey was disseminated between 2022 and 2023 to maternal and neonatal health focal points in all 55 AU countries. Of these, 33 submitted responses and 30 completed the full survey.
According to the World Health Organization (WHO), stillbirths are classified into two types: antepartum (before labour) or intrapartum (during labour). Early gestation stillbirth takes place between 22-27 weeks, while late gestation stillbirth takes place at 28 weeks or more. However, the survey found that there were varied definitions of stillbirths with the most common definition being 28 completed gestational weeks or 1000 grams.
Nearly half of the 33 countries that responded to the survey (17) reported that stillbirths are included in their legal framework for civil registration. Nine countries indicated no such framework for stillbirths, while focal points in six countries were unsure.
A majority of countries indicated that a national policy, guideline, or law mandates the recording of stillbirths within the health system. These legal or policy instruments included birth and death registration acts (e.g., Zimbabwe, Morocco), national health plans (e.g., Zambia, Algeria), maternal and perinatal death surveillance and response (MPDSR) guidelines (e.g., South Sudan, Liberia, Congo, Burkina Faso, Nigeria), and civil registration and vital statistics (CRVS) frameworks (e.g., Sierra Leone, Mozambique).
Four countries (Central African Republic, Equatorial Guinea, Togo, and Gambia) reported having no such requirement, while one (Lesotho) indicated uncertainty.
Similarly, 22 countries reported having a national policy, guideline, or law that requires stillbirths to be formally investigated and reviewed. Eight countries reported the absence of a formal policy framework for such investigations, and two countries (Malawi and Libya) were unsure.
Nearly all countries reported that stillbirths are routinely recorded through the health sector with standard data collection forms and a nationally agreed definition for reporting. Stillbirth data collection varies across countries, with most relying on health facility reporting to national systems.
Most countries, 26 of 33, reported using a standard classification system for assigning stillbirth causes of death, typically at the facility level by doctors or clinical officers, though practices and cadres varied.
Most countries reported a national strategic plan that incorporates stillbirths. Eight countries reported no formal system in policy and two countries did not know (Comoros and Libya).
Over half of the countries, 19, reported having set a national target for reducing stillbirth. Eleven countries reported no such target, two countries did not know (Liberia and Libya).
The survey found that challenges to collecting and reporting data at the facility and national levels include limited resources for routine information systems and maternal newborn health and limited capacity of staff to collect and use the data.
More than 60% of countries have committees at various levels to review stillbirth data, but insufficient resources and capacity hinder data use.
National reports with data on stillbirth are generated for the Ministry of Health in 21 countries (64%), though only 17 countries (52%) reported publishing the data publicly.
According to the report, countries are categorized into three readiness levels with regard to their stillbirth data systems. The first category is countries with systems in place requiring strengthening, including Angola, Congo, Kenya, Madagascar, Nigeria, Rwanda, Uganda, Zambia and Zimbabwe.
The other category includes those with policy or implementation gaps. These are Burkina Faso, Djibouti, Ethiopia, Eswatini, Lesotho, Malawi, Namibia, Morocco, Sierra Leone, South Sudan, Gambia, Togo and Comoros.
Those needing foundational support include Algeria, Democratic Republic of Congo, Libya, Liberia, Mozambique and Niger.
Among the recommendations is the need to Invest in national policies, integration of data systems, and building workforce capacity. Also, regional guidance, implementation research, and case studies of best practice may support countries in moving from data collection to action.
