Beyond counting stillbirths to understanding their determinants in low-and middle-income countries: a systematic assessment of stillbirth data availability in household surveys

Background: Every year 2.65 million babies are stillborn, 98% of which occur in low and middle-income countries (LMIC). Global and nationally representative data on stillbirths in LMICs is limited, preventing our understanding of context-specific risk factors and causes. The Demographic and Health Surveys (DHS) are the primary data source on stillbirths available for 88 LMICs globally. Objective: To systematically map data availability for stillbirths from all countries with DHS surveys, to outline the limitations and challenges with using the data for understanding the determinants and causes of stillbirth, and for cross-country comparisons. Method: We assessed data sources from the DHS program website, including published DHS reports and their associated questionnaires for surveys completed between 2005 and 2015. Results: The DHS program completed 114 surveys across 70 LMICs between 2005 and 2015. Ninety-eight (86.0%) surveys from 66 countries collected stillbirth data adequately to calculate a stillbirth rate, while 16 surveys from 12 countries had not..The method used to count stillbirths varied; 96 (84.2%) surveys used a live birth history with a reproductive calendar, while 16 (14.0%) surveys from 12 countries (17.1%) did a full pregnancy history. Antenatal and delivery care information for stillbirths was only available for 15 surveys (13.2%) from 12 countries (16.0%); the remainder captured this only for live births. Data on maternal conditions/complications was captured in 17 surveys (16.0%), but in only six could these be linked to stillbirths. Only three surveys conducted verbal autopsies on stillbirth to report cause of death. Data on other risk factors was limited and varied considerably. Conclusions: Substantial variation exists across surveys in the measurement of stillbirths with limited scope to examine risk factors or causes. Without immediate improvements, understanding country-specific trends and determinants for stillbirths will remain hampered, limiting the development and prioritisation of programmatic interventions to prevent these deaths. Key words: Maternal health, child health

Aliki Christou

The University of Sydney