An international study published in PLOS Medicine documents the progressive decline in stillbirth and early neonatal mortality between 1990 and 2023 across 17 low- and middle-income countries (Ghana, Kenya, Malawi, Mali, Nigeria, Rwanda, Senegal, Tanzania, Uganda, Zambia, Zimbabwe, Egypt, Jordan, Bangladesh, Indonesia, Colombia, and Peru).

The study was conducted by Dr Mohammed Ali (World Health Organization, Geneva) and Prof. Saverio Bellizzi (United Nations University Institute for Water, Environment and Health, Ontario, Canada), in collaboration with Prof. Luca Cegolon, Professor of Hygiene and Preventive Medicine at the University of Trieste.

Lower perinatal mortality was found to be associated with residence in urban areas, higher levels of maternal education, greater household socioeconomic status, and stronger national welfare systems. By contrast, maternal age of 30 years or older was associated with an increased risk.

Stillbirth and early neonatal mortality remain a major global health challenge, with the vast majority of cases occurring in low- and middle-income countries that rely on household surveys—such as the Demographic and Health Surveys (DHS)—for their estimates, as civil registration systems are often incomplete.

However, DHS data tend to underestimate the scale of the problem and misclassify cases of stillbirth and early neonatal death, limiting their usefulness for planning maternal and child health interventions.

“Although most countries have experienced a decline in perinatal mortality, progress remains uneven and significant socioeconomic disparities persist. Strengthening maternal and neonatal health services and improving data collection systems in low- and middle-income countries remain essential to accelerate progress towards the Sustainable Development Goal (SDG) of reducing perinatal mortality,” state Prof. Cegolon and Dr Bellizzi.

The study, recently published in PLOS Medicine, analysed 93 DHS surveys conducted between 1990 and 2023 across 17 low- and middle-income countries, covering a total of 1,019,253 reported pregnancies among 733,181 women. Pregnancies lasting at least seven months were included, in line with the standard definition of stillbirth.

Age-specific risks of stillbirth and early neonatal death were estimated using life-table methods and a modified Gompertz-Makeham model, which is able to correct for common DHS data-quality issues, including underreporting, misclassification between stillbirths and deaths occurring on days 0–1 after birth, and age heaping at death—that is, the tendency to systematically report neonatal deaths as occurring at 7 days of age rather than on adjacent days.