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In March 2025, the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) released its latest report on stillbirths, .

The new report estimates in 2023 alone, 1.9 million babies were stillborn, or one every 17 seconds. Sub-Saharan Africa and South Asia bear the majority of this burden, accounting for 80% of all stillbirths. Meanwhile, nearly 900,000 of these deaths occurred during labour, most of which are preventable with timely, quality care. Current estimates include only late gestation stillbirths (babies born with no signs of life at 28 weeks of gestation or later). Including all stillbirths from 22 weeks onwards increases the estimated rate by 40%.

To explore the findings in more depth, this interview features insights from Hannah Blencowe, Deputy Director of the MARCH Centre and Associate Professor in Global Maternal and Child Health at LSHTM and Lucia Hug, Statistics Specialist and lead author of the report from UNICEF.

The recent report highlights that progress in reducing stillbirths has been much slower than the progress in reducing under-five mortality. Why is that, and what is needed to improve this?

LH: In contrast to under-five mortality, especially for children aged 1 to 59 months, where we’ve seen significant improvements over the decades, stillbirths haven’t received the same level of attention or prioritisation – progress was never very fast to begin with.

At the UN IGME, we only have consistent estimates of stillbirths from around 2000 onwards, and it hasn’t been a major focus for many health systems. Much of the progress in child mortality has been driven by immunisation and improved nutrition. Stillbirths, while also impacted by maternal health and immunisation, haven’t been monitored very closely or addressed.

HB:  Stillbirths are a maternal health issue, but to date they haven’t been fully adopted by the global maternal health community. The drivers of stillbirths are very similar to those of early neonatal deaths, and the child health community has recognised stillbirth as a critical concern.

Until all women have access to high-quality antenatal and intrapartum care, we’re likely to continue seeing stagnation in rates. Even though the majority of women are giving birth in facilities, the quality of care they receive is still lacking in many places. Stillbirth is seen as one of the most sensitive markers of maternal health, and while it’s hard to measure maternal mortality itself, stillbirth can serve as a proxy indicator.

Were there any surprising findings in this year’s report?

LH: One thing is the slowing rate of reduction in stillbirths. We had seen signs of this before, but now it’s more evident. On a positive note, data availability has improved. More countries are submitting data and engaging with us, which helps strengthen both the estimates and the programmes that rely on them.

We reach out to country governments to review the data, estimates and methods, so these estimates are not just produced by us. It’s not just an academic exercise, it’s really a collaborative process. Countries care about these numbers and get engaged, and I think that’s a positive development. It also reflects the strengthening of their data systems. Eventually, we expect that this will also strengthen their programming, because it goes hand in hand.

Why are global targets important, and how can we ensure stillbirths remain a priority?

LH: Targets set a normative standard. For stillbirths, the global country level target is no more than 12 per 1,000 births. It’s not a relative reduction like for some other indicators, it’s a clear benchmark, a standard that countries should aim for.

HB: The original global stillbirth country target was established in 2014 through the Every Newborn Action Plan, which was a major advocacy milestone. Stillbirths had not been included in the SDG targets in 2015, mainly because of insufficient and inconsistent data, which made it difficult to set targets or track progress. Since then, significant progress has been made. WHO and UNICEF have worked closely with countries to improve data collection and definitions. With better data and growing momentum, there’s no excuse not to include stillbirths in future global accountability frameworks.

What are the main barriers to accurate stillbirth reporting, and how can they be addressed?

LH: The Demographic and Health Survey (DHS) Program, which has currently been terminated, made an important advancement in their last round by collecting full pregnancy histories in standardised, more detailed surveys. This included stillbirths and any outcome of pregnancy, before they would only collect the outcomes of live births in the full birth history and less attention was based on stillbirths. In that sense, it was a big improvement to get data in countries where we don't have functioning administrative systems.

In terms of administrative systems, we need to strengthen health systems so that stillbirths are properly recorded in facilities, with data quality checks built in and support for health workers who record this data. Most births in many countries happen in facilities, so improving data collection there can make a big difference.

HB: We’re now operating in a very different fiscal and political environment than in 2014–2015, which presents new challenges for advocacy and implementation. For example, the recent termination of the DHS program means that we’re losing the future impact of recent innovations such as routine use of pregnancy history on stillbirth data. This is especially critical as surveys provide information on stillbirths where burden is highest.

What it really comes down to is the need for greater investment in health systems, especially in ensuring that births and outcomes are counted accurately. Strengthening administrative systems has relied heavily on external funding. It’s a tough environment, but we will continue to advocate for this.

Has the quality of data remained the same in this year’s report, or have there been improvements?

LH: Some people suggest that the lack of visible improvement of stillbirth risk in empirical data in administrative systems might actually be due to better data recording, meaning that more stillbirths are recorded than previously and the increase is not due to worsening situation, but the quality of reporting has improved. However, it’s difficult to distinguish between real trends and improvements in data quality.

That said, I wouldn’t say the data situation is strong enough yet to allow for truly robust data quality assessments. Data quality is always a complex issue. Even when you have a lot of data, it’s not always straightforward to evaluate.

What’s clear is that data availability has increased, which is a positive development. But just having more data isn’t enough, we still need to work on data quality.

Hannah, you’ve worked in the field of stillbirth research for over two decades. What major shifts or milestones have you witnessed during that time?

HB: I first got interested in stillbirth when I moved to Malawi in 2003. Working as a paediatrician with the staff on a labour ward seeking to improve neonatal outcomes, we started noticing the high number of stillbirths, many of which were overlooked. And while many were working on newborn projects, there were all these stillbirths that no one seemed to care about. They were just seen as numbers. I think that’s what really drew me in.

The brought global attention, especially in high-income countries, and helped spark action in places like the UK and the Netherlands. But in many countries, stillbirths remained invisible. Since 2020, UNICEF’s leadership has helped shift the narrative and the culture – now it’s part of the conversation in the global community.

We live in very different times now. For example, with AI, we can now assess gestational age quite accurately, there are new studies using AI-enabled ultrasound to date pregnancies. That could really change things. The old excuses don’t hold up anymore. We should be recording all babies, whether they live or not, even before the 28-week cutoff, which is quite arbitrary and comes from a time when we didn’t have the kind of neonatal care we do now.

The next step is getting that change to happen in ministries of health. Hopefully, that’s what we’ll see in the next five years.

That’s a powerful example of how advocacy has helped bring stillbirths onto the global agenda. What stillbirth-related research is currently being conducted at the MARCH Centre?

HB: There’s a new study starting, the , led by Professor Rashida Ferrand in Harare, Zimbabwe. They’re using AI-enabled ultrasound to date pregnancies and treat infections and looking at birth outcomes, with stillbirths as one of the primary outcomes. We’ve also been partners in the PRECISE Network,  a pregnancy cohort study in The Gambia, Mozambique, and Kenya. The study follows women through pregnancy and after delivery.

There is also growing research on the impacts of climate change on stillbirth, including findings that exposure to extreme heat in the final week of pregnancy may increase the risk of stillbirth and early newborn death.

Researchers from MARCH led the EN-INDEPTH study, which demonstrated that pregnancy histories are more effective than birth histories in capturing stillbirths in household surveys. This evidence contributed to the Demographic and Health Surveys (DHS) updating their core questionnaire to include pregnancy histories. 

MARCH also played a key role in developing the new Global Advocacy and Implementation Guide, aimed at governments, health professionals, facility managers, and advocates for maternal and child health.

What are your top three priorities moving forward?

HB: First, the impact of hypertensive disorders in pregnancy. These conditions are a major contributor to stillbirth and other adverse outcomes and addressing them could make a significant difference.

Second, improving access to quality obstetric care, especially ensuring that emergency referrals happen promptly when complications arise.

Third, prioritising support for women who’ve experienced a previous stillbirth. These women face much higher risks in future pregnancies and have been traumatised. We’re encouraging supportive bereavement care immediately after the death and early engagement with care when planning their next pregnancy, providing tailored support and working together with them to ensure they get the best quality care possible.

The report also highlights the importance of compassionate bereavement care. How has this evolved in recent years?

HB: When we first began the stillbirth estimates, we knew the numbers mattered, but so did the people behind them. That’s why we involved voices from the  (a collaboration of researchers, parents, advocates, and policymakers) from the start. Providing opportunities for parents to share their stories. For many, it’s about honouring the legacy of their children, and those stories are powerful and really do drive change.

A lot of the legal and policy shifts we’ve seen in North America and Europe around stillbirth and bereavement care have come from parents speaking out.

We are seeing progress – with positive examples of how people-centred compassionate bereavement care can be integrated into health systems in a range of contexts and national bereavement guidelines starting to be developed. Guidelines are the foundation, but they also need to be implemented. There’s still a long way to go, but I’m encouraged by the progress we’re seeing.

Looking ahead, what improvements would you like to see in the next 5–10 years?

LH: Ideally, we want stillbirth data to be collected through robust administrative systems. That means ensuring the information is accurately recorded, made available, and used effectively. If countries are consistently collecting and reviewing this data, we can better understand the causes and trends. Ultimately, the goal is to reduce the levels of stillbirth. And when a stillbirth does occur, it’s important that women and families understand why it happened and receive the appropriate care and support they need.