EC Gynaecology

Objective: To evaluate stillbirth trends in South Africa by geographic, population group and broad and main causes of stillbirth.

Methods: National causes of deaths statistics were used to analyse the 1997 and 2018 causes of data in South Africa. Data from the WHO Globocan was used to report stillbirth rate changes over time for South Africa and data was compared against regional SBR. Changes in the number of stillbirths and percent2 distribution of stillbirths are reported.

Results: In 1997 and 2018, the overall number of stillbirths was 297,585 (3%) of total deaths happening in the same period. The stillbirth rate has declined from 2000 to 2019, with 21.1% decline, and 1.2% Annual rate of reduction (ARR). This decline is much less than the regional sub-Saharan decline of 22.9% and world decline of 35.1%. Sixty-nine percent (205,891) of stillbirth were of Black African population; 22% (66,342) were unspecified and 6% (16,971) were coloured (mixed race) population. Most stillbirth occurred in KwaZulu-Natal province with 26% of stillbirth in the period, Gauteng province with 23% of stillbirths, Western Cape province with 10% of stillbirth and Mpumalanga province with 8% of stillbirths over the period. The top four ascertainment of still birth were unspecified (31%); 28% did not have an autopsy performed; 16% had a post-mortem examination and 13% had an opinion of attending medical practitioner. The top four broad groups of underlying cause of stillbirth included other disorders originating in the perinatal period (69%); 13% maternal factors and complications (13%); respiratory and cardiovascular disorders (7%) and disorders related to length of gestation and foetal growth (5%). The top five main groups of underlying causes of stillbirth are: perinatal conditions; conditional malformations; certain infections and parasitic infections; external causes of morbidity and mortality, symptoms, and sign not elsewhere classified.

Conclusion: The slight changes in the number of stillbirth and SBR over years indicate suggests potential benefits in investigation of stillbirth and address causes. Additionally, medical observed deliveries and the importance of routine antenatal care visits re essential for early identification of maternal related risk to implement appropriate management. It is also important to address health systems issues associated with the main causes of stillbirth to prioritise health practices and urgent health systems related interventions needed to decrease stillbirths across provinces in South Africa.

Keywords: South Africa; Stillbirths; Stillbirth Rate; Deaths; Pregnancy

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