The hospital room smelled of antiseptic, but for Aisha [not real name], it might as well have been filled with the weight of a painful memory. She lay in the hospital bed, her arms wrapped tightly around her stomach, which only hours ago had carried life. In the hallway, her husband Yusuf [not real name], paced the hallway, his hands clutched in silent prayer. He had been waiting for hours, reassured that the delivery was progressing, until the nurse emerged, her face solemn.
"Mr. Yusuf," her voice was gentle but heavy with an unbearable weight. "I'm so sorry... your baby didn't make it." For a moment, the world stopped, there was only silence where a newborn's cries should have been. At that moment, Yusuf realised something terrifying, he had lost his daughter, but seeing his wife's face, he was losing his wife too.
Pregnancy should be a time of great excitement, as a woman anticipates holding her newborn, surrounded by friends and family. However, for many, this may not be the case; as their baby may be lost before they take their first breath.
A stillbirth is foetal death after 28 weeks, either before or during childbirth. It is classified into two types based on timing: antepartum stillbirth (macerated stillbirth) and intrapartum stillbirth (fresh stillbirth). Antepartum stillbirth occurs when the foetus dies before labour and remains in the womb for some time. Intrapartum stillbirth occurs during labour or delivery, with the foetus showing no signs of decomposition. It is often associated with birth complications, lack of oxygen, or issues with the umbilical cord
According to a report by the United Nations Children's Fund (UNICEF), over 40% of all stillbirths occur during labour -- a loss that could be prevented with improved monitoring and access to emergency obstetric care when required.
Deep-rooted beliefs and stigma often prevent women from seeking antenatal care or delivering in health facilities, increasing the risk of complications. In some communities, stillbirths are viewed as a sign of spiritual misfortune or blamed on the mother, discouraging open discussions and hindering efforts to address the issue.
A neglected tragedy
In the global discourse on maternal and child health, stillbirths continue to be one of the most neglected and underreported tragedies in the global discussion on maternal and child health. They serve as a sensitive indicator of the quality of care of pregnancy and childbirth.
Every year, nearly 2 million babies are stillborn worldwide, yet the issue receives little attention in comparison to neonatal (the death of a live-born infant) and maternal mortality.
These numbers represent more than just statistics, they reflect families plunged into grief and mothers who endure emotional trauma that others may never understand.
Over the past two decades, significant progress has been made in reducing the global stillbirth rate, with a 35% decline , from 21.3 stillbirths per 1,000 births in 2000 to 13.9 in 2021.
To meet the Every Newborn Action Plan (ENAP) target, 56 countries must accelerate their progress by investing in quality antenatal and delivery care. If all countries achieved or exceeded the ENAP target, 2.6 million, stillbirths can be prevented by 2030.
Nigeria: A silent epidemic
Nigeria ranks among the top six countries with the highest number of stillbirths. These six countries, including India, Pakistan, DRC, Ethiopia and Bangladesh, account for almost half of the estimated global number of stillbirths and 36% of global live births in 2021. That means one out of every four stillbirths in sub-Saharan Africa happens in Nigeria. Yet, discussions on maternal and child health rarely highlight this crisis.
With a stillbirth rate (SBR) of 24 per 1,000 total births, the country's burden is twice the global target of 12 per 1,000 total births set by the ENAP. Despite efforts to improve maternal and child health, the indices have not improved -- over 404,305 stillbirths were recorded between 2014 and 2023 in Nigeria alone, according to a qualitative analysis conducted by the Improving Nigeria's Capacity to Use Data on Registered Stillbirths for Decision-Making & Planning (SPEED) Project.
The distribution of stillbirth cases across the country is also uneven, with northern Nigeria disproportionately affected. States such as Zamfara, at 53 per 1,000 births, and Katsina, at 52 per 1,000 births, have more than twice the national estimate, highlighting deep disparities in maternal healthcare access and quality.
Katsina accounts for 11.14% of stillbirths, making it the highest state, and Ekiti State accounts for 0.26%, which is the lowest. Factors contributing to these rates include limited access to quality antenatal care, delays in seeking medical help, high rates of maternal infections, complications during labour, and inadequate health facilities -- all of which disproportionately affect women in rural and underserved areas.
Stillbirth data gaps persist across the world
Despite the numbers, stillbirths are rarely included in health policies, funding priorities, or even routine health data tracking.
The first step to prevent stillbirths is to obtain standardised measurements of stillbirth rates across countries. One of the key reasons stillbirths remain neglected is the lack of comprehensive data. A study of the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) survey conducted by WHO, reviewed how stillbirths are included in national policies with responses from 155 countries.
The survey revealed that:
- Fewer than 1 in 5 countries have set a specific target to reduce stillbirths.
- While 65.8% of countries have a national maternal death review panel, only 43.9% have a national policy that requires stillbirths to be reviewed.
- Globally, nearly all countries have a national policy that requires every death to be registered. However, only 45.5% of reviewed national policies made mention of registering stillbirths.
- Only 5 countries had national policy documents recommending training of health workers in filling out death certificates using the International Classification of Diseases (ICD)-10 for stillbirths.
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Without accurate reporting, governments and policymakers struggle to allocate resources effectively. Data collection and analysis are crucial in addressing stillbirths by identifying high-risk areas, improving healthcare policies, guiding targeted interventions, and raising public awareness.
Breaking the silence and driving change
If Nigeria is serious about reducing maternal and child mortality, it must stop neglecting stillbirths. Policies must include stillbirths as a key maternal health indicator, and health systems must prioritise data collection, emergency obstetric care, and antenatal services.
More importantly, we must begin to acknowledge the grief of families who experience stillbirths and provide them with the psychosocial support they need. It is time to turn data into action and ensure that no family suffers in silence.
Addressing Nigeria's stillbirth crisis requires urgent and targeted interventions, from improving maternal healthcare services and investing in skilled birth attendants to tackling socio-cultural barriers that delay critical care. The silence surrounding stillbirths must be broken, and concerted efforts must be made to ensure that every pregnancy has a fair chance of a safe outcome.
