The use of perinatal deaths to assess pregnancy outcomes has been a practical approach particularly in settings and circumstances where it is not always easy to distinguish between stillborn and liveborn infants who die shortly after birth. However, due to difficulties in measurement and etiological differences between the two components of perinatal deaths – stillbirths and early neonatal deaths – its value is limited [1,2]. Separate measure of stillbirths as an indicator of access to and quality of antenatal and delivery care, therefore, is becoming increasingly important. The higher stillbirth rates shown among lower socio-economic groups of populations in both developing and more developed parts of the world [3-5] extend the use of stillbirth rate as a development indicator as well.
Obtaining reliable estimates of stillbirth rates and making cross-country comparisons has been problematic for several reasons. Routine vital registration information is suggested to be an underestimate of the true picture particularly in developing countries [6,7]. Community surveys rely on self-reports which may not always be valid [8]. Relying only on facility-based data may be misleading since considerable number of deliveries occur at home in many developing country settings. A variety of definitions and cut-off levels for registration involving different gestational ages ranging from 20 to 28 weeks or birth weights ranging from 350 to 1000 g further complicates interpretation of rates [1,9-15].
In addition to routinely collected data, medical literature includes a range of studies reporting on the prevalence of stillbirths. The results of these studies show variation across and within countries. For example, per 1000 live births, it has been reported as 61 in Zimbabwe, 18 in Turkey and ranging from 3.2 to 7.1 among different ethnic groups in Canada all using the definition involving birth weight of more than 500 g [4,16,17].
Although there is a wealth of information through routine registration systems and a variety of ad hoc studies, due to the complexities described above, reliable estimates of stillbirth rates do not exist for many settings. Rates vary across and within settings, and summarizing outcomes is not always straightforward. Meta-analytical methods are increasingly being used in comparing and summarizing outcomes for important public health outcomes. They offer valuable tools, particularly for research carried out across different settings, by providing an opportunity to investigate potential sources of variation [18].
We conducted a systematic review and performed meta-analysis of available information from both routine data and other published studies to explore the feasibility of obtaining an overall estimate of the stillbirth rates across various regions of the world and to investigate possible sources of heterogeneity across these rates.
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