Stillbirth rate holds steady in 2021 after increase in first year of Covid-19 pandemic, new CDC report shows
Stillbirths have been trending down for decades in the United States. But the rate ticked up in the first year of the Covid-19 pandemic, and new data from the US Centers for Disease Control and Prevention shows a second year of stalled progress.
More than 21,000 stillbirths were reported in 2021 – or nearly 6 for every 1,000 pregnancies that made it to 20 weeks or later, according to a report from the CDC’s National Center for Health Statistics.
The new report tracks stillbirth rates since 1990, when there were about 7.5 fetal deaths for every 1,000 pregnancies at 20 weeks or later. The rate dropped to a low of 5.7 per 1,000 in 2019 but rose to 5.74 in 2020 and stayed at 5.73 in 2021.
“There has been some slow progress over the last several years, but this should really be a pretty startling reminder of the progress that we have to continue to make on this issue,” said KJ Hertz, senior director of federal affairs for the infant and maternal health nonprofit March of Dimes.
Despite a 4% decline, Black women were still the most at risk of having a stillbirth. There were nearly 10 fetal deaths for every 1,000 pregnancies at 20 weeks or later among Black women in 2021, according to the new report – twice as high as the rate for White women. Native Hawaiian and Pacific Islander women as well as American Indian women also had higher than average rates.
Black women are often more at risk for certain medical conditions that are associated with stillbirth, such as chronic hypertension and diabetes – but that doesn’t explain the full disparity, experts say.
“Even after accounting for medical conditions and other baseline risk factors, there’s still an increased risk for Black women. The risk is not race-based but based on the kind of care that you get associated with that,” said Dr. Uma Reddy, a maternal and fetal medicine specialist with Columbia University who also helped develop guidance on the management of stillbirth for the American College of Obstetricians and Gynecologists.
“Maybe it’s issues with access to care or having concerns heard. We see a similar pattern to maternal mortality.”
Smoking is a well-established risk factor for stillbirth. In 2021, women who smoked while pregnant were nearly two times more likely to have a fetal death, according to the new report. Rates were also higher than average for teens and women 40 and older.
But nearly a third of all fetal deaths have an unknown or unspecified cause, the new report shows. Expert say this lack of complete information exemplifies the need for greater emphasis and investment into solving the problem.
In the US, there’s a lack of focus on the broader public health concerns and societal harms that these losses create – along with the heavy personal grief, said Dr. Robert Silver, chair of the obstetrics and gynecology department at University of Utah Health.
“We haven’t emphasized reducing stillbirth or made it a priority the way that some other countries have,” he said.
The US has a higher stillbirth rate than about three dozen other countries, according to data from the World Bank.
The March of Dimes and other advocates are campaigning for nationwide policies, including the Shine for Autumn Act, which focuses on preventing stillbirths through enhanced data collection, and the Maternal and Child Health Stillbirth Prevention Act, which would allow funds from other specific programs to be utilized specifically for stillbirth prevention.
“More analysis, reporting and research would allow us to more accurately track trends in infant mortality than we do currently and to create more effective prevention programs,” Hertz said.
The information that is available, however, shows that some progress is possible.
“Stillbirth is preventable,” Reddy said. “A fraction of stillbirths are due to a genetic cause, but for most, we’re able to improve the rate with better care and better understanding.”