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Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review

Aminu, Mamuda, Unkels, Regine, Mdegela, Mselenge, Utz, Bettina, Adaji, Sunday and van den Broek, Nynke (2014) Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG An International Journal of Obstetrics and Gynaecology, 121 (s4). pp. 141-153. ISSN 1471-0528

Item Type: Article


Annually, 2.6 million stillbirths occur worldwide, 98% in developing countries. It is crucial that we understand causes and contributing factors.

We conducted a systematic review of studies reporting factors associated with and cause(s) of stillbirth in low- and middle-income countries (2000–13). Narrative synthesis to compare similarities and differences between studies with similar outcome categories.

Main results
A total of 142 studies with 2.1% from low-income settings were investigated; most report on stillbirths occurring at health facility level. Definition of stillbirth varied; 10.6% of studies (mainly upper middle-income countries) used a cut-off point of ≥22 weeks of gestation and 32.4% (mainly lower income countries) used ≥28 weeks of gestation. Factors reported to be associated with stillbirth include poverty and lack of education, maternal age (>35 or <20 years), parity (1, ≥5), lack of antenatal care, prematurity, low birthweight, and previous stillbirth. The most frequently reported cause of stillbirth was maternal factors (8–50%) including syphilis, positive HIV status with low CD4 count, malaria and diabetes. Congenital anomalies are reported to account for 2.1–33.3% of stillbirths, placental causes (7.4–42%), asphyxia and birth trauma (3.1–25%), umbilical problems (2.9–33.3%), and amniotic and uterine factors (6.5–10.7%). Seven different classification systems were identified but applied in only 22% of studies that could have used a classification system. A high percentage of stillbirths remain ‘unclassified’ (3.8–57.4%).

To build capacity for perinatal death audit, clear guidelines and a suitable classification system to assign cause of death must be developed. Existing classification systems may need to be adapted. Better data and more data are urgently needed.

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More Information

Uncontrolled Keywords: Causes of stillbirth, factors associated with stillbirth, low income countries, middle income countries, stillbirth classification
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Depositing User: Mselenge Mdegela


Item ID: 15975
Identification Number:
ISSN: 1471-0528
Official URL:

Users with ORCIDS

ORCID for Mamuda Aminu: ORCID iD
ORCID for Regine Unkels: ORCID iD
ORCID for Mselenge Mdegela: ORCID iD
ORCID for Bettina Utz: ORCID iD
ORCID for Sunday Adaji: ORCID iD
ORCID for Nynke van den Broek: ORCID iD

Catalogue record

Date Deposited: 05 May 2023 15:31
Last Modified: 05 May 2023 15:31


Author: Mamuda Aminu ORCID iD
Author: Regine Unkels ORCID iD
Author: Mselenge Mdegela ORCID iD
Author: Bettina Utz ORCID iD
Author: Sunday Adaji ORCID iD
Author: Nynke van den Broek ORCID iD

University Divisions

Faculty of Health Sciences and Wellbeing > School of Psychology


Sciences > Health Sciences

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