Tag Archives: Stillbirths

Three new tools from the World Health Organization

On 16 August, 2016 the World Health Organization (WHO) launched three new tools to count and review stillbirths, and maternal and neonatal deaths!

Browse the standardised system to capture and classify stillbirths and neonatal deaths in the WHO Application of the International Classification of Disease-10 to deaths during the perinatal period (ICD-PM).

Read the guide and toolkit, Making every baby count: audit and review of stillbirths and neonatal deaths. This publication assists countries to conduct audits and reviews to recommend and put into action solutions to prevent future stillbirths and neonatal deaths.

Explore Time to respond: a report on the global implementation of maternal death surveillance and response to review the findings of the WHO & UNFPA global survey of national MDSR systems in 2015.


Browse the press release and WHO website to learn more about these three tools, including related papers by the BJOG.

Read this Lancet commentary about all three publications.

Explore this photo story to learn more about MDSR implementation in ten countries around the world.

View this infographic about improving data to learn about what the WHO is doing to help countries save mothers’ and babies’ lives.

Do you know how many women each day experience a stillbirth worldwide? Browse this infographic on the tragedy of stillbirths to find out how many, and more!

The WHO application of ICD-10 to deaths during the perinatal period: ICD-PM

This is the first publication to help countries strengthen their data on maternal and neonatal deaths, and stillbirths that the WHO launched in August, 2016. This report presents a standardised system that enables the accurate capture and categorisation of stillbirths and neonatal deaths around the world. The ICD-PM is meant to guide those assisting healthcare providers and those tasked with death certification to accurately classify perinatal deaths.

Three distinct features of the ICD-PM are worth noting:

  • It captures the time of the perinatal death – either before, during or seven days after labour
  • It applies a multi-faceted approach to categorising the cause of death
  • It links a perinatal death to the mother’s condition (e.g. diabetes or hypertension), even if there is no condition to report. This feature aligns with the recommendation of the Every Newborn Action Plan to capture maternal complications with the registration of a perinatal death

The report includes tools and classification codes to facilitate consistent reporting. This is the first time that all stillbirths, and neonatal and maternal deaths can be consistently classified across all low-, middle- and high-income settings.

Visit the MamaYe-E4A website to read the evidence summary, and to link to the report and other relevant publications.

Making Every Baby Count: Audit and review of stillbirths and neonatal deaths

This second publication – launched by the WHO in August, 2016 – aims to help countries improve their data on maternal and neonatal deaths, and stillbirths. This document provides guidance on the review and investigation of perinatal deaths to recommend and put into action solutions to avoid future cases of similar causes. The guide and tools have been developed to be used at multiple levels of a health system from a few individuals at a health facility to a national programme. The tools offer a simpler version of the WHO application of ICD-10 (ICD-10) to deaths during the perinatal period (ICD-PM) to be used in low-resource settings to help initiate and build up audit (or review) systems.

Moreover, the guide integrates elements of the ICD-PM classification system to carry out an in-depth review of the causes and factors leading to all stillbirths and neonatal deaths.

The structure of the guide provides an overview of the key components to develop an audit system by:

  • justifying the purpose of the guide and development of an audit system
  • discussing the issues around defining and categorising causes of death, and providing examples of differing systems to classify preventable causes of deaths and near misses
  • defining six necessary approaches to set up and complete an audit cycle at the facility level
  • describing how to integrate community deaths into an established facility-based audit system
  • promoting a supportive atmosphere for the success of an audit system and giving advice on how to create an enabling environment
  • providing guidance on how to extend an audit system to a regional or national level as well as strengthening links to civil registration and community surveillance systems

Visit the MamaYe-E4A website to read the evidence summary, and to link to the report and other relevant publications.

Time to Respond: a report on the global implementation of maternal death surveillance and response

This is the third publication that the WHO launched in August 2016 to help countries improve their data on maternal and neonatal deaths, and stillbirths. This document presents the findings of a global survey conducted by the WHO and UNFPA to determine the status of MDSR implementation in countries where there is a national system.

The report helps countries improve their review process for maternal deaths at the facility level (hospitals and clinics). It also gives guidance for developing a safe environment (free of blame) for healthcare providers to improve the quality of care at facilities. Lastly, it offers an approach to capture deaths taking place beyond the health system (e.g. home births).

The document presents implementation and case study insights, which include identifying barriers to successful systems. The next global survey will take place in 2017 and will be repeated every two years.

Visit the MamaYe-E4A website to read the evidence summary, and to link to the report and other relevant publications.

MBRAACE-UK – Perinatal mortality surveillance report: UK perinatal deaths for births from January to December 2014

This report was published in May 2016 and is based on information collected of perinatal deaths in the UK for births from January to December 2014. The document focuses on deaths reported through the secure online reporting system, which include all late foetal losses (22nd to 23rd weeks of gestational age), stillbirths (a baby delivered at or after 24 weeks of gestational age with no signs of life) and neonatal deaths (a liveborn baby delivered at 20 weeks of gestational age or later, or weighing 400g or more when gestation is unavailable) who died within 28 days of being born.  The findings are displayed in mortality rates for stillbirths, neonatal deaths and extended perinatal deaths (both stillbirths and neonatal deaths). The report offers key findings and recommendations, as well as describing causes of death and factors that influence rates of perinatal death.

Developments in PNDSR in South Africa

Scale of the problem

In South Africa, perinatal deaths are defined as all stillbirths and early neonatal deaths (from live birth to seven full days after birth). While the country has accepted the definition* of reporting and recording all deaths (foetal and neonatal) weighing more than 500 grams, it is uncertain if all hospitals where deliveries take place are correctly reporting all deaths weighing less than 1000 grams, especially stillbirths. This may be influenced by a South African law that requires all defined stillbirths to have a burial and notification of death. In rural areas and busy hospitals, this may be seen as labour intensive for already overworked staff. Continue reading

Piloting PNDSR in Tigray region to inform national implementation – Part 1

This case study is the first of two. The second part will be published in 2017 and will report on progress toward scaling up perinatal and neonatal death surveillance and response (PNDSR) across the country.


In December 2015, Ethiopia began piloting a perinatal and neonatal death surveillance and response system in Tigray region in response to national commitments to improve newborn survival. The perinatal mortality rate in Ethiopia is high, estimated 46 per 1,000 births in 2011)[1]. The Tigray Regional Health Bureau (RHB) initiated the implementation of PNDSR after learning the importance of maternal death surveillance and response to generate evidence to save pregnant women’s lives following the scale up and national launch of maternal death surveillance and response (MDSR) in May 2013. The World Health Organization (WHO) has been supporting the region following its good performance during the initial phase of MDSR implementation.

Continue reading

Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh

This article by Animesh Biswas and colleagues, published by Health in September 2014, presents findings from a mixed-method study examining the process, feasibility, and acceptance of community death notification in Thakurgaon district, Bangladesh. The study found that community death notification was achievable and acceptable at the district level.

Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby

This article by Kate Kerber and colleagues in BMC Pregnancy & Childbirth presents the findings of a review and assessment of evidence for facility-based perinatal mortality audit in low- and middle- income countries, including their policy and implementation status on maternal and perinatal mortality audits.

The authors found that only 17 countries have a policy on reporting and reviewing stillbirths and neonatal deaths despite evidence suggesting that birth outcomes can be improved if the audit cycle is completed. Key challenges in completing the audit cycle and where improvements are needed were identified in the health system building blocks of “leadership” and “health information systems”. Evidence based solutions and experiences from high-income countries are provided to help address these challenges.

The authors conclude that the system needs data mechanisms (e.g. standardised classification for cause of death and best practice guidelines to track performance) as well as leaders to champion the process (e.g. bring about a no-blame culture) and access decision-makers at other levels to address ongoing challenges.

Facility death review of maternal and neonatal deaths in Bangladesh

This article by Animesh Biswas and colleagues in PLoS ONE presents findings of a qualitative study with healthcare providers involved in Facility Maternal and Newborn Death Reviews (FDRs) in two districts in Bangladesh: Thakurgaon and Jamalpur. The study aimed to explore healthcare providers’ experiences, acceptance, and effects of carrying out FDRs.

The study found that there was a high level of acceptance of FDRs by healthcare providers and there were examples of FDRs leading to improvements in quality of care at facilities, such as the use of FDR findings in Thakurgaon district hospital which ensured that adequate blood supplies were available, which saved the life of a mother who had severe post-partum bleeding. The article also identified gaps and challenges in carrying-out FDRs to consider for future efforts, including ensuring incomplete patient records and inadequately skilled human resources to carry out FDRs.

The authors conclude that FDRs are a simple and non-blaming mechanism to improving outcomes for mothers and newborns in health facilities.

To read more about maternal and newborn death reviews in Bangladesh, take a look at several case studies: two from the MDSR Action Network website: “Mapping for Action” and “eHealth to support  MPDRs”; and another in the WHO’s global MDSR report here.