Grant: IPPH Travel Awards - CPHA Annual Conference

Introduction: Stillbirths, at 2.6 million annually worldwide, remains stubbornly high; this is in contrast to neonatal and under-five mortality rates worldwide which has shown a decrease in recent years. Stillbirth is a neglected public health challenge globally. The global target of 9 stillbirths per 1000 total births, and national target of 12 per 1000 total births (especially in the Low and Middle Income Countries) by 2030 will be difficult to achieve at current rates. Studies heretofore have not quantified the relationship between stillbirth and its social determinants, leaving an evidence-gap for decision making, policy and practice. Main findings: Stillbirth rates varied across all countries with an average rate of 12.8 per 1000 total births. Thirty-seven countries (all from African continent) formed a cluster of high stillbirth rates (hot-spots); 13 countries formed a cluster of low stillbirth rates (cold spots), (from Central Asia and Canada). Society-wide gender inequality, anaemia in pregnancy were significant factors associated with higher stillbirth rates; while higher antenatal care coverage (ANC), skilled birth attendants during delivery were factors associated with lower stillbirth rates. A 44% improvement of stillbirth rate was associated with: skilled birth attendants during delivery increased from 70% to 88%, ANC coverage increased from 55% to 70%, prevalence of anaemia in pregnancy decreased from 27% to 11%, and gender inequality index decreased from 43% to 21%. Call to action: Recognizing the urgency in reducing stillbirths globally, multi-pronged strategies should be designed to promote gender equality and strengthen the reproductive and maternal health services-infrastructure in Africa, Eastern Mediterranean, and South Eastern Asia.Factors that place women at disadvantageous positions (low level education and literacy, economic insecurity, violence) are foundational and long-lasting solutions to address stillbirth rates.