Stillbirths have risen for the first time in seven years, with striking increases seen in babies of black ethnicity and from the most deprived backgrounds.
The findings in the perinatal mortality report from the group Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE-UK) highlight widening inequalities, with babies of black ethnicity more than twice as likely to be stillborn compared with white babies.
Overall, stillbirths in 2021 (the most recent data reported by hospitals) increased to 3.54 per 1,000, from 3.33 per 1,000 in 2020, ending a run of year-on-year reductions across the UK since 2013.
There were 2,473 stillbirths in 2021, compared with 2,292 stillbirths the year before. In 2019 there were 2,399 deaths.
Prof Elizabeth Draper, an epidemiologist at the University of Leicester and MBRRACE-UK’s perinatal lead, said the overall increase could be linked to reduced access to services during the pandemic. “This was right in the middle of the pandemic and pregnant women were very worried,” she said. “Our hope is – and we are fairly confident – that rates will come down again next year.”
However, Draper said the widening inequalities seen in minority ethnic groups and babies born to the most deprived mothers were deeply concerning and “clearly something that needs more investigation”.
Robert Wilson, who leads the joint policy unit for the Sands and Tommy’s baby loss charities, said the report painted “an alarming picture”.
“The situation described in this report is simply unacceptable,” Wilson said. “This requires a comprehensive response from all levels of government that matches the urgency and scale of the issue.”
The government has set targets for halving the number of stillbirths and neonatal deaths by 2025 compared with 2010 levels, but the latest figures suggest the UK is not on track to meet this.
On several measures, health inequalities worsened during the period. For the least deprived quintile, stillbirth rates in 2021 fell slightly compared with 2020, to 2.37 per 1,000 births, while the figure for the most deprived quintile rose to 4.69 per 1,000. For babies of black ethnicity, the figure rose from 6.42 per 1,000 total births in 2020 to 7.52 per 1,000 total births in 2021, an increase of 17%.
Dr Ranee Thakar, the president of the Royal College of Obstetricians and Gynaecologists, said: “It is concerning to read today’s report, especially to see that perinatal mortality rates increased in 2021 after seven years of year-on-year reduction. Urgent action is required to address this step backwards and to drive sustained reductions in both the inequalities highlighted and increased rates of perinatal mortality.”
The analysis could not explicitly quantify the impact of the pandemic. About 12% of mothers of stillborn babies tested positive for Covid, but as the researchers did not have the equivalent figure for overall births it was not possible to say whether this had any impact on the trend. However, Draper noted that most of the increase in stillbirths was in babies who died before the start of labour rather than during labour. She said this suggested that access to services may have been driving the overall trend, rather than women receiving worse care once they arrived at hospital.
“With signs like reduced foetal movement, it could be that women delayed longer before coming into hospital,” she said.
Birte Harlev-Lam, the executive director midwife at the Royal College of Midwives, said: “We should not forget that behind these statistics there are women and families who have experienced loss, and the huge impact that has. What is clear from this report is that we need to address health inequalities and improve care for black women and those living in the most deprived areas and their babies.”
An MBRRACE report released last year that revealed a nearly 20% increase in maternal deaths in 2018-20, compared with previous years, excluding Covid deaths.
