Unexplained stillbirth in sub-Saharan Africa: Tanzania and Zambia

14 February, 2021

Dear HIFA-Zambia, HIFA and CHIFA colleagues,

An interesting new study below from Tanzania and Zambia.

CITATION: C Bedwell et al. Understanding the complexities of unexplained stillbirth in sub-Saharan Africa: a mixed-methods study

BJOG 2020

First published: 15 December 2020 https://doi.org/10.1111/1471-0528.16629



Objective: To understand the complexities surrounding unexplained stillbirth for the development and implementation of culturally acceptable interventions to underpin care in Tanzania and Zambia.

Design: Mixed-methods study.

Setting: Tertiary, secondary and primary care facilities in Mansa, Zambia, and Mwanza, Tanzania.

Sample: Quantitative: 1997 women giving birth at two tertiary care facilities (one in each country). Qualitative: 48 women and 19 partners from tertiary, secondary and primary care facilities.

Methods: Case review using data from a target of 2000 consecutive case records. Qualitative interviews with a purposive sample of women and partners, using a grounded theory approach.

Results: A total of 261 stillbirths were recorded, with a rate of 16% in Tanzania and 10% in Zambia, which is higher than the previous estimates of 2.24 and 2.09%, respectively, for those countries. Women in both countries who reported a previous stillbirth were more likely to have stillbirth (RR 1.86, 95% CI 1.23–2.81). The cause of death was unexplained in 28% of cases. Qualitative findings indicated that not knowing what caused the baby to be stillborn prevented women from grieving. This was compounded by the poor communication skills of health professionals, who displayed little empathy and skill when counselling bereaved families.

Conclusions: The stillbirth risk in both facilities was far higher than the risk recorded from national data, with women reporting a previous stillbirth being at higher risk. Women want to know the cause of stillbirth and an exploration of appropriate investigations in this setting is required. Providing health professionals with support and continuing training is key to improving the experiences of women and future care.


Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited.


When she loses the baby, they don't even sympathise with the mother. They will say it is bad luck, go home, and that's all. (Partner, Tanzania)

On discharge, no one talked or counselled me about my loss; to them, it was business as usual. (Woman, Zambia)

They just told me that my baby died in the uterus … but they didn't tell me what went wrong with my baby. (Woman, Tanzania)

I was in shock; it was unbelievable that I lost my baby just like that. The male nurse started blaming me for been lazy in pushing, I was so hurt but I could not speak. (Woman, Zambia)


Women were reluctant to raise questions about their stillbirth with health professionals, despite being keen to understand the cause. This may stem from the culture of blame experienced by women in sub‐Saharan Africa within their own communities. It may also relate to their gender and status, which often prevents them from having a voice in the community and health system.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org