Racial and Ethnic Disparities in Stillbirth, 2015–2017

A fetal death is the spontaneous loss of a fetus during pregnancy. U.S. national data cover losses at 20 or more weeks of gestation, commonly called stillbirths. About 23,000 were reported in 2017. Racial and ethnic disparities in fetal death are well documented but largely unexplained. CDC analyzed fetal death reports and birth certificates for 2015–2017 to look more closely.

How it was done

The analysis used National Vital Statistics System data for U.S. residents from all 50 states and the District of Columbia, counting losses at 20 weeks or more. Rates are fetal deaths per 1,000 live births plus fetal deaths. Causes were examined only in jurisdictions using the 2003 revision of the standard fetal death report and where more than half the reports named a cause; the five most common cause categories were compared by race and Hispanic origin.

Who is most affected

The overall rate was 6.0 per 1,000.

The rate among Black women was more than twice that among White or Hispanic women. Compared with mothers aged 20–39, the rate was 30% higher among mothers under 20 and also significantly higher among those over 40. Women carrying more than one fetus had more than twice the rate of those carrying one.

Fetal mortality rates by selected maternal characteristics, 2015–2017. CDC figure.

By state

Rates were generally higher in the South. Alabama had the highest state rates among White women (6.9) and Hispanic women (7.0). Among Black women, rates topped 16 per 1,000 in New Jersey (17.3), West Virginia (16.8) and Mississippi (16.3).

Fetal mortality rates by state, 2015–2017. CDC figure.

Causes

Even where most reports named a cause, 31% of fetal death reports gave none — similar for Black, White and Hispanic mothers. The five most common cause categories were:

1. complications of the placenta, cord and membranes;
2. maternal complications of pregnancy;
3. congenital malformations, deformations and chromosomal abnormalities;
4. maternal conditions that may be unrelated to the pregnancy;
5. syndrome of infant of a diabetic mother and neonatal diabetes mellitus.

Compared with White mothers, Black mothers had higher rates of fetal death from:

• maternal conditions possibly unrelated to the pregnancy (1.4 versus 0.4 per 1,000; 3.4 times as high);
• maternal complications of pregnancy (1.8 versus 0.6; 3.1 times);
• syndrome of infant of a diabetic mother and neonatal diabetes (0.3 versus 0.1; 2.8 times);
• unspecified causes (3.3 versus 1.6; 2.0 times).

Rates were higher among Black women for every selected category except congenital malformations, which were similar across groups. Hispanic women also had higher rates than White women for maternal complications of pregnancy and for the diabetes-related category.

What it means

The U.S. fetal death rate has been fairly steady since 2006, but disparities persist, appearing in four of the five most common causes. The reasons are not fully understood; possible contributors include differences in health before pregnancy, socioeconomic status, access to quality care, stress, and racism, including institutional bias. Better preconception health and prenatal care for Black women could narrow the gap, but incomplete information on causes makes prevention hard to design. The authors called for better reporting of causes on fetal death reports and more research into preventable causes.

Limitations: causes could not be examined nationwide, since some states do not use the 2003 report form and others named a cause in fewer than half their reports, so the cause findings are not nationally representative; and nearly a third of reports even in the included areas lacked an informative cause, so better reporting could change the rates for other categories.

Sources

• Pruitt SM, Hoyert DL, Anderson KN, et al. "Racial and Ethnic Disparities in Fetal Deaths — United States, 2015–2017." MMWR 2020;69(37).