1957 - United Nations Statistics Division

A stillbirth is generally understood to be the birth of a
viable foetus that is dead at birth or, in other words, a
foetal death occurring late enough in pregnancy for there
to have been a fair chance of survival, that is, after at
least 28 completed weeks of gestation.
Criteria of viability are usually based on the duration
of pregnancy, measured in days, weeks, or months. The
minimum period of gestation varies widely, ranging, according
to available information, from 3 to 7 months.
The minimum interval most frequently specified is 28
weeks. 49 Some countries use an additional requirement
that the foetus be a minimum length, ranging from 30 to
35 centimetres. In a number of cases, the only specification
is simply that the foetus must be viable or that it
must be recognizable as a human being. On the other
hand, some countries do not consider viability but classify
as stillbirths all foetuses which arc reported to have been
born dead.
Although full information on the definition of "stillbirths"
could not be obtained for all the areas and years
for which data are shown in this volume, some information
on current practices in distinguishing stillbirths
from abortions is available from the Handbook of Vital
Statistics Methods and it is set forth in the tables.
Foetal deaths more than any other are subject to severe
limitations as regards completeness of registration. It
would appear that, even with a highly efficient registration
system, the proportion of foetal deaths escaping
registration is considerably larger than the corresponding
birth and death omissions, but it is difficult-if not impossible-to
estimate the extent. Consequently, no precise
information on completeness of coverage (similar to that
which was devised for other tables) could be developed
for foetal deaths and, hence, no quality code appears in
Table 20. Perhaps the most that can be said, in general,
is that the coverage of foetal deaths in countries where
most confinements are medically attended is more complete
than in others.
It may be noted that certain countries classify as "stillbirths"
live-born infants dying shortly after birth, i.e.,
within 24 hours or before registration as a live birth. For
clarity, these might be termed "pseudo-stillbirths". The
countries that are known to follow these practices are
noted when they appear in the tables.
Table 20
Table 20 is the trend table which shows the number of
late foetal deaths (stillbirths), together with late foetaldeath
ratios, for the period 1948-1956. The definitions of
"stillbirth" on which the data are based may be found in
the Handbook of Vital Statistics Methods, Annex 3.
Coverage: The coverage of this table, 129 geographic
areas, is limited only by the policy of restricting ratios to
frequencies of 15 or more. Thus, a few potential areas
are not included because of the smallness of the numbers
involved.
The restrictions imposed on coverage by the need to
achieve strict correspondence between the numerator and
denominator of the ratio is not so effective as it is in rate
tables, because the ratios are computed in relation to the
,. Deriving from the fact that prior to 1950, the international definition
of a "stillbirth" specified 28 weeks as the lower limit of
viability.
37
number of live births rather than to population estimates.
It is generally true that if stillbirth statistics are
available, live-birth figures will also be at hand.
Ratio computation: The ratios shown in the table are the
numbers of stillbirths reported per 1,000 live births in
the same period, rather than per 1,000 of the combined
total of live births and stillbirths. This method of computation
is adopted in view of the variability in the completeness
of reporting of stillbirths and the comparative
stability of the reporting of live births.
All ratios have been computed in the Statistical Office
of the United Nations on live births shown in Table 6,
except in the case of Ceylon where official stillbirth ratios
were used for lack of recorded live births in the "Proclaimed
Areas".
Limitations: All the limitations described on p. 36 are
applicable to data in this table. Those of special significance
are variations in completeness and problems of
definition.
It is difficult to identify incompleteness in foetal-death
registration. Foetal deaths are known to be incompletely
registered in most countries of the world, but when
foetal deaths and live births are both under-registered,
the resulting ratios may be of reasonable magnitude. As
a matter of fact, for the countries where live-birth registration
is poorest, the ratios may be the largest, effectively
masking the incompleteness of the base data. For this
reason, possible variations in birth-registration completeness
must always be borne in mind in evaluating foetaldeath
ratios.
In addition to the indirect effect of live-birth underregistration,
foetal-death ratios may be seriously affected
by date-of-registration tabulation of live births. When the
annual number of live births registered and reported fluctuates
over a wide range due to changes in legislation or to
special needs for proof of birth on the part of large segments
of the population, then the foetal-death ratios will
fluctuate also, but inversely. Because of these effects, data
for countries known to tabulate live births by date of registration
should be used with caution unless it is also
known that statistics by date of registration approximate
those by date of occurrence.
Finally, it may be noted that the counting as "stillbirths"
of live-born infants who die before registration
has the effect of inflating the foetal-death ratios unduly
by decreasing the birth denominator and increasing the
foetal-death numerator. This factor should not be overlooked
in using data from this table. The potential size
of the problem has been set forth in the Handbook of
Vital Statistics Methods, p. 58.
Table 21
Foetal deaths and ratios by period of gestation are set
forth in Table 21 for each year 1950-1956. This is the first
time that statistics of this type have been presented in the
Demographic Yearbook. Examination of the table will
show that they are by no means consistent and comparable
statistics. Many are late foetal deaths only, i.e., those
of 28 weeks or more gestation; others are deaths occurring
after 6 months' gestation. However, they do provide
some idea of the number of countries which tabulate
foetal deaths by gestational age, which is a further exten-