The stillbirth rates across Europe have shown a significant improvement over recent decades, though some countries are exceptions. For instance, Germany and Belgium have witnessed a notable rise in these rates since 2010, in contrast to most European nations, which have either seen a decrease or stability in their figures. Researchers have explored how factors such as rising maternal age and the occurrence of multiple births might affect these trends and variations observed throughout Europe. Their findings suggest that these variables account for only a small part of the differences.
Like life expectancy, the stillbirth rate has generally improved over the past few decades. However, this advancement varies across Europe. While many countries have successfully reduced their rates to below three stillbirths for every 1,000 live births, certain nations are experiencing stagnation or increases in their rates. Notable disparities exist between countries as well. A recent investigation from the Max Planck Institute for Demographic Research (MPIDR) in Rostock, Germany, in collaboration with researchers from the University Medical Center Rotterdam, the University of Iceland, and the National University Hospital of Iceland, sought to understand the factors driving these trends.
“Initially, we examined the changes in stillbirth rates in Europe from 2010 to 2021, with a special focus on whether the recent rise in Germany was an isolated occurrence,” explains Maxi Kniffka, a researcher at MPIDR. The study also looked into whether the increase in maternal age and changes in the rates of multiple births could clarify the differing trends among various countries. Both of these factors are commonly regarded as significant explanations for shifts in fertility rates.
To conduct the study, researchers analyzed data from the Euro-Peristat network, established in 1999 under the EU Health Monitoring Programme. “We assessed annual stillbirth rates based on maternal age and the prevalence of multiple births. This data set was standardized across countries to create a consistent definition of stillbirth*, minimizing distortions in country comparisons,” says Kniffka.
Trends in Germany and Belgium
The analysis indicates that most European nations continue to either lower their stillbirth rates or maintain them at a low level. Germany and Belgium, however, are notable for their distinct and significant increase in stillbirths since at least 2010. In Germany, the number of stillbirths per 1,000 births climbed from 2.8 in 2010 to 3.7 in 2021. Similarly, Belgium saw a rise from 4.6 to 5.6 during the same timeframe. In contrast, countries like Spain and Denmark reported declines in their rates, dropping from 3.1 to 2.7 and from 3.1 to 2.9, respectively, while Austria and Italy experienced stagnant rates.
The research concluded that factors such as increasing maternal age and variations in multiple birth rates only partially explain the rising stillbirth rates. The age of mothers at childbirth is generally increasing, which is linked to a higher likelihood of stillbirth; this rise can contribute to an increase or lessen the decrease in stillbirth rates in certain nations. Meanwhile, the overall incidence of multiple births has decreased in many countries. “Since pregnancies resulting in multiple births carry a higher risk for stillbirths, this decline has aided in lowering stillbirth rates in most regions,” Kniffka explains. However, in Germany, the minimal drop in multiple births has been insufficient to offset the increasing stillbirth rate.
Maternal age and multiple birth rates provide only a limited explanation for the differences among countries, as demographic factors are converging and the general risk of stillbirth related to advanced maternal age decreased across the nations under study between 2010 and 2021. For instance, Germany reported a higher stillbirth rate in 2021 compared to the average of all countries included in the study. Therefore, variations in maternal age or the frequency of multiple births have a minor impact on this.
Need for Further Research on the Causes of Increase
The researchers recognize that a comprehensive understanding of the changing stillbirth rates in most European countries, particularly in Germany, is still lacking. However, in Belgium, the rise may also be associated with alterations in the number of late-term abortions, which are included in the stillbirth statistics. Several potential causes could explain the increase in stillbirth rates. Due to limited data availability, only two factors were initially analyzed, but future research will delve deeper into this issue.
Stillbirth rates serve as a reflection of the quality of a country’s healthcare system. “If stillbirth rates are no longer declining, or indeed are on the rise, as seen in Germany, it calls for a closer examination of the underlying causes,” asserts Maxi Kniffka.
