INTRODUCTION
Stillbirth is a devastating pregnancy outcome that not only has emotional, psychological and financial consequences for affected women and families,1 but also impacts individual healthcare workers, health care networks and the wider society.2The global stillbirth rate is estimated to be 18.4 per 1,000 births, equating to approximately 2.6 million stillbirths every year.3 The World Health Organisation’s (WHO)Every Newborn: An Action Plan to End Preventable Deaths aims to reduce the stillbirth rate to \(\mathrm{\leq}\)12 per 1,000 births by 2030 worldwide.4 For countries already meeting this target, mostly high-income nations, the Every Newborn initiative aims to reduce equity gaps within the population.4, 5
Despite similar access to healthcare services,6inequities in stillbirth rates continue to persist in high income nations, especially in certain minority ethnic groups. For example, women of ethnic minorities who birth in Australia or Europe have stillbirth rates 2-3 times higher than Caucasian women.7-9 A similar trend is observed in women of African ancestry compared to their Caucasian counterparts in the United States.10, 11 A higher incidence of modifiable risk factors associated with stillbirth are observed in some minority ethnic groups12 and may contribute, at least partly, to the higher rates of stillbirth observed. Given increasing international migration to high-income countries,13 it is pertinent to understand the ethnic variation in causes of stillbirth in order to address the persistent equity gaps.
A recent systematic review by Reinebrant and colleagues14 evaluated the causes of stillbirth according to geographical region and economic development around the world. Others have evaluated risk factors associated with stillbirth in various ethnic groups.12 However, whether differences in the actual causes of stillbirth between ethnicities exist is unknown. The aim of this study, therefore, was to perform a systematic review of the literature to investigate the causes of stillbirths in various ethnic groups in high income countries. This will assist in deepening the understanding of possible ethnic differences in causes of stillbirth and work towards the WHO’s goal to reduce equity gaps in stillbirth.