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.