In 2026, a woman can reach the hospital. But reaching care is not the same as receiving care that keeps her and her baby alive.
“The longest walk I’ve ever done was walking out of a hospital three times without a baby.” With those words, Grace Mwashighadi, Co-Chair of the Lancet Stillbirth Advisory Committee, set the tone for the 2026 International Maternal and Newborn Health Conference (IMNHC) in Nairobi, a gathering that placed the global crisis of stillbirth alongside, and inseparable from, the unfinished agenda on maternal and newborn survival.
Mwashighadi described how health systems met her loss with silence, and how workers did not know what to say. “Stillbirth is not only a health issue,” she told delegates. “It is about dignity, respect, and whether, in some of the most vulnerable moments of people’s lives, they are truly seen and cared for.”
Her testimony opened a conference that confronted a troubling paradox at the heart of Kenya’s own health record. Two decades ago, giving birth at home was the norm for most Kenyan women. Today, nearly nine in ten delivers in a health facility.
And yet the country’s maternal mortality ratio remains stubbornly high at 355 deaths per 100,000 live births, a figure the Ministry of Health (MoH) has described as unacceptably elevated, alongside a neonatal mortality rate of 21 per 1,000 live births. More women are reaching facilities. Too many are still dying inside them. And the babies lost before they drew a single breath are, in most countries, still not being counted at all.
The scale of the stillbirth crisis in Africa was laid out starkly in the State of Africa’s Stillbirths report, published by Africa CDC, UNICEF, WHO, the London School of Hygiene and Tropical Medicine, and the International Stillbirth Alliance. Its central finding is unsparing: every 30 seconds, a baby is born still somewhere on the continent.
Africa experiences roughly the same number of stillbirths today as it did in 2000
In 2023 alone, nearly one million late-gestation stillbirths occurred across Africa, about 52 per cent of the global total. Africa’s intrapartum stillbirth rate is 43 times higher than that of Europe.
Africa experiences roughly the same number of stillbirths today as it did in 2000. Progress in reducing rates has been offset by population growth, leaving the absolute toll virtually unchanged over two decades. Without accelerated action, the report projects five million stillbirths between 2026 and 2030; and finds that Africa needs to move eight times faster in its annual rate of reduction simply to meet the global 2030 target of 12 or fewer stillbirths per 1,000 total births.
“The two million mark has persisted for too long without significant change,” said Helga Fogstad, Director of Health at UNICEF’s Global Programme Division. “Stillbirth is one of the clearest indicators of whether our health systems are delivering quality care at the moment of birth, especially for the most vulnerable. If we are serious about improving outcomes, stillbirth must be part of how we measure success and accountability.”
Researchers from the Johns Hopkins Bloomberg School of Public Health, the African Population and Health Research Centre (APHRC), the International Centre for Equity in Health at Universidade Federal de Pelotas, and the Countdown to 2030 collaboration presented findings from a landmark multi-country study spanning 21 African nations.
Sub-Saharan Africa accounts for 47 per cent of global stillbirths and 46 per cent of newborn deaths, and the region needs a twelvefold increase in its annual mortality reduction rate to reach the SDG target of fewer than 70 maternal deaths per 100,000 live births by 2030.
To accelerate preventable mortality decline in Africa, health facility capability and quality of care should be enhanced
“Delivery gains are necessary, but they are not sufficient by themselves,” said Dr Cheikh Mbacké Faye, Regional Director of APHRC’s West Africa Regional Office. “To accelerate preventable mortality decline in sub-Saharan Africa, health facility capability and quality of care should really be enhanced.”
His analysis was underscored by the framework at the heart of the conference’s analytical work, what Prof Agbessi Amouzou of the Johns Hopkins Bloomberg School of Public Health was careful to name in full as the Maternal, Newborn and Stillbirth Transition Framework. It is not, he emphasised, a maternal health model with neonatal and stillbirth data appended as afterthoughts.
“We develop maternal mortality, stillbirth and neonatal mortality transition,” he told delegates. “It brings together mothers and newborns in an integrated manner. The approach helps you integrate the three components.”
Stillbirth, in this model, is a coequal measure of whether a health system is functioning. Its reduction or failure to reduce is one of the measurable thresholds a country must cross to progress through the framework’s five phases.
Most African countries sit in phases two and three of the mortality transition framework, where mortality remains high to moderate, and the priorities are stronger integrated care around childbirth and better data systems. Kenya’s placement in phase three is consistent with high institutional delivery coverage alongside persistent gaps in the quality of intrapartum care and emergency obstetric readiness.
Kenya is strengthening bereavement care as part of respectful maternity and newborn services
The State of Africa’s Stillbirths report includes a Kenya country spotlight on bereavement care, an aspect of maternal health that rarely surfaces in policy discussions. Kenya is described as strengthening bereavement care as part of respectful maternity and newborn services, with counties leading practical innovations. Structured trainings are also building health workers’ confidence and communication skills. Facilities are designating bereavement champions who mentor colleagues. Peer support models are expanding through civil society organisations, including the TEARS Foundation Kenya.
Yet commitment on paper is not translating into accountability on the ground. The report’s analysis of 46 African countries finds that while 98 per cent include stillbirth prevention in national health strategies, only 44 per cent have set a measurable national stillbirth rate target.
Kenya is not named as one of only two African countries to have achieved the Every Newborn Action Plan (ENAP) stillbirth rate target.
Bereavement care is largely absent from national policy frameworks across the continent. Only 26 of 48 countries have integrated stillbirth into Maternal and Perinatal Death Surveillance and Response systems. The report describes this as a policy-implementation cascade: broad commitment at the top, sharply narrowing accountability at the bottom.
The financing picture is equally stark. Between 2002 and 2019, only 0.003 per cent of global aid for women, children, and adolescents specifically referenced stillbirths.
“Countries are counting stillbirths, but not consistently or in ways that fully support accountability or improvement,” said Dr Adeniyi Aderoba, Regional Adviser on Maternal and Perinatal Health at WHO Africa and Co-Chair of the Lancet Stillbirth Advisory Committee.
When stillbirth rates remain high, they reflect gaps in quality of care, emergency response
According to Dr Jean Kaseya, Director-General of Africa CDC, a health system that cannot prevent or count stillbirths lacks the foundational capacities needed to protect women, newborns, or communities, particularly during health emergencies.
“The report’s five-point call to action, commit and invest, capacitate health systems, count and learn, centre families and communities, and contextualise action, maps directly onto the gaps Kenya’s own Ministry of Health acknowledged at the IMNHC conference,” he said. “What the conference identified as quality gaps, the report names as stillbirth drivers. They are the same system. The same failures. And, the report insists, the same solutions.”
Dr Lucy Mazaba Mazyanga, Regional Director of the Eastern Africa Regional Coordinating Centre at Africa CDC, placed the challenge in its broadest context. “It is not only a maternal and newborn health issue, but a signal of system performance,” she said. “When stillbirth rates remain high, they reflect gaps in quality of care, delays in emergency response, shortages of skilled health workers, and weaknesses in data and accountability. These are the same gaps that undermine progress in maternal survival, newborn health, and broader system resilience. When we prevent stillbirth, we strengthen the entire system.”
Dr Aderoba was equally direct about the limits of evidence alone. “Real progress will depend on political commitment, sustained investment, and how countries and partners translate evidence into national policies, financing priorities and stronger health systems. This must be a multi-sectoral effort that leaves no woman and no baby behind, and no stillbirth unrecorded or unaddressed.”
