Exploring Multilevel Determinants of Stillbirth: A Comprehensive Analysis Across Sub-Saharan African Countries

ABSTRACT Background Stillbirths and associated outcomes remain a significant concern in Sub-Saharan Africa (SSA), with approximately 44% of global stillbirths. Methods Using Demographic and Health Surveys (DHS) data, this study examined determinants of stillbirth among women in 29 SSA countries. Our cross-sectional analysis included a weighted sample of women 15-49 years of age who had given birth or experienced stillbirth. We used bivariate analyses and multilevel logistic regression approaches. Findings Stillbirth prevalence was 319·06/1000 live births. Among individual-level factors, risk increased with age. Higher maternal education levels were significantly associated with decreased stillbirth risk. Single women had significantly lower odds of stillbirth compared to those who no longer lived together/separated from their partner. Contextually, women with a job had an increased risk compared to women without a job, and living in a rural residential area was a significant factor. Interpretation The complex interplay of individual-level factors and contextual factors influences stillbirth outcomes in SSA. Cross-sector holistic approaches to maternal and neonatal health are needed to address the multifaceted determinants of stillbirths. Funding There was no funding for the study. Evidence before the study The prevalence of stillbirth is higher in SSA compared to other regions. Factors influencing stillbirth are complex and include individual, household, and community-level factors. We searched PubMed and Medline with no language restrictions using the search terms (“stillbirth” AND “determinant” AND “Sub-Saharan Africa”). By 2023, no studies were published on the determinants of stillbirth in Sub-Saharan Africa. Earlier studies were conducted in the context of other countries without using the calendar method to calculate stillbirth or the national demographic dataset. Added value of this study The relative importance of risk factors for stillbirth in different SSA countries. Protective effect of household leadership dynamics on reducing stillbirth odds in SSA. Implications of all the available evidence Focused interventions to reduce stillbirths, such as promoting female household leadership and equity. Improving access to education and maternal health literacy. Public health initiatives to prioritize social and familial support for pregnant women to create environments conducive to positive pregnancy outcomes. Clinicians could promote pregnancy spacing and family planning to promote optimal maternal and child health, especially among women with higher parity. Healthcare policies for more investment and strengthening of maternal and child care services.