The stillbirth rate for Bhutan is 10 per 1,000 live births, which is lower than 16 per 1,000 live births estimated in a medical journal, Lancet Series 2015.

This is according to a retrospective study published in the recent Bhutan Health Journal.

Stillbirth is an important public health concern but there is no reliable stillbirth rate for Bhutan, the study states.

“Despite stillbirth rates being an important quality indicator of antenatal and obstetric care, attention by health systems for stillbirth is low,” it states.

However, with the launch of Bhutan every newborn action plan (2016 -2023) last year, the country has set a stillbirth rate target of 12.1 or fewer stillbirths per 1,000 live births by 2023.

“Without the baseline, it would be difficult to track the progress, and thus this study was critical to determine the stillbirth rate for Bhutan,” it states.

Officials with the health ministry’s public health department, Drugs Regulatory Authority and UNICEF country office carried out the study to estimate the stillbirth rate for Bhutan.

WHO defines stillbirth as a fetal death at gestational age at or after 28 completed weeks or weighing at least 1,000 grams or a crown-heel length of at least 35 centimetres.

The delivery registers of all 253 health facilities in the country in 2015 recorded a total of 11,126 live births and 108 stillbirths, which calculates to 10 stillbirths per 1,000 live births.

Of the total recorded live births, 5,514 were from the referral hospitals, 3,789 from district and other hospitals, 763 live births from Basic Health Unit (BHU) I, and 1,060 from BHU II.

Similarly, 52 stillbirths were from referral hospitals, 45 from the district and other hospitals, four and seven from BHU I and II respectively.

While WHO estimated a total number of 12,860 pregnancies and deliveries in 2015, maternal and child health record in the health facilities reported only 11,122 deliveries in the facility and attended at home. The study states that this indicates a possible gap with under-reporting.

According to the study, stillbirth rate for Bhutan was estimated to be 16 per 1,000 live births for 2015 based on regional estimates.

However, it states that it may not depict an actual picture because Bhutan has well-established primary health care, good antenatal care coverage and institutional and skilled birth attendant rate have drastically improved in the past years.

Another study, a hospital-based study with data from 2006 -08 estimates stillbirth rate at 17.72 per 1,000 live births. “The definition did not conform to that of WHO and hence its comparability.”

According to the study, the researchers observed incomplete data in institutional delivery records in some of the health facilities indicating the underreporting gaps, and stillbirths occurring at home were not tracked.

“True rate is inconclusive due to differences between estimated stillbirth rate and the one found from this study,” it states.

In order to find the true burden of stillbirths in the country, the study recommends institution of stillbirth surveillance and to improve the quality of existing data source with a special focus on stillbirths through periodic monitoring and supervision.

Dechen Tshomo