National Center for Health Statistics Activities to Understand Stillbirth

CDC’s National Center for Health Statistics (NCHS) estimates the number of stillbirths that occur nationally, and helps to improve the quality of the available data. Read about their efforts below.

Estimating the Occurrence of Stillbirth in the United States

Data about stillbirth are collected across the country on fetal death reports. Healthcare providers complete fetal death reports for fetuses who do not survive pregnancy, and then submit the reports to their state vital records office. States then share their data with the National Vital Statistics System (NVSS) located within NCHS at CDC. Through the NVSS, the NCHS collects annual national statistical data on all deaths and on fetal deaths of 20 or greater weeks of pregnancy (or stillbirths) occurring in the United States (all 50 states, District of Columbia, New York City and five U.S. territories). This process provides estimates of the number of stillbirths that occur in the United States.

Improving the Quality of Stillbirth Information

The Birth Data Quality Workgroup, a collaboration among the NCHS, the National Association of Public Health Statistics and Information Systems, and individual vital statistics programs is engaged in several efforts to improve the quality of data collected on stillbirth. Recent activities include

• Drop underperforming items: Researchers at NCHS reviewed data items for potential elimination from the national birth and stillbirth files due to reasons of poor data quality. This assessment resulted in dropping a number of items from the birth certificates, as well as from the report of fetal death.
• Develop training materials: NCHS recently launched the new e-learning training “Applying Best Practices for Reporting Medical and Health Information on Birth Certificates.” The training is designed for both clinical and non-clinical hospital staff and includes guidance on accurate reporting of fetal cause of death. NCHS collaborated with its state partners and the CDC Learning Connection’s E-learning design group to develop e-learning training for hospital staff (both administrative and clinical) to improve reporting of birth and stillbirth (fetal death) medical and health information. The e-learning training will be tied to the newly updated U.S. Standard Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death [614 KB / 50 pages].
• Identify best practices: NCHS and the National Association for Public Health Statistics and Information Systems (NAPHSIS) are developing recommendations for best practices, or standard ways of doing things, like collecting and reporting data, for state birthing facility reports and reviews. They are also identifying approaches to engage hospitals to improve the accuracy and completeness of reporting of birth and stillbirth (fetal death) information. The goal is to develop a national model that all vital records programs can use to improve birth and stillbirth data.
• Release new information: NCHS released the first national vital statistics report on fetal cause of death “Cause of Fetal Death: Data from the Fetal Death Report, 2014. [602 KB / 25 pages]”  This report presents data on cause of fetal death by maternal (age, race and Hispanic origin), and infant characteristics (sex, gestational age and birthweight).  View a micro-data file with cause of death information is also available.

Notable Accomplishments of NCHS Activities on Stillbirth

• Released national fetal death file for 2018: This file includes a wealth of demographic characteristics of the population, like age, and health information on mothers and their deliveries.
• Released fetal death data for 2014-2017 via the interactive data tool WONDER in early 2019. In addition to including national level fetal death data, WONDER also includes state level data, which are not available on public use files.
• Re-released 2015-2017 national fetal death data files in early 2019 to include cause of death data. In addition to including health and demographic information, these files include information on the cause of fetal death. Cause of death data for the years 2014-17 will be available via the interactive data tool WONDER in the future.
• Published the NCHS Data Brief “Lack of Change in Perinatal Mortality in the United States, 2014-2016,” August 2018. This report [510 KB / 8 pages] documents a lack of change in the perinatal mortality rate based on the obstetric estimate of gestational age measure from 2014 through 2016, similar to that based on the LMP based measure of gestational age from 2011 through 2013.