In many Nigerian communities, motherhood is celebrated as a woman’s ultimate fulfilment, and the birth of a child is met with immense joy and high expectations. However, when a woman gives birth to a stillborn child, the narrative shifts. Instead of receiving support and understanding, many women face stigma, societal blame, and emotional isolation, writes GODFREY GEORGE
Her pregnancy had stretched well into its tenth month, and Mrs Precious Okoro’s anxiety had reached its peak.
Her due date had passed nearly a month ago, yet the doctors insisted there was nothing wrong.
“They kept assuring me everything was fine,” she recalled, her voice laced with frustration. “But I had to keep pushing for another ultrasound, which they only agreed to reluctantly. This was my first pregnancy after three long years of trying, and I found it strange—no, unsettling—that it was now creeping into the eleventh month.”
But that wasn’t all. Okoro revealed that by the 35th week, she had stopped feeling her baby’s movements – a silence that sent waves of dread through her.
A typical pregnancy lasts about 40 weeks, calculated from the first day of a woman’s last menstrual period.
However, when a pregnancy extends beyond 42 weeks, it’s classified as post-term—a term that strikes fear into the hearts of expectant mothers.
According to Health Today, a trusted medical journal, pregnancies are divided into stages: early-term (37–38 weeks), full-term (39–40 weeks), late-term (41 weeks), and anything beyond 42 weeks, is deemed post-term, often leading to high-risk complications.
Despite slight variations, most pregnancies fall within the expected 40-week timeline.
Okoro’s pregnancy, however, was dangerously approaching its 44th week—an alarming outlier. Overwhelmed by growing concerns, she sought a second opinion at a government facility in Edo State, where she was immediately scheduled for an urgent caesarean section.
The doctors confirmed the unimaginable: the fetus had been lifeless for weeks and was likely beginning to decompose.
“They were shocked I was still alive and had no complications. A dead baby in my womb for weeks? It’s a miracle I survived,” Okoro recalled in disbelief.
After the procedure, she remained at the hospital for days, unable to bring herself to return home, despite being cleared for discharge.
“It wasn’t my first pregnancy. Before this, we had experienced three miscarriages, but none of them had dragged on this long. I felt ashamed.”
“My mother stayed by my side, urging me to go home, but I didn’t want to,” Okoro recalled, her voice filled with sadness. “My husband only visited once—on the day of the evacuation. When I got home, I found him lounging in the living room, his legs propped up on the centre table, watching the news. He greeted me casually and carried on as if I wasn’t even there.”
This moment marked the beginning of a breakdown in their communication. Months later, in October 2012, Okoro became pregnant again.
“At a routine check-up, they said I was three weeks along. I told my husband, and for a brief time, things seemed to improve at home,” she said. But as her due date approached, complications began to emerge.
“I had palpitations, fainting spells, and nightmares about losing my baby. I ended up moving into the hospital, and while the doctors reassured me that everything was fine, I couldn’t shake the overwhelming fear,” she recalled.
On the day of delivery in July 2013, Okoro’s doctor was unavailable, but the contractions left her with no choice but to proceed. Tragically, her daughter was stillborn.
“I cried as it my life depended on it. I thought I was going to die. I wanted to end it all,” she said, her grief palpable.
When she returned home, her mother-in-law, sisters-in-law, and a pastor welcomed her with prayers, but her pain lingered an unspoken weight. Despite vowing never to conceive again until fully ready, Okoro became pregnant again within just two months.
“That pregnancy ended in another miscarriage at four months. It wasn’t until 2016 that I gave birth to my twins, and we decided to close the chapter of childbearing,” she said.
Asked what might have caused her stillbirths, she said, “The doctors mentioned rhesus factor and other risks, but I was too traumatised to retain much. My focus was on how to have a child of my own.”
Although Mrs Okoro was fortunate to eventually have a set of twins after enduring multiple stillbirths, Mrs Miriam (surname withheld) faced a different reality, one marked by unending heartbreak.
She has endured three stillbirths and has now resolved to pursue surrogacy, unable to bear the trauma any longer. Her journey began before her wedding day—May 7, 2016—a date moved forward from their original December plans due to her pregnancy.
Miriam described her first trimester as harrowing.
“I felt an unrelenting heat in my stomach, as though it was boiling. Even in air-conditioned rooms, I’d sweat profusely. Chewing ice cubes offered fleeting relief, but the heat would return, leaving my skin flushed and red,” she recounted.
Despite taking doctor-prescribed medications, the symptoms persisted. Then, one November night, her world crumbled.
“I felt a sharp pain, like contractions. My husband was away, so I called my younger brother and a neighbour. They rushed me to the hospital. It was two weeks before my due date, but the doctors said it was normal. In the delivery room, we fought for over 45 minutes to save my baby, but the doctors eventually told me the baby had died. It was my first pregnancy. I never expected it,” she said.
Since then, Miriam has lost two more pregnancies. Now, she has decided she’s had enough.
“My husband and his family have begged endlessly, but it’s my body. I can’t keep going through this trauma. Three times is enough to drive any woman insane. I won’t risk losing my sanity,” she said, resolute in her decision.
Burden of stillbirths
Stillbirths, defined as the death of a fetus at 20 weeks of gestation or later, result from complex and preventable factors.
Studies into stillbirth and post-traumatic stress disorder at St George’s Hospital, London, for example, defined stillbirth as a loss after 18 weeks of gestation rather than using the United Kingdom’s classification of stillbirth as a loss after 24 weeks.
According to the United Nations International Children’s Emergency Fund in a November 23, 2020 article, “Hidden Tragedy: Nigeria accounts for one of the highest stillbirth rates in Africa,” one stillbirth occurs every 16 seconds.
The vast majority of stillbirths, 84 per cent, occur in low- and lower-middle-income countries, according to the report A Neglected Tragedy: The Global Burden of Stillbirths. In 2019, three in four stillbirths occurred in sub-Saharan Africa or Southern Asia.
Nigeria accounts for one of the highest stillbirth rates on the African continent. It is one of six countries that bear the burden of half of all stillbirths globally, alongside India, Pakistan, the Democratic Republic of the Congo, China, and Ethiopia.
Between 2000 and 2019, Nigeria reported a 15 per cent increase in the number of stillbirths. It is estimated that the total number of stillbirths in Nigeria in 2019 was 171,428.
A stillbirth is defined in the report as a baby born with no signs of life at 28 weeks of pregnancy or more.
At a global conference in October on “Ending Preventable Stillbirths: A Renewed Call to Action,” the then health minister, Dr Osaghie Ehanire, said, “The need for awareness of stillbirths in Nigeria cannot be overemphasised…Stillbirths have been overlooked as a global public health challenge, despite the fact that useful preventive measures could easily augment maternal and newborn health interventions to limit their occurrence.”
Nigeria has the second-highest rate of stillbirths in the world, with 42.9 per 1,000 births. The government has set a target of reducing this to 27 per 1,000 live births by 2030.
The Minister noted that achieving this goal would require a multipronged approach and multisectoral collaboration—particularly with the education sector, which plays a vital role in shaping the health-seeking behaviour of women and adolescents.
“Losing a child at birth or during pregnancy is a devastating tragedy for a family, one that is often endured quietly, yet all too frequently, around the world,” said Henrietta Fore, UNICEF Executive Director.
“Every 16 seconds, a mother somewhere will suffer the unspeakable tragedy of stillbirth. Beyond the loss of life, the psychological and financial costs for women, families, and societies are severe and long-lasting. For many of these mothers, it simply didn’t have to be this way. A majority of stillbirths could have been prevented with high-quality monitoring, proper antenatal care, and a skilled birth attendant.”
The global stillbirth report warns that the COVID-19 pandemic could worsen the global number of stillbirths. A 50 per cent reduction in health services due to the pandemic could cause nearly 200,000 additional stillbirths over a 12-month period in 117 low- and middle-income countries, including Nigeria. This would lead to an 11.1 per cent increase in stillbirths. According to modelling done for the report by researchers from the Johns Hopkins Bloomberg School of Public Health, 13 countries could see a 20 per cent increase or more in the number of stillbirths over 12 months.
Most stillbirths are due to poor-quality care during pregnancy and birth. The report highlights the lack of investment in antenatal and intrapartum services and the need for strengthening the nursing and midwifery workforce as key challenges.
“While the high number of stillbirths in Nigeria is a huge loss, we must remember that every single one is an individual tragedy, one that reaches far beyond the loss of life for the family concerned,” said Peter Hawkins, UNICEF Representative in Nigeria.
“Each stillbirth has a traumatic and long-lasting impact on women and their families, who often endure profound psychological suffering and stigma in their communities. Perhaps even more tragically, the majority of these deaths could have been avoided with high-quality care before and during birth.
“More than 40 per cent of all stillbirths occurred during labour—a loss that could be prevented with improved monitoring and access to emergency obstetric care when needed,” said Peter Hawkins.
Around half of stillbirths in sub-Saharan Africa and Central and Southern Asia occur during labour, compared to just 6 per cent in Europe, Northern America, Australia, and New Zealand. In Nigeria, more than 50 per cent of stillbirths occur during the intrapartum and delivery period.
Even before the COVID-19 pandemic caused critical disruptions in health services, UNICEF noted, that few women in low- and middle-income countries received timely and high-quality care to prevent stillbirths.
“Half of the 117 countries analysed in the report have coverage that ranges from a low of less than two per cent to a high of only 50 per cent for important maternal health interventions such as C-section, malaria prevention, management of hypertension in pregnancy and syphilis detection and treatment.
“Coverage for assisted vaginal delivery – a critical intervention for preventing stillbirths during labour – is estimated to reach less than half of pregnant women who need it.
“As a result, despite advances in health services to prevent or treat causes of child death, progress in lowering the stillbirth rate has been slow,” it noted.
The UNICEF report also stated that from 2000 to 2019, the annual rate of reduction in the stillbirth rate was just 2.3 per cent, compared to a 2.9 per cent reduction in neonatal mortality, and 4.3 per cent in mortality among children aged one to 59 months.
“Progress, however, is possible with sound policy, programmes and investment,” it added.
For UNICEF, stillbirth is not only a challenge for poor countries.
In 2019, 39 high-income countries reported a higher number of stillbirths than neonatal deaths, and 15 countries had a higher number of stillbirths than infant deaths. A mother’s level of education is one of the greatest drivers of inequity in high-income countries concerning stillbirth rates.
According to Nigeria’s Health and Demographic Survey 2018, stillbirths are more prevalent in the North West and North Central geopolitical zones—regions where adult female literacy is low, ranging from 4.5 per cent in the North West to 6.2 per cent in the North East and 20.4 per cent in the South West.
A study published by 11 researchers on December 30, 2019, in BMC Pregnancy and Childbirth (Volume 19), titled “Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study,” revealed that in 2015, Nigeria’s estimated 317,700 stillbirths accounted for 12.2 per cent of the 2.6 million estimated global stillbirths. This suggests that Nigeria continues to make a substantial contribution to the global burden of stillbirths. The study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria.
The researchers—Friday E. Okonofua, Lorretta Favour C. Ntoimo, Rosemary Ogu, Hadiza Galadanci, Gana Mohammed, Durodola Adetoye, Eghe Abe, Ola Okike, Kingsley Agholor, Rukiyat Abdus-salam, and Abdullahi Randawa—conducted a cross-sectional study of all deliveries over six months in six general hospitals (four in the south and four in the north) and two teaching hospitals (both in the north). They found that there were 4,416 single births and 175 stillbirths, with a mean stillbirth rate of 39.6 per 1,000 births (range: 12.7 to 67.3 per 1,000 births) across the hospitals.
Of these, 22.3 per cent were antepartum (macerated) stillbirths, 47.4 per cent were intrapartum (fresh) stillbirths and 30.3 per cent were unclassified.
Acute hypoxia accounted for 32.6 per cent of the stillbirths. Other causes were maternal hypertensive disease (6.9 per cent), and intrapartum unexplained (5.7 per cent), among others.
After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery.
What causes stillbirths?
A medical practitioner, Dr Festus Akiomon, said key causes include antepartum (before labour) complications such as maternal hypertensive diseases, antepartum haemorrhage, infections, and fetal growth restrictions.
“Congenital malformations and unexplained factors also play roles,” he added.
Akiomon also noted that intrapartum (during labour) stillbirths, often referred to as fresh stillbirths, primarily result from hypoxia (oxygen deprivation), preterm labour, infections, or trauma during delivery.
“Instrumental deliveries, like forceps or vacuum-assisted births, increase risks when mismanaged.
“Risk factors include poor antenatal care, referrals from unorthodox settings (traditional birth attendants), multiparity (multiple pregnancies), previous stillbirths, low birth weight, and early gestational deliveries,” he noted.
First stillbirth at 25
For 25-year-old Deborah, a cleaner based in Calabar, Cross River State, getting pregnant before marriage was not in the plan.
However, the young lady said she met a man, who promised to marry her, not knowing that he had a family based in Port Harcourt, Rivers State.
The cleaner was already in her third month when she realised the man had been lying to her, and this broke her heart.
Deborah had already fought with her mother, who had advised her against living with a man who had yet to pay her bride price.
Going back home with a pregnancy for a married man was the last thing she thought of doing. But, she had to.
The cleaner went back home to her mum, though she failed to reveal being pregnant.
“I didn’t tell her. I had a room that my dad allocated to me when he shared some rooms for his children. I went in there, cleaned it up, and made sure I was mostly indoors. I also wore oversized clothing to hide the pregnancy. But my mother, being who she was, called me one day and asked me if I was sick.
“She must have seen that my face was swelling and my breasts had become suppler. I lied and ran away from home for a few days, but I returned and locked myself back in.”
“I knew the baby wasn’t feeding well because I wasn’t eating well to get the required nutrients. The shame of admitting to my mother that the same man she had warned me not to live with was the one who got me pregnant was eating me up. I would spend hours thinking at night and I wouldn’t sleep. I also noticed once that I was spotting, but I paid no attention to it.
“I also refused to register for antenatal care, even after my mother got to know and begged me to do so. The shame was just too much. I have three other sisters whom I was supposed to be a good example to, and I just couldn’t face them. I was also drinking lots of alcohol because I was feeling too much pain around my waist, and the man who was responsible for the pregnancy was nowhere to be found.
“Although I didn’t tell my mother he was responsible, I’m sure she figured it out, because we were both living together, and she had visited the house once to ask me to come back home, but I refused,” Deborah said.
Speaking to our correspondent, her mother, Mercy, said she was in her room one Monday night when two women, who were her tenants came knocking and shouting that Deborah was in labour.
She ran out almost unclad and saw her daughter soaked in water.
“I saw that her water had broken, but I wasn’t sure why because from my own assessment, she wasn’t due,” Mercy said.
Mercy said the women rushed Deborah to a nearby private clinic in a tricycle.
“I didn’t join them. I was trying to contact her father on the phone to let him know what was going on when I got a call from one of my daughters who had accompanied Deborah, saying she had given birth in the tricycle. She just said something dropped from Deborah’s inside. I knew it was the baby. They were already in front of the clinic, as I learned, and she was rushed in. The doctors confirmed that the birth was premature and that the child had died in her womb days before.
“The heartbreak I felt, I’m not sure I’ve ever felt it before. I gave birth to five children, and all of them are alive, so I don’t know why my own daughter would lose her first child in such a manner. Somehow, I blame myself for what happened. I should have protected her. I should have stood by her. I failed her,” she cried
Psychological impact
The death of a baby due to stillbirth is a tragic event for mothers, fathers, siblings, and the wider family.
Researchers and clinicians studying the psychological outcomes after stillbirth highlight the emotional and health risks that follow.
Some research focused more on the social environment and support, role identity, and aspects associated with disenfranchised grief. Other studies, though fewer, have explored the economic cost of stillbirth, which includes a person’s potential lifetime contribution to the economy.
Fox et al., for instance, found a conservative annual burden of child death to be US$1.6bn in the United States of America alone, whereas Malacrida, another researcher, noted a macroeconomic cost of perinatal death to society.
This is not due to lost labour and productivity, but because the lack of societal recognition of perinatal death makes mothers vulnerable to mental, emotional, and social health risks, which contribute to a global financial burden.
According to the health journal Elsevier, in its June 2017 issue of Seminars in Fetal and Neonatal Medicine (Volume 22), the conflation of categories in previous research, along with differing international classifications of stillbirth—some countries categorising by weight and others by gestational age—means that while this review focuses on stillbirth, it also includes international perinatal death studies, which encompass neonatal deaths.
In an article by Tosin Popoola, Joan Skinner, and Martin Woods, titled, ‘Exploring the Social Networks of Women Bereaved by Stillbirth: A Descriptive Qualitative Study’, published on PubMed Central, it was noted that the loss of a baby to stillbirth is a deeply traumatic and devastating experience for women.
However, women do not simply lose a baby when they experience stillbirth.
According to them, when a child is lost to stillbirth, women often lose their emerging social status as an ‘expecting mother’, leading to shame and low self-esteem.
“The experience of shame after stillbirth often leads to social withdrawal, loneliness, and relationship deterioration, which may lead to prolonged or complicated grief,” they noted.
This is true of Deborah’s case. Asked how she feels about her experience, she said, “I honestly don’t know. A part of me feels overwhelming shame and guilt that I killed my own child. The other part is a feeling of not being capable of carrying my own child full term. I have not been able to fully process it all to this point since it happened in March this year.”
Generally, bereaved people experience changes in their social networks, and this is no different for mothers of stillborn babies.
However, in stillbirth bereavement, mothers may feel unsupported and isolated, research has shown.
As a result of social withdrawal due to stigma, women’s social networks may become smaller, disconnected, or under-resourced and their family may emerge as the primary source of support.
However, the social ramifications of stillbirths, Popoola et al noted, extend beyond the family.
“Even if the family was supportive, the bereaved mother would need others outside the family to successfully reintegrate back into society,” they noted.
A psychologist, Dr Usen Essien, on his part, noted that stillbirths were a significant public health problem.
“In 2019 alone, 171,428 babies were stillborn in Nigeria. Dated but important studies on perinatal loss in Nigeria suggest that social support protects against depression and anxiety. However, social norms have also been reported to prevent new social relationships after stillbirth in Nigeria.
“For example, research suggests that Nigerian women have little to no opportunities to connect with their social networks after stillbirth due to the absence of rituals and funerals for stillborn babies,” he noted.
Essien further advised families that have women who have experienced stillbirths to be kind to them, go closer to them, and try to make sure they don’t raise the topics in everyday conversations.
“That feeling of inadequacy or loss is paramount for these women, and all they need is support and not judgment,” he added.
A women’s and child’s rights advocate, Mrs Mercy Chepaka, noted that women who have had stillbirths should not be looked down upon or seen as less of a woman or mother.
“They are mothers. The fact that they lost their babies for whatever reason does not deny them the status of motherhood, and Nigerians, especially women need to be kinder to them, show them support and make sure they are seen and included in social activities and are not isolated because of their experiences. This is what leads to depression and may lead to suicide,” she added.