This document provides an analysis of perinatal death statistics in South Africa for 2015. Some key findings include: - There were 21,378 total perinatal deaths in 2015, comprised of 13,702 stillbirths and 7,676 early neonatal deaths. - The leading broad causes of perinatal death were fetus and newborn affected by maternal factors/complications of pregnancy/delivery (21.3%) and respiratory/cardiovascular disorders specific to the perinatal period (17.0%). - For stillbirths specifically, the top broad causes were fetus and newborn affected by maternal factors/complications (27.5%) and respiratory/cardiovascular disorders (4.

1. Perinatal Deaths
in South Africa,
2015
Findings from registered
deaths, 2015
Dr Pali Lehohla
Statistician-General
#StatsSA

2. Perinatal death defined
Perinatal deaths
§ are a combination of foetuses that are born dead (stillbirths) and babies that die in
the first week after birth (early neonatal deaths)
Stillbirth or foetal death
§ The intra-uterine death of a product of conception of at least 26 weeks of
pregnancy; the death is indicated by the fact that after complete birth, the foetus
does not breathe or show any evidence of life
Early neonatal death
§ Is the death of a live born-child during the first 7 completed days of life

3. Why perinatal deaths count
The National Development Plan 2030 aims to
improve maternal health, child survival; child
development and children’s standard of living.
National and Provincial Governments must use
information available about the perinatal deaths and their
distribution by age, sex, location and proportion
vulnerable in their policy formulations and planning for
improvements in:
• the decentralisation of government services
• the health of children and their mothers
• social protection and care of children

4. • The data allows us to better understand perinatal deaths in
South Africa and the rest of the provinces; reflects the state of
health of pregnant women, and women delivering stillbirths
and newborns that die.
• Quality of information on the perinatal deaths collected can be
improved through:
• Accurate and full completion of all fields on the death
notification form e.g. Information on mothers
• Correct and detailed information on causes of death e.g
stillbirths causes
Why perinatal deaths count

5. From deaths to statistics
Dr. verifies perinatal
death or Nurse only for
stillbirths & completes
death notification form
(DHA 1663)
1 2Submitted to DHA &
entered on population
register
3Stats SA receives the
form, code causes of
death using ICD-10,
process and analyse
Statistics
released
Perinatal
death occurs
Responsible for
registration of births and
deaths
Registration of perinatal deaths is
governed by the Births and Death
Registration Act No. 51 of 1992, as
amended
Form BI/DHA-1663

6. Results

7. Number of perinatal deaths, 2015
64%
13 702
Stillbirths
21 378
Total perinatal deaths
recorded in 2015
7 676
Early neonatal
deaths
36%

8. 5 982
11 969
13 702
5 702
11 019
7 676
25 310
21 378
5 000
10 000
15 000
20 000
25 000
30 000
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
NUMBEROFDEATHS
YEAR OF DEATH
Stillbirths Early neonatal deaths Perinatal deaths
Since 1999, the number
of stillbirths has been
higher than early
neonatal deaths
Number of registered stillbirths and early neonatal
deaths by year of death, 1997−2015

9. 7 003
12 787
11 275
5 847
10 866
9 062
3 000
6 000
9 000
12 000
15 000
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
NUMBEROFPERINATALDEATHS
YEAR OF DEATH
Male Female
Number of perinatal deaths by sex and year of
death, 1997−2015*
*Excluding deaths with unspecified sex
More male than
female perinatal
deaths
2015
55% 45%

10. 8 590
7 115
5 853
3 000
6 000
9 000
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
NUMBEROFSTILLBIRTHSDEATHS
YEAR OF DEATH
Male Female
Number of stillbirths by sex and year of death,
1997−2015*
2015
55% 45%
*Excluding deaths with unspecified sex
More male than
female stillbirths

11. 4 251
6 267
4 160
2 440
4 349
3 209
3 000
6 000 1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
NUMBER OF EARLY NEONATAL DEATHS
YEAR OF DEATH
Male Female
Number of early neonatal deaths by sex and year
of death, 1997−2015*
More male than
female early neonatal
deaths
*Excluding deaths with unspecified sex
2015
56% 44%

12. Provincial distribution recorded perinatal deaths - 2015
in South Africa,
2014
Unspecified: 0,1%
Outside of South Africa: 0,1%
Close to half of all perinatal deaths
recorded in South Africa were in
KwaZulu-Natal and Gauteng

13. Perinatal deaths as a percentage of total
infant deaths and stillbirths by province of death, 201558,6%
37,4%
53,5%
53,5%
57,4%
52,3%
55,7%
52,3%
48,9%
53,3%
WESTERN
CAPE
EASTERN
CAPE
NORTHERN
CAPE
FREE
STATE
KWAZULU-
ZULU
NORTH
WEST
GAUTENG MPUMA-
LANGA
LIMPOPO SOUTH
AFRICA
Perinatal deaths accounted for more than half of of infant deaths and stillbirths in 7 of the 9 provinces

14. Perinatal deaths as a percentage of total
infant deaths and stillbirths by district of death, 2015
• Perinatal deaths account for over 50% of infant deaths in 41 of the 52 districts
• Ranging from 17,2% in O.R Tambo to 74,0% in iLembe
Non-metro Rank Metros
iLembe 74,0% 1 eThekwini 67,1%
Sisonke 70,6% 2 City of Cape Town 64,8%
West Coast 69,6% 3 Ekurhuleni 62,4%
Eden 68,1% 4 Nelson Mandela Bay 55,4%
Amajuba 67,9% 5 City of Johannesburg 55,3%
Namakwa 67,8% 6 Mangaung 54,4%
uThungulu 66,6% 7 City of Tshwane 52,0%
Ugu 65,6% 8 Buffalo City 48,8%

15. Sex ratios of early
neonatal deaths, 2015
Sex ratios of
stillbirths, 2015
LP
130
MP
143
KZN
118
EC
125
FS
122
NW
145
NC
156
WC
139
GP
126
LP
113
MP
121
KZN
115
EC
124
FS
138
NW
121
NC
132
WC
115
GP
130
SA 122 male
per 100 female
stillbirths
SA 130 male
per 100 female early
neonatal deaths

16. Sex ratios at perinatal death, 2015
LP
120
MP
128
KZN
116
EC
124
FS
132
NW
131
NC
141
WC
122
GP
128South Africa
124 male per 100
female perinatal
deaths

17. Unadjusted perinatal mortality rates, 2015
Perinatal mortality rate 17,4 per 1 000 total births
Stillbirth rate 11,2 per 1 000 total births
Early neonatal rate 6,3 per 1 000 live births

18. Age at early neonatal death, 2015
Age in days
More than a third (37,6%) of
early neonates die on their
First and Only day of life

19. Population group of perinatal deaths, 2015
Population group
Stillbirths
Early neonatal
deaths
Perinatal deaths
N=13 702 N= 7 676 N= 21 378
Black African 77,8% 81,5% 79,1%
Coloured 1,3% 1,1% 1,2%
White 0,6% 0,6% 0,6%
Indian or Asian 6,2% 8,2% 5,8%
Other 0,2% 0,1% 0,2%
Unspecified 14,0% 11,4% 13,1%

20. Distribution of stillbirths by birth weight, 2015
Birth weight (grams) Number Percentage
Less than 1 000 2 298 16,8
1 000−1 499 1 898 13,9
1 500−1 999 1 690 12,3
2 000−2 499 1 403 10,2
2 500 and above 2 595 18,9
Unspecified 3 818 27,9
Total 13 702 100,0
53,2% of recorded stillbirths weighed less than 2,5kg

21. Overview of
mothers experiencing
perinatal deaths

22. Information on mothers based on new death notification
form
• The new death notification form:
• Contains a section on perinatal deaths with pertinent details of both the
mother and the child while the old form only contains information on the
child.
• Statistics are coded from what is recorded on the death notification form
• Analysis on mother information excludes high unspecified cases
• There is need for medical practitioners to fully and accurately complete
the mother’s section
• The new death notification form accounted for 96,7% (20 665) of the
21 378 perinatal deaths in 2015.

23. Percentage distribution of perinatal deaths by age
of the mother, 2015
*Excluding unknown/unspecified
0,3%
12,7%
24,9%
24,5%
19,6%
12,8%
4,7%
0,4%
0,1%
10-14 15−19 20−24 25−29 30−34 35−39 40−44 45−49 50−54
PERCENTAGEOFPERINATALDEATHS
AGE OF MOTHER
N= 8 458*
Almost half of perinatal deaths occur amongst mothers aged 20 to 29 years

24. Percentage distribution of mothers experiencing perinatal
loss by outcome of last previous pregnancy, 2015
68,5%
23,3%
6,5%
N = 5 225*
*Excluding unknown/unspecified
Stillbirth
More than two thirds of women who experienced perinatal deaths had a previous live birth

25. Percentage distribution of perinatal deaths
by delivery type, 2015
*Excluding unknown/unspecified
66,5%
76,7%
74,1%
29,5%
18,7%
21,5%
4,0%
4,6%
4,5%
EARLY NEONATAL DEATHS STILLBIRTHS PERINATAL DEATHS
Spontaneous Ceasarean section Other
N= 7 044*N= 5 233*N= 1 811*
Most perinatal deaths were delivered through spontaneous delivery

26. Percentage of perinatal deaths by mother’s attendant
at delivery, 2015
N= 10 281*
*Excluding unknown/unspecified
N = 10 281*6,0%
2,3%
51,3%
40,4%
Other (Traditional birth attendant/Family member)
Other trained person
Trained midwife
Physician
More than 90% of deliveries were attended by a healthcare worker

27. Causes of Stillbirths,
Early neonatal deaths &
Perinatal deaths

28. Proportion of perinatal deaths with Ill-defined causes
7676
13702
21378
1,1%
60,8%
39,4%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
5 000
10 000
15 000
20 000
25 000
Early neonatal deaths Stillbirths Perinatal deaths
Percentageill-defined
Numberofperinataldeaths
The high levels of ill-defined causes of deaths among stillbirths remain problematic

29. Main groups of underlying causes, 2015
Percentage of perinatal deaths
Almost all perinatal deaths were due to
‘certain conditions originating in the
perinatal period’

30. Top ten leading broad causes of perinatal deaths
1
Fetus and newborn affected by maternal factors
and by complications of pregnancy, labour and
delivery
21,3%
2
Respiratory and cardiovascular disorders
specific to the perinatal period
17,0%
3
Disorders related to length of gestation and fetal
growth
7,6%
4 Infections specific to the perinatal period 2,8%
5 Other congenital malformations 2,0%
6
Haemorrhagic and haematological disorders of
fetus and newborn
1,5%
7
Congenital malformations of the circulatory
system
0,7%
8 Congenital malformations of the nervous system 0,7%
9 Digestive system disorders of fetus and newborn 0,6%
10
Chromosomal abnormalities, not elsewhere
classified
0,4%
1
Fetus and newborn affected by maternal factors
and by complications of pregnancy, labour and
delivery
21,4%
2
Respiratory and cardiovascular disorders specific
to the perinatal period
16,8%
3
Disorders related to length of gestation and fetal
growth
7,3%
4 Infections specific to the perinatal period 2,8%
5 Other congenital malformations 1,9%
6
Haemorrhagic and haematological disorders of
fetus and newborn
1,6%
7 Congenital malformations of the nervous system 0,7%
7 Congenital malformations of the circulatory system 0,7%
9 Digestive system disorders of fetus and newborn 0,7%
10
Chromosomal abnormalities, not elsewhere
classified
0,5%
2014 2015
Fetus & fetal is spelt according to ICD-10 standards

31. Top 5 leading broad causes of death, 2015
Stillbirths
13 702 Stillbirths
1. Fetus and newborn affected by maternal
factors and by complications of
pregnancy, labour and delivery (27,5%)
2. Respiratory and cardiovascular
disorders specific to the perinatal period
(4,6%)
3. Disorders related to length of gestation
and fetal growth (3,7%)
4. Other congenital malformations (1,3%)
5. Congenital malformations of the
nervous system (0,6%)
The Top 5 broad
causes of stillbirths
represent
37,7%
of stillbirths cases
Fetus & fetal is spelt according to ICD-10 standards

32. Top 5 leading broad causes of death, 2015
Early neonatal deaths
7 676 early neonatal deaths
1. Respiratory and cardiovascular
disorders specific to the perinatal period
(38,5%)
2. Disorders related to length of gestation
and fetal growth (13,8%)
3. Fetus and newborn affected by maternal
factors and by complications of
pregnancy, labour and delivery (10,4%)
4. Infections specific to the perinatal period
(7,6%)
5. Haemorrhagic and haematological
disorders of fetus and newborn (4,2%)
The Top 5 broad
causes of death for
early neonates
represent
74,5%
of early neonatal
deaths
Fetus & fetal is spelt according to ICD-10 standards

33. South Africa top five underlying causes
of stillbirths, 2015
1
Fetus and newborn affected by maternal conditions that may
be unrelated to present pregnancy 14,1%
2
Fetus and newborn affected by complications of placenta,
cord and membranes 10,8%
3 Intrauterine hypoxia (Lack of Oxygen) 4,1%
4
Disorders related to short gestation and low birth weight, not
elsewhere classified 3,5%
5
Fetus and newborn affected by other complications of labour
and delivery 1,3%
N=13 702
Fetus & fetal is spelt according to ICD-10 standards

34. N = 7 676
South Africa top five underlying causes of
early neonatal deaths, 2015
1
Fetus and newborn affected by maternal conditions that
may be unrelated to present pregnancy 14,0%
2
Disorders related to short gestation and low birth weight,
not elsewhere classified 7,5%
3 Birth asphyxia (Brain lacking oxygen) 5,3%
4 Other conditions originating in the perinatal period 4,3%
5 Bacterial sepsis of newborn 4,0%
Fetus & fetal is spelt according to ICD-10 standards

35. South Africa top five underlying causes of perinatal
deaths, 2015
1
Fetus and newborn affected by maternal conditions that may
be unrelated to present pregnancy 11,2%
2
Fetus and newborn affected by complications of placenta, cord
and membranes 7,8%
3
Disorders related to short gestation and low birth weight, not
elsewhere classified 7,0%
4 Respiratory distress of newborn 5,1%
5 Birth asphyxia (Brain lacking oxygen) 3,4%
N = 21 378
Fetus & fetal is spelt according to ICD-10 standards

36. Where do perinatal
deaths occur?

37. 68,1%1,7%
Hospital
Emergency
Room
outpatient
0,9%
Dead on
arrival
3,5%0,4%
Nursing
Home
Distribution of perinatal deaths by place
of death occurrence, 2015
*Other, Unknown or Unspecified 25,5%
Home
Over two thirds of
perinatal deaths
occurred in a
hospital

38. Remarks

39. Summary
• Perinatal deaths decreased by 6,8% from 22 948 in 2014 to 21 378 in 2015.
• In 2015, the proportion of stillbirths was 64,1% (13 702) whereas early neonatal
deaths accounted for 34% (7 676) of all perinatal deaths.
• Overall, in 2015 there were:
• 17,4 perinatal deaths per 1 000 total births; 11,2 stillbirths per 1 000 total births
& 6,3 early neonatal deaths per 1 000 live births.
• The sex profile of perinatal deaths for 2015 shows more male than female perinatal
deaths.
• The sex ratio at death was 124 male deaths per 100 female perinatal deaths.
• All provinces had more male perinatal deaths, ranging from
• 116 (KwaZulu-Natal) to 141 (Northern Cape) male perinatal deaths per 100
female perinatal deaths
• Higher proportions of perinatal deaths in Gauteng and KwaZulu-Natal.

40. Summary
Leading causes show that:
For perinatal deaths:
• Fetus and newborn affected by maternal factors and by complications of
pregnancy, labour and delivery was the leading cause of perinatal deaths in
201
• Respiratory and cardiovascular disorders specific to the perinatal period 2nd
leading cause in 2015
For stillbirths & early neonatal deaths:
• Stillbirths: In 2015, Fetus and newborn affected by maternal hypertensive
disorders was the 1st leading cause of stillbirths.
• Early neonatal deaths: In 2015, Respiratory and cardiovascular disorders
specific to the perinatal period was the 1st leading cause of early neonatal
deaths.
Fetus & fetal is spelt according to ICD10 standards

41. The NDP and SDGs call for ending preventable deaths of
newborns and universal access to health care by 2030
Perinatal deaths show importance of:
Reducing
‘Scandal of
Invisibility’ of
perinatal deaths
• Perinatal deaths account for 56% of all infant
deaths
• High unspecified causes for stillbirths (61%)
• 69% unspecified antenatal care visits information
Investing in
maternal and
perinatal health
• High proportion of perinatal deaths can be
prevented
• Top causes:
N = 21 378
1. Maternal conditions unrelated to present pregnancy (11,2%)
2. Complications of placenta, cord and membranes (7,8%)
3. Short gestation and low birth weight (7,0%)
4. Respiratory distress (5,1 %)
5. Birth asphyxia (3,4%)

42. 2015 Data set on mortality and causes
of death is available on Stats SA
website or on request from Stats SA
Thank you