Reduction of stillbirth rate in refugee and migrant populations living on the Thailand Myanmar border: A retrospective study 1986–2023

Abstract

Understanding the local causes of stillbirth is essential to providing safe care in pregnancy and birth. This study describes the rate and causes of stillbirth and identifies factors associated with stillbirth in the migrant and refugee population residing in border regions between Thailand and Myanmar. A retrospective review of medical records of all singleton pregnancies delivered or followed at antenatal clinics of the Shoklo Malaria Research Unit from 1986 to 2023, with a known outcome of pregnancy and estimated gestational age of 28 weeks and more. Multivariable logistic regression was performed to compare the factors between livebirths and stillbirths. During the 37 years period there were 65,101 singleton births including 721 stillbirths. The stillbirth rate decreased to a third of the initial rate from 26 per 1000 (49/1,904) [95% Confidence interval (CI): 19–34] in 1986–1990–8 per 1000 (66/7,790) [95% CI: 7–11] in 2020–2023. In 1986, 80% of births took place at home with the proportion declining significantly over time settling to 10–15% from 2012. Out of 721 stillbirths, 574 (79.5%) were classifiable. 26.0% (149/574) of those were designated as intrapartum and 74.0% (425/574) as antepartum stillbirth. Causal classification was possible for 67.7% (488/721) of stillbirths, with the top 3 causes being antepartum haemorrhage 26.0% (127/488), congenital abnormality 12.9% 63/488); and maternal infection 12.3% (60/488). It is possible to decrease the stillbirth rate in refugee and migrant populations despite intermittent conflict. Improving access to health clinics and skilled attendance at birth has the potential to reduce preventable stillbirths.