A major national study reveals nearly one in 150 pregnancies ends in stillbirth — a rate higher than previously reported — raising urgent questions about prevention efforts in South Dakota, where maternal mortality already reaches well above the national average.
The research, published Oct. 27 in the Journal of the American Medical Association, analyzed 2.8 million commercial insurance births from 2016 to 2022 and found 6.8 stillbirths per 1,000 births, according to researchers at Harvard T.H. Chan School of Public Health and Mass General Brigham. That exceeds the Centers for Disease Control and Prevention’s published rate of 5.74 per 1,000.
Why It Matters
South Dakota’s stillbirth rate of 6.19 per 1,000 births, based on recent data from Count the Kicks, a fetal movement awareness program, aligns with the national average. But the state faces compounding maternal health crises that make the study’s findings particularly relevant for South Dakota families.
The state recorded 79 pregnancy-related deaths from 2014 to 2023, representing 68.7 deaths per 100,000 live births — significantly higher than the national average, according to the South Dakota Department of Health. American Indian and Alaska Native women face a mortality rate of 184.6 per 100,000 births, compared to 39.0 for white mothers.
Risk Factors Often Absent
The JAMA study revealed that 27.7 percent of stillbirths occurred without any identifiable clinical risk factors — a finding that challenges current prevention strategies.
The research highlights the pressing need to improve stillbirth risk prediction and prevention, particularly given that stillbirths affect nearly 21,000 families each year in the United States and nearly half of those occurring at 37 or more weeks are thought to be preventable.
Among stillbirths occurring at 40 weeks or later, 40.5 percent had no identifiable risk factors, according to the study. The research examined 12 common risk factors including obesity, gestational diabetes, chronic hypertension, fetal growth restriction and decreased fetal movement.
Income and Racial Disparities
Stillbirth rates varied significantly by income and race, with one in 112 births ending in stillbirth in low-income areas and one in 95 births in areas with higher proportions of Black families compared to white families, the study found.
Rural Access Not a Factor
Stillbirth rates did not differ by rurality or measured access to obstetric care, even as South Dakota faces severe gaps in rural maternity care. The March of Dimes classified 56.1 percent of South Dakota counties as so-called “maternity care deserts,” compared to a national average of 32.6 percent.
The South Dakota Office of Rural Health confirms only 17 of the state’s 49 rural hospitals still provide labor and delivery care.
Federal Response
The National Institutes of Health launched a Stillbirth Research Consortium in September with more than $37 million in funding over five years to develop prevention tools and technologies.
The consortium will focus on unexplained stillbirths, which account for more than 60 percent of the nearly 24,000 annual U.S. cases, according to the NIH. People who experience stillbirth are nearly five times more likely to experience another stillbirth or pregnancy complication.
Recent CDC data shows the U.S. stillbirth rate dropped 2 percent in 2024 to 5.4 per 1,000 births — the lowest in decades but still far above rates in peer countries.
The South Dakota Department of Health’s Maternal Mortality Review Committee, which began reviewing cases in October 2021, examines all deaths of South Dakota residents occurring during pregnancy or within one year after delivery.
