Silent cries: The overlooked pain and grim reality of stillbirths

When Grace Mwashighadi stepped into a maternity ward, she eagerly awaited the cry of her baby.

Instead, she was met with silence, an absence filled with the unknown. She had a stillbirth.

“The longest walk I have ever taken was leaving a hospital three times without a baby,” says Mwashighadi, a global health specialist and co-chair of the Lancet Stillbirth Advisory Committee.

Too often, she reflects, the experience of stillbirth is met with silence, and health systems are ill-prepared to support grieving families.

“A lot of the time, people did not know how to manage my grief or how to support me. I distinctly remember how isolating that silence felt.”

Mwashighadi shared her experience at the recently concluded International Maternal and Newborn Health Conference 2026, an account that echoes the reality endured by thousands of women across Kenya and the African continent.

For 20-year-old Melan Nafula, grief has become a painful pattern. Her heart remains heavy with loss.

After enduring prolonged labour, a ruptured uterus, emergency surgery and a blood transfusion, she lost her baby. Again.

“This is my third baby to die,” she says in despair. “I feel empty. Carrying a pregnancy to term, only to have a stillbirth,” Nafula tells The Standard from her hospital bed at Pumwani Maternity Hospital.

“I carry pregnancies to term, but I never get to enjoy motherhood,” she says. “I am scared of conceiving. How can I, when I keep losing my babies? I even fear for my life.”

Mwshighadi and Nafula cases are not isolated. They mirror thousands of others across Kenya and the continent, where women walk into delivery rooms full of hope, only to leave with empty arms.

Yet their grief often remains invisible, unspoken, undocumented and unaddressed.

According to the first-ever continental report titled “State of Africa’s Stillbirths”, a baby is stillborn in Africa every 30 seconds.

Globally, an estimated 1.9 million late-gestation stillbirths were recorded in 2023, nearly one million of them in Africa.

Half of these deaths occur during labour, often within health facilities, signalling critical gaps in the quality of care at the moment when both mother and child are most vulnerable.

Three-quarters of stillbirths recorded in 2023 occurred in Western and Eastern Africa, with more than half concentrated in a handful of countries, including Nigeria, the Democratic Republic of Congo (DRC), Tanzania and Sudan.

Yet despite the scale, stillbirth remains one of the most overlooked tragedies in maternal and newborn health.

“Africa’s intrapartum stillbirth rate is more than 40 times higher than that of Europe. While some countries have made progress, overall gains have been slow, with the continent recording nearly the same number of stillbirths today as it did in 2000,” read part of the report.

Weaknesses exposed

According to the report, launched in Nairobi during the global maternal and newborn conference, an estimated five million stillbirths could occur in Africa between 2026 and 2030 without urgent intervention.

“Stillbirths expose weaknesses in quality of care, surveillance and emergency readiness,” says Adeniyi Aderoba, Regional Adviser for Maternal and Perinatal Health at the World Health Organisation (WHO) Africa Region and co-chair of The Lancet Stillbirth Advisory Committee.

Unlike other health indicators, stillbirths are often missing from policy priorities, financing frameworks and accountability systems.

In many communities, stigma and cultural beliefs deepen the silence.

“In some parts of Africa, stillbirth is associated with misfortune or even witchcraft,” Aderoba explains. “This discourages families from speaking about their loss or seeking support.”

In Nigeria, he adds, a mother leaving the hospital carrying a black nylon bag silently signals the loss of a baby.

“When people see you leaving the hospital with that bag, the message is loud,” he says.

The report notes that progress in reducing stillbirths is stalling across Africa, with only South Africa and Tanzania having met Every Woman, Every Newborn, Everywhere (Ewene) targets on eliminating preventable stillbirths.

The initiative is a global maternal and newborn health framework designed to accelerate action and hold countries accountable for reducing maternal and newborn deaths, aligning with the WHO.

Stillbirths, according to the report, expose weaknesses in quality of care, surveillance, and emergency readiness, which are the same system capacities required to protect populations during outbreaks, crises, and routine care.

The Africa-led report, developed by more than 80 experts from over 20 countries, provides the first continent-wide stocktake dedicated exclusively to stillbirths and issues a strong call to action.

It aims to strengthen Africa’s capacity to prevent, detect and respond to health threats through resilient, self-reliant health systems.

In Kenya, the stillbirth rate stands at 16 per 1,000 births, against the Sustainable Development Goal target of fewer than 12 per 1,000.

Ministry of Health data indicate that anaemia is the leading cause of stillbirth in the country.

Loise Nyanjau, head of maternal health at the ministry, explains that “stillbirth is a condition where a foetus is born dead or dies in the womb before delivery”.

She notes that causes are varied, ranging from maternal health conditions during pregnancy to environmental factors surrounding delivery.

Dr Kireki Omanwa, a consultant obstetrician-gynaecologist and president of the Kenya Obstetrical and Gynaecological Society (KOGS), adds that stillbirth is often triggered by multiple risk factors.

These include weak health systems, delays in accessing care and delays within facilities due to shortages of skilled personnel and essential medical supplies. 

Stillbirth can also result from clinical complications, such as reduced foetal movement that goes unnoticed.

“We see pregnant women who come to the hospital and, when asked when they last felt the baby move, they say, ‘daktari, alicheza kama siku mbili zimepita’,” says Dr Kireki.

“When asked why they did not seek care immediately, they say they thought the baby was simply resting. By then, it is often too late.”

Conditions such as gestational diabetes and hypertensive disorders during pregnancy can also lead to stillbirth. These affect the baby’s growth and oxygen supply, sometimes with fatal consequences.

Umbilical cord complications, including cord knots or entanglement around the neck, can also cut off oxygen supply to the foetus. 

Dr Kireki explains that a baby is connected to the mother through the placenta and umbilical cord. While in the womb, the foetus receives oxygen and nutrients from the mother through the umbilical cord. However, at times, the baby may turn, tightening the cord around its neck and cutting off oxygen, which can result in death.

Beyond clinical causes, structural barriers also play a role.

“A mother may decide to seek care, but poor roads, lack of transport or insecurity prevent her from reaching a facility in time. By morning, when it is safe enough to walk to the hospital, the baby may already be gone,” says Dr Kireki.

Ewene framework

Despite the grim statistics, efforts are underway to reduce stillbirths and improve maternal and newborn health.

Kenya has adopted the Ewene framework, a global initiative aimed at accelerating progress and strengthening accountability.

The strategy emphasises access to quality antenatal care, skilled birth attendance and postnatal care.

“Poor nutrition is a major contributor to anaemia, which in turn increases the risk of stillbirth. We are scaling up efforts to improve maternal nutrition and ensure healthy pregnancies,” says Nyanjau.

The government is also working with Community Health Promoters to provide education and support from preconception through pregnancy and after delivery. 

“Quality care is critical at every stage,” she says. “Any woman planning a pregnancy should engage with a healthcare provider early.”

Digital health systems are also being rolled out to improve data collection and tracking of maternal and newborn outcomes.

UNICEF is among the partners supporting the Kenyan government to strengthen antenatal care services and increase demand for clinic attendance through group ANC models.

Dr Laura Oyiengo, a maternal and newborn health specialist, says the organisation is focused on improving care during pregnancy, labour and delivery.

This includes training health workers in emergency obstetric care, equipping facilities with essential supplies and promoting Maternal and Perinatal Death Surveillance and Response (MPDSR).

“We are also strengthening perinatal death audits to ensure that every stillbirth is reviewed and lessons are learned,” says Dr Oyiengo.

She emphasises the importance of preparation before pregnancy.

“Women should seek preconception care and be screened for any conditions that may affect their pregnancy,” she says.

She also encourages early and consistent antenatal care.

Antenatal care

WHO recommends at least eight ANC visits, yet the majority of women attend only four.

In addition, Dr Oyiengo encourages women to develop a birth plan, including identifying a health facility, arranging transport and sharing the plan with a partner or family member.

Nevertheless, she cautions pregnant women against self-medication, urging them to seek care from qualified health professionals whenever they feel unwell.

The government is also leveraging digital systems to improve the collection of data on stillbirths, as well as maternal and newborn outcomes, for planning purposes.

With devolved healthcare, counties are expected to adopt digital systems to enhance efficiency.

“The pregnancy journey should be smooth, and all mothers are entitled to respectful maternal care. Any woman planning a pregnancy should engage with the health system in her area and consult a qualified healthcare provider for guidance,” emphasises Nyanjau.

While much focus is placed on preventing stillbirths, experts say support after loss is equally critical.

“Most of the time, we do not think about what happens after a stillbirth,” says Dr Kireki, noting that once a mother is clinically stable, the emotional impact of the loss is often overlooked.

“We say, ‘you will have another baby, but this is not the right approach. This was a baby. The grief is real,” he adds.

He advocates for counselling and psychosocial support to help mothers process their loss and express their emotions.

According to Dr Kireki, simple acts—such as allowing a mother to name the baby and participate in related rites and ceremonies—can aid healing.

“We need to support the mother because she has been carrying the baby for months, and suddenly the baby is no longer there. It is not something one can simply switch off. The loss comes with trauma, and even in future pregnancies, there will be fear that it could happen again,” he says.

In response, Nyanjau notes the provision of bereavement packages, through which mothers and their families are linked to psychosocial care within health facilities, with psychologists and Community Health Promoters guiding them through the grieving process.