Clarifications regarding Singapore’s stillbirth and perinatal mortality rates

The Ministry of Health (MOH) is aware of online speculation about a rising trend in Singapore’s stillbirths and perinatal mortality in 2022 and 2023, and would like to clarify that our stillbirths and perinatal mortality rates remain low and stable.

The definition of a stillborn child was changed when the Registration of Births and Deaths Act 2021 (RBDA 2021) was amended. The stillbirth threshold was changed from “after the 28th week of pregnancy” to “after the 22nd week of pregnancy”, to align with the World Health Organization’s International Classification of Diseases statistical reporting guidelines. This definition was brought into force on 29 May 2022.

Arising from this definitional change, there was an increase in the number of stillbirths reported in 2022 and 2023. To aid in the interpretation of the data, the amendment to the definition of a stillborn child was clearly stated alongside reported data, in Note 4 of the Immigration and Checkpoints Authority (ICA)’s Singapore Demographic Bulletin Report (SDB Report) Q4 Oct-Dec 2023, as well as in Explanatory Note 22 and footnote 8 of the Report on Registration of Births and Deaths (RBD Report) 2023. Both reports are published on the ICA website.

Earlier this year, the RBDA 2021 was further amended to change the stillbirth threshold from “after the 22nd week of pregnancy” to “after the 24th week of pregnancy”. This amendment was made following feedback to remove any potential confusion regarding foetal viability by aligning the stillbirth threshold with the cut-off for abortions in the Termination of Pregnancy Act 1974, which allows a foetus no more than 24 weeks to be aborted, after which, an abortion is only allowed due to medical exigencies. This definition of stillborn child was brought into force on 16 April 2024.

Overall, the stillbirth and perinatal mortality rates in Singapore continue to compare well with other high-income countries globally. To illustrate this point, the number of stillbirths after the 28th week of pregnancy (i.e. using the previous definition of stillborn child) has remained stable (Figure 1). Similarly, when the previous definition of stillborn child is applied to perinatal mortality (which refers to deaths of infants under one week of age and stillbirths) and perinatal mortality rates, the baseline trend of stillbirths and perinatal mortality remains stable (Figure 2).

It is inaccurate and misleading to compare the number of stillbirths before and after the changes to the definition of stillborn child, without the appropriate contextual information that was provided. ICA will continue to include footnotes and explanatory notes in both SDB and RBD reports on the definitional changes, alongside reported data on stillbirths and perinatal mortality, to contextualise data interpretation. We urge the public to avoid speculation and to verify information found on the Internet against authoritative sources.

Annex

Figure 1. Stillbirth and Stillbirth Rate from 2003 to 2023, based on a 28-week threshold

Figure 2. Perinatal Mortality and Perinatal Mortality Rates from 2003 to 2023, based on a 28-week threshold