Estimating the timing of stillbirths in countries worldwide using a Bayesian hierarchical penalized splines regression model

Reducing the global burden of stillbirths is important to improving child and maternal health. Of interest is understanding patterns in the timing of stillbirths-that is, whether they occur before the onset of labour (antepartum) or during labour (intrapartum)-because stillbirths that occur intrapartum are largely preventable. However, data availability on the timing of stillbirths is highly variable across the world, with low- and middle-income countries generally having few reliable observations. In this paper, we develop a Bayesian penalized splines regression framework to estimate the proportion of stillbirths that are intrapartum for all countries worldwide. The model accounts for known relationships with neonatal mortality, pools information across geographic regions, incorporates different errors based on data attributes, and allows for data-driven temporal trends. A weighting procedure is proposed to account for unrepresentative subnational data. Results suggest that the intrapartum proportion is generally decreasing over time, but progress is slower in some regions, particularly Sub-Saharan Africa.