Stillbirth mortality by Robson ten-group classification system: A cross-sectional registry of 80 663 births from 16 hospital in sub-Saharan Africa

Claudia Hanson, Karolinska Institutet, Stockholm, Sweden
Kristi Sidney Annerstedt, Karolinska Institutet, Stockholm, Sweden
Maria Del Rosario Rosario Alsina, Karolinska Institutet, Stockholm, Sweden
Muzdalfat Abeid, Aga Khan University,Tanzania
Hussein Kidanto, Aga Khan University
Helle Mölsted Alvesson, Karolinska Institutet, Stockholm, Sweden
Andrea B. Pembe, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
Peter Waiswa, Makerere University, Kampala, Uganda
Jean-Paul Dossou, Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
Tumbwene Mwansisya, Aga Khan University



To assess stillbirth mortality by Robson ten-group classification and the usefulness of this approach for understanding trends.

Design Cross-sectional study.

Setting Prospectively collected perinatal e-registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda.

Population All women aged 13–49 years who gave birth to a live or stillborn baby weighting >1000 g between July 2021 and December 2022.


We compared stillbirth risk by Robson ten-group classification, and across countries, and calculated proportional contributions to mortality.

Main outcome

Measures Stillbirth mortality, defined as antepartum and intrapartum stillbirths.


We included 80 663 babies born to 78 085 women; 3107 were stillborn. Stillbirth mortality by country were: 7.3% (Benin), 1.9% (Malawi), 1.6% (Tanzania) and 4.9% (Uganda). The largest contributor to stillbirths was Robson group 10 (preterm birth, 28.2%) followed by Robson group 3 (multipara with cephalic term singleton in spontaneous labour, 25.0%). The risk of dying was highest in births complicated by malpresentations, such as nullipara breech (11.0%), multipara breech (16.7%) and transverse/oblique lie (17.9%).


Our findings indicate that group 10 (preterm birth) and group 3 (multipara with cephalic term singleton in spontaneous labour) each contribute to a quarter of stillbirth mortality. High mortality risk was observed in births complicated by malpresentation, such as transverse lie or breech. The high mortality share of group 3 is unexpected, demanding case-by-case investigation. The high mortality rate observed for Robson groups 6–10 hints for a need to intensify actions to improve labour management, and the categorisation may support the regular review of labour progress.