Parents after stillbirth or neonatal death: mental health, care and inequality

Every year, millions of parents around the world have a baby who is stillborn or who dies in the first weeks of life. Where their mental health has been measured, they report markedly more anxiety, depression and trauma symptoms than parents whose baby lived. The care they receive, and whether their baby is even counted, depends heavily on where they live and who they are.

For parents whose baby has died before or shortly after birth, the death often comes where they expected a beginning: in a maternity unit, among other families with newborns, with a body still recovering from pregnancy. Afterwards come decisions few people are prepared for, about seeing and holding the baby, a post-mortem and a funeral, alongside a return home to a prepared room, to leave arrangements and to questions from people who may not know what happened. This study brings together what the evidence shows about how many parents this affects, their health and relationships afterwards, the care they receive, and the gaps between countries and between ethnic and social groups.

Millions of parents each year, and most of their babies are not counted

The World Health Organization estimates that there are “nearly 2 million stillbirths every year”, counting babies who die after 28 weeks of pregnancy but before or during birth. More than 40% happen during labour, and WHO says that with good-quality care in pregnancy and childbirth most are preventable^[1]. Approximately 2.3 million more babies die in the neonatal period, the first weeks after birth^[4]. These are modelled estimates, not counts: WHO notes that most stillborn babies do not receive a birth certificate and are not registered^[1]. The parents of most stillborn babies in the world are, in effect, invisible in official statistics.

A paper in The Lancet’s Ending Preventable Stillbirths series, on the economic and psychosocial consequences of stillbirth, concludes that the negative effects, “particularly on parental mental health, might be moderated by empathic attitudes of care providers”^[5]. That is a reason to look closely at care, not only at outcomes.

Where babies are counted, definitions differ. The UK’s MBRRACE-UK surveillance counts from 24 completed weeks of pregnancy; for babies born in 2024 it reported an extended perinatal mortality rate (stillbirths plus neonatal deaths) of 4.77 for every 1,000 births^[6]. The United States counts fetal deaths from 20 weeks, and its perinatal mortality rate (those fetal deaths plus deaths in the first week of life) was 8.36 per 1,000 live births and fetal deaths in 2023^[3]. These rates measure different things and cannot be compared directly.

Anxiety, depression and trauma symptoms are markedly higher, especially in the first months

Grief after a baby dies is a normal response, not an illness. But a consistent body of research finds that a substantial minority of parents also develop symptoms of depression, anxiety or post-traumatic stress at levels that warrant attention. A 2021 systematic review of 13 quantitative studies concluded that parents after stillbirth “have a considerably higher risk of reporting symptoms of depression, anxiety, and PTSD compared with parents with live births”, with risk ratios across studies ranging from 1.74 to 6.70. Symptoms were generally highest soon after the death and eased over time, but the longest follow-up in the studies reviewed was 30 months, so little is known about the longer term^[7].

The clearest population-based picture comes from Norway. In the national Mother and Child Cohort Study, which recruited pregnant women across the country between 1999 and 2008, 174 women were pregnant again after a stillbirth. In the third trimester of that next pregnancy, 22.5% had raised anxiety symptoms and 19.7% raised depression symptoms, compared with 4.4% and 10.3% of women whose previous pregnancy had ended in a live birth. After adjustment for other factors, that was 5.47 times the odds of anxiety and 1.91 times the odds of depression^[2]. These are symptom scores on a short checklist, not clinical diagnoses.

Older, smaller studies point the same way. In a 1999 UK study of 60 women pregnant after a stillbirth and 60 matched controls, those who conceived within a year of the stillbirth were more depressed and anxious, while those who conceived later resembled the controls^[8]. In Sweden, a population-based survey of women who had a stillbirth in 1991 found that the proportion with high anxiety symptoms was 2.1 times that among women whose baby was born alive^[9].

For babies who die after birth, evidence is thinner. In a US study in Florida of 176 mothers and 73 fathers whose infant or young child died in neonatal or paediatric intensive care, 79% of whom were Hispanic or Black, 13 months after the death 35% of mothers and 24% of fathers had clinical depression, and 35% of mothers and 30% of fathers had clinical PTSD. Parents recorded 98 hospital admissions and 132 newly diagnosed chronic health conditions over that year^[10]. The study had no comparison group, so it describes need rather than excess risk.

Fathers and partners are affected too, but rarely studied

Almost everything known about parents’ mental health after a baby dies comes from mothers. A 2006 systematic review of the psychological effects of stillbirth and neonatal death on fathers found 17 studies published between 1966 and 2005^[11], and of the 13 studies in the 2021 review, only two included men^[7]. Where fathers have been studied, the Florida intensive care study above found depression and PTSD rates among them only somewhat below mothers’^[10]. Same-sex partners, non-birthing mothers and gender-diverse parents are almost absent from the data.

The research on partners also shows that care practices which help some parents may not suit all. A national survey of women in England with a registered stillbirth in 2012 found, from mothers’ reports, that 92% of partners saw and 82% held their stillborn baby. Partners who held the baby had higher odds of depression (2.72 times) and, less firmly, of post-traumatic stress symptoms three months later than those who did not, although parents are consistently satisfied with their decision to hold their baby^[12]. The authors call for larger prospective studies; the finding argues for offering parents real choices and support around those choices, not for any single rule.

Couples’ relationships can come under strain. In the US National Survey of Family Growth, which followed 7,770 pregnancies for a median of 7.8 years, marriages and cohabiting relationships after a stillbirth had 1.40 times the hazard of ending as those after a live birth^[13]. That is a raised risk, not an expected outcome, and it points to couples needing support together as well as individually.

Black and Asian families, and families in poorer areas, more often have a baby die, and in England report poorer care

Which parents experience a baby’s death is not evenly spread. In the United States in 2023, the perinatal mortality rate for babies of Black non-Hispanic women was 15.04 per 1,000 live births and fetal deaths, more than double the 6.76 for White non-Hispanic women; the rate was 7.57 for Hispanic women and 6.03 for Asian non-Hispanic women. Rates were also high for Native Hawaiian or Other Pacific Islander women (14.09) and American Indian and Alaska Native women (10.63); the NCHS reports that the rate was highest for Black and Native Hawaiian or Other Pacific Islander women^[3]. In the UK, MBRRACE-UK reports that babies of Asian and Black ethnicity “continue to experience higher mortality rates than babies of White ethnicity”, and that stillbirth rates remain highest for mothers living in the most deprived areas^[6]. These differences reflect gaps in health, circumstances and care before and during pregnancy, not anything about the parents themselves.

The same groups can also meet poorer care after their baby has died. A survey in England of mothers who had a stillbirth in 2012–2013, contacted through birth registrations, found that women from more deprived areas were less likely than others to say medical staff had spoken to them in a way they could understand during labour (73% compared with 90%) and less likely to feel treated with respect by midwives (79% compared with 90%). Ethnic minority, younger and single mothers were also more likely to report disadvantage in care. Only 30% of women approached responded (473 women), so the survey may not represent everyone^[14].

Waiting is part of the experience too. In a random sample of 477 women in England who had a stillbirth in 2013, 95% said they were asked for consent to a post-mortem, but a third waited longer than 12 weeks for the result^[15]. In the US intensive care study, more Hispanic and Black mothers than White mothers had moderate or severe depression six months after their child died^[10]. For the parents most likely to have a baby die, the evidence, though limited, suggests that care afterwards may also fit their needs less well.

Where most babies die, parents face stigma, silence and little or no leave

WHO projects that, if current trends continue, nearly half of future stillbirths (48%) will occur in sub-Saharan Africa^[1], yet most research on parents comes from high-income countries. Even an international effort in 2025 to agree which outcomes matter in stillbirth care, with 542 participants from 29 countries, drew 95.6% of its parent participants from high-income countries^[16].

What evidence exists from lower-income settings is mostly qualitative. A systematic review of 34 studies from 17 low- and middle-income countries found that parents’ grief often goes unrecognised by health workers and communities, and that this “exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status”^[17]. Stigma is not confined to poorer countries: in a self-selected online survey of 817 bereaved parents, almost all of them women, 38% believed they had been stigmatised because of their stillbirth^[18]. As a volunteer sample, that figure cannot be generalised, but it shows the problem is common enough to be named.

Time away from work is a concrete measure of whether a death is recognised. A 2026 scoping review of 49 low- and middle-income countries found that every one had a national maternity leave policy, but only 10 (fewer than 20%) made provision for leave after a stillbirth. Where they did, leave averaged 50.1 days, against 107.7 days after a live birth in the same countries^[19]. A mother whose baby is stillborn still needs to recover physically from the birth, and both parents are grieving.

What the evidence asks of us

The figures point to a small number of clear priorities for health services, governments, funders and researchers, in every country.

• Count every baby. WHO’s observation that most stillborn babies are never registered^[1] means most bereaved parents are statistically invisible. Registering stillbirths and neonatal deaths, using comparable definitions, is the foundation for both prevention and support.
• Treat bereavement care as part of maternity and newborn care. The Lancet series’ conclusion that empathic care may moderate the harm to parents’ mental health^[5], and the English finding that disadvantaged mothers more often felt they were not spoken to understandably or with respect^[14], make the quality of care after a death a measurable service standard, not an extra.
• Watch for anxiety and depression, including in the next pregnancy. The Norwegian and UK cohort findings^[2][8] suggest maternity services should expect raised anxiety in pregnancies after a stillbirth and offer mental health support alongside routine antenatal care.
• Include fathers and partners. With only two of 13 studies in a recent review including men^[7], services and researchers need to reach partners directly, and to support choices around seeing and holding the baby rather than prescribe them^[12].
• Close the gaps by ethnicity and deprivation. Higher death rates for babies of Black and Asian mothers in the UK and of Black mothers in the US^[6][3] call for action on prevention and for bereavement care designed with the communities most affected.
• Recognise stillbirth in leave policy. With fewer than one in five of the low- and middle-income countries reviewed providing leave after a stillbirth^[19], extending leave to parents whose baby is stillborn is a practical, low-cost policy step. The wider picture of bereavement and employment is covered in our study of bereavement and work.
• Fund research where most babies die. Studies of parents’ mental health and care in low- and middle-income countries, and longer follow-up everywhere, are the largest gaps in the evidence^[7][16].

Parents whose child dies at an older age are covered in our study of bereaved parents after a child’s death, and differences in bereavement experience by ethnicity and faith in minority ethnic and faith communities and bereavement.

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer. It uses “stillbirth” and “neonatal death” as the baby loss organisations and the studies cited do, and speaks of babies and parents throughout, because that is how bereaved parents describe them.

Why we're publishing this

The death of a baby before or soon after birth is among the most common forms of bereavement in the world and among the least visible. Many of these babies are never registered, their parents may be given little or no leave, and grief that others do not recognise can bring stigma as well as sorrow. Baby loss and stillbirth organisations have long made the case for better counting, better care and better support. This study gathers the international evidence behind that case in one place, with every figure sourced, so that those organisations, and the health services and governments they work with, can use it.

How to read this data

The global counts of stillbirths and neonatal deaths are modelled estimates by WHO and partner agencies, not counts, because most stillbirths are not registered. The UK and US rates are counted from registrations and surveillance, but they use different gestational thresholds (24 and 20 weeks), so they cannot be compared with each other or with WHO’s 28-week definition. The mental health evidence comes mainly from cohort studies and surveys in Norway, Sweden, the UK and the US; most measure symptoms on questionnaires rather than clinical diagnoses, and several are small. The English care surveys had low response rates, and the stigma survey was a self-selected online sample, so their percentages describe respondents, not all parents. Associations, such as that between holding a baby and partners’ later symptoms, or between stillbirth and relationships ending, do not show cause. Evidence about fathers, about parents after neonatal death specifically, and about parents in low- and middle-income countries is thin, and where it is missing we say so.

Use this data

Free to cite with attribution to Understanding Bereavement. Charities, hospitals, services and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This study summarises published research about groups of people for general information. It is not medical advice or bereavement support, and it cannot describe or predict anything about an individual parent or family. If you are worried about yourself or someone close to you, please speak to a GP, midwife or another qualified professional.

Sources

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3. Valenzuela CP, Gregory ECW, Martin JA. Perinatal mortality in the United States, 2022 and 2023. NCHS Data Brief No. 530, National Center for Health Statistics, 2025. cdc.gov/nchs/products/databriefs/db530.htm
4. Murless-Collins S, Ezeaka VC, Masoud NS, et al. Born Too Soon: care for small and sick newborns, evidence for investment and implementation. Reproductive Health, 2025. europepmc.org/article/PMC/PMC12188657
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6. MBRRACE-UK. Perinatal mortality surveillance: UK perinatal deaths of babies born in 2024. MBRRACE-UK, University of Leicester / NPEU, 2026. timms.le.ac.uk/mbrrace-uk-perinatal-mortality/surveillance
7. Westby CL, Erlandsen AR, Nilsen SA, Visted E, Thimm JC. Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review. BMC Pregnancy and Childbirth, 2021. europepmc.org/article/PMC/PMC8600867
8. Hughes PM, Turton P, Evans CD. Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: cohort study. BMJ, 1999. europepmc.org/article/PMC/PMC31099
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11. Badenhorst W, Riches S, Turton P, Hughes P. The psychological effects of stillbirth and neonatal death on fathers: systematic review. Journal of Psychosomatic Obstetrics and Gynaecology, 2006. europepmc.org/article/MED/17225626
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16. Bakhbakhi D, Davies A, Siassakos D, et al. A core outcome set for stillbirth care: an international consensus study. BJOG, 2025. europepmc.org/article/PMC/PMC12592755
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19. Pandey AK, Gautam D, Sachdeva R, et al. Leave policy after stillbirth in LMICs: how much are we thinking about bereaved mothers? A scoping review. BMJ Open, 2026. europepmc.org/article/PMC/PMC13295910