This statistical release is the second in the series of annual reports on perinatal deaths in South Africa derived from the civil registration system maintained by the Department of Home Affairs (DHA). It focuses on the aggregate number of registered stillbirths and infant deaths occurring during the first week of life. It also provides information on trends in the number of perinatal deaths covering the period 1997 to 2014 and causes of perinatal deaths from 2012 to 2014.

Overall, the number of perinatal deaths increased consistently from 13 020 in 1997 to a high of 25 287 in 2009; and thereafter there was no consistent pattern. The total number of perinatal deaths that occurred in 2014 and were registered at DHA was 21 908, which was a 3,6% decline from the 22 274 perinatal deaths for 2013. In 2014, about two-thirds of perinatal deaths were stillbirths (65,8%) and the remaining one-third early neonatal deaths (34,2%). The estimated mortality rates for 2014 ranged from 6,2 early neonatal deaths per 1 000 live births; 11,8 stillbirths per 1 000 total births to a national perinatal rate of 17,9 perinatal deaths per 1 000 total births.

Over the 18-year period (1997−2014), there were more male than female stillbirths, early neonatal deaths and perinatal deaths for all the years. In 2014, provincial differences indicated that for all death types (stillbirths, early neonatal deaths and perinatal deaths) all provinces had sex ratios above 100. The national sex ratio at perinatal death was 122 male deaths per 100 female perinatal deaths. The national average for stillbirths was 119 male stillbirths per 100 female stillbirths and 127 early neonatal deaths per 100 female early neonatal deaths. The highest sex ratios at death were observed in Gauteng for stillbirths, in Eastern Cape for early neonatal deaths and in Free State for perinatal deaths. Overall, Mpumalanga had the lowest sex ratios for stillbirths, early neonatal deaths and perinatal deaths.

A majority of early neonatal and perinatal deaths took place in Gauteng and KwaZulu-Natal, and the least in Northern Cape. For stillbirths, most deaths occurred in KwaZulu-Natal, closely followed by Gauteng. Other differentials indicated that black Africans comprised the majority (over 80%) of all death types (stillbirths, early neonatal deaths and perinatal deaths.

The distribution of the ten leading underlying causes of stillbirths and perinatal deaths indicated that foetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery maintained its rank as the top-ranking cause of stillbirths and perinatal deaths between 2012 and 2014. For both stillbirths and perinatal deaths), the proportions of death attributed to foetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery increased over the three years. Although it ranked third over the three-year period for early neonatal deaths, its proportions increased from 9,0% in 2012 to 10,8% in 2014.

Over the three-year period, respiratory and cardiovascular disorders specific to the perinatal period has been the leading underlying cause of early neonatal deaths and the second leading cause of perinatal deaths. Amongst stillbirths, it moved from the third position between 2012 and 2013 to the second position in 2014. For stillbirths, disorders related to length of gestation and foetal growth ranked second in 2012 and in 2013 and thereafter was displaced to the third place in 2014. It was consistently the second leading cause of death for early neonatal deaths and third perinatal deaths.

The results show that perinatal deaths in South Africa are characterised by higher stillbirths as compared to neonatal deaths. The underlying causes for both stillbirths and early neonatal deaths show that mortality during the perinatal period can be reduced by effective and efficient care during pregnancy and special efforts such as warmth and hygiene to ensure that newborns survive the critical first seven days of life. Consequently, these findings are essential for planning, monitoring and evaluation of interventions and programs aimed at improving the health and survival of infants. Their usefulness may however, be undermined if the data are not of high quality. Overall, the characteristics of the mother were poorly reported. The information is presented in the appendix section of the 2014. Perinatal report and will be monitored for improvements. Addressing gaps in perinatal deaths data will go a long way towards in-depth analysis of the perinatal deaths and adequate understanding of the status of perinatal deaths in the country.