## Perinatal Mortality

### Perinatal mortality rate

#### Definition

The perinatal mortality rate is the sum of the number of perinatal deaths (stillbirths and early neonatal deaths) divided by the number of pregnancies of seven or more months' duration (all live births plus stillbirths).

##### Coverage:

Population base: Pregnancies of seven or more months to women age 15–49 at time of survey (IR file, BR file)

Time period: Five-year period preceding the survey (v008 to v008-59)

Numerator: Number of fetal deaths in pregnancies of seven or more months plus number of deaths of live-born children in the 0–6 days following birth

Denominator: Number of pregnancies of seven or more months that terminated in a fetal death plus pregnancies that endedwith a live birth

Variables: IR file, BR file.

 vcal_1 Calendar v008 Date of interview (CMC) v018 Row (position) in calendar of month of interview b3 Date of birth of child (CMC) b5 Child is alive (1 = yes, 0 = no) b7 Age at death in months (imputed) v005 Woman’s individual sample weight

#### Calculation

Numerator:

The sum of the number of stillbirths plus the number of early neonatal deaths in the five years preceding the survey.

1)     Number of stillbirths: From the reproductive calendar, number of pregnancies that lasted seven or more months and terminatedin a fetal death in the five years precedingthe survey.

·        For each position in the calendar (vcal_1) from v018 to v018+59: tally stillbirth if there is a “T” (termination) in the position followed by six “P”s (pregnancy) (“TPPPPPP”).

2)     Number of earlyneonatal deaths: Number of childrenwho died at age 0–6 days afterbirth in the five years precedingthe survey.

·        For births in the birth history tally all early neonatal deaths (b6 in 100:106) if the birth took place in the five years preceding the survey (v008 >= b3 >= v008-59).

Denominators:

The sum of the number of stillbirths plus the number of live births in the five years preceding the survey.

1)     Number of stillbirths, given in numerator 1 above.

2)     Number of live births in the five years preceding the survey (v008 >= b3 >= v008-59).

Perinatal mortality rate: Quotientof numerator divided by denominator multiplied by 1000.

#### Handling of Missing Values

Missing values are not allowed for any of the variables that make up the rate. Age at death for living children is imputed if unknown or missing.

#### Notes and Considerations

The perinatal mortality rate is defined by dividing the number of perinatal deaths (stillbirths and early neonatal deaths) by either the number of live births or by the sum of live births and stillbirths. Both definitions are prevalent in the literature. The DHS Program has chosen to report the latter.

The definition of the pregnancy duration for stillbirth in general has changed in the literature over time. Originally, it was pregnancies lasting 28 weeks that ended in a fetal death. The duration limit was subsequently lowered to 24, 22, and even 20 weeks. For the purpose of calculating perinatal mortality, however, the definition remains at 28 weeks. DHS asks and records pregnancy duration in months so the equivalent of seven months is used. The durations of pregnancy are taken as reported by the respondents and do not necessarily have a clinical basis.

The number of stillbirths is estimated from the Contraceptive Calendar. See the Contraceptive Calendar Tutorial at https://www.dhsprogram.com/data/Calendar-Tutorial/index.cfm for a description of the calendar, how the data are stored and how to analyze the calendar data, and videos on Completing the Contraceptive Calendar and the Data Structure of the Contraceptive Calendar.  See particularly Example 4: Still births and perinatal mortality at https://www.dhsprogram.com/data/Calendar-Tutorial/index.cfm#example4.

#### Changes over Time

Earlier DHS reports prior to about 1998 used a somewhat different basis for perinatal rates. Deaths of live-born children were considered early neonatal deaths if they occurred 0 to 7 days after birth, given the large amount of  heaping on day 7 and the consideration of the likelihood of rounding “in the first week of life” by interviewers to seven days, due to questionnaire coding requirements. In more recent years The DHS Program has used the stricter definition of 0 to 6 days.  Also, the denominator for the rates was previously the number of live births rather than the sum of live births and stillbirths.

#### References

DHS Contraceptive Calendar Tutorial. Example 4 – Still births and Perinatal Mortality. https://www.dhsprogram.com/data/Calendar-Tutorial/index.cfm#example4

#### Resources

DHS-7 Tabulation plan: Tables 8.4

API Indicator IDs: CM_PNMR_C_PMR