The Secrecy of Stillbirths in Uganda

Stillbirths are a major problem in Uganda and other parts of sub-Saharan Africa. They are relatively common, but because of the secrecy surrounding them, the true numbers remain uncertain.

“This is a huge problem—not only for Uganda, but for many parts of sub-Saharan Africa,” says pediatrician and PhD candidate at the Centre for International Health, Martin Chebet.

For the past two years, Chebet has worked on the BabyGel project (external link), supervised by Professor Thorkild Tylleskär and Professor Ingunn Engebretsen.

Little attention to stillbirths

A stillbirth occurs when a mother gives birth to a baby who is born dead. This is a common occurrence in Uganda, where Chebet originates from. Despite the high frequency, stillbirths receive far less attention than other child health issues, such as neonatal mortality.

“WHO, UNICEF, and other major health organizations initiate programs and interventions to reduce newborn and maternal mortality. But very little attention has been given to stillbirths,” Chebet explains.

As a pediatrician with a background in clinical practice, Chebet has also been involved in obstetric care, assisting mothers during childbirth.

“It was very common—also after I left clinical practice—that mothers gave birth to babies who were born dead. Often, it was difficult to tell what caused it.”

This experience sparked his curiosity to better understand the causes of stillbirths and to draw attention to the issue. This led him to conduct research in eastern Uganda, where cultural interpretations strongly influence how medical conditions are understood.

“I was aware that some cases of stillbirth might be interpreted by the community not as medical conditions, but as cultural or spiritual issues. However, I did not realize how deeply these beliefs influenced community perceptions.”

Chebet explains that cultural beliefs affect how women in labor are treated—both in hospitals and within their communities. They also contribute to the concealment of stillbirths, meaning authorities often remain unaware that these events have occurred.

Documenting the hidden problem

“Our study mainly focused on documenting how common stillbirths are in communities in eastern Uganda, particularly in Mbale and Budaka, where the study took place,” Chebet says.

The research also examined how stillbirths are understood in a cultural context.

“That culture plays a significant role was not surprising. But both local health workers and I were surprised by the depth of cultural influence surrounding stillbirth practices.”

Harmful beliefs linked to stillbirths

The study, published last summer, identified several deeply rooted cultural beliefs.

“One of the most common beliefs—almost universal in this community—is that when a baby is born dead, the baby’s body, its clothes, and even the soil around the grave are potentially harmful,” Chebet explains. “The focus often shifts to the family and especially the mother, who may be prevented from having children in the future.”

As a result, families are extremely secretive when a stillbirth occurs. Burials are conducted quickly and discreetly to avoid stigma, judgment from neighbors, or fears of witchcraft.

“Whether the stillbirth happens at home or in a hospital, families rush to bury the baby immediately. This is very different from burial practices for older children or adults, where funerals may take place days later and be attended by many people.”

Stillbirth burials are unannounced and usually attended only by close family members—sometimes as few as two or three people. Mothers rarely attend the burial, often because they are still recovering in hospital.

“Some mothers said it was taboo for them to attend, but many said they wanted to be present and were unable to because they were still ill.”

In Uganda, children are typically buried within the family compound, with graves marked by soil mounds or concrete. However, for stillborn babies, families deliberately conceal the grave.

“They ensure the grave is completely flat and indistinguishable from the surrounding ground so outsiders cannot identify it,” Chebet says. “Surprisingly, about 30 people we interviewed said their babies were buried inside the living house, which they believed was the safest place.”

A problem without numbers

Although secrecy around stillbirths is well documented, it is difficult to determine whether this practice directly contributes to increased stillbirth rates.

“It is basically impossible to say for sure because people don’t want to talk about it,” Chebet explains.

Even hospital staff are often reluctant to discuss the issue. Many women deliver at home, making it impossible to capture accurate data. As a result, the government underestimates the magnitude of the problem.

“We published a paper last year showing that the frequency of stillbirths in this community is much higher than government estimates.”

Without reliable data, it is impossible to assess the true burden of stillbirths.

“One widespread belief is that stillbirths are not medical conditions, but something caused by people—often through witchcraft.”

When stillbirths are attributed to supernatural causes, families are less likely to seek medical care or investigate treatable conditions, allowing the problem to persist.

“By hiding stillbirths, we cannot determine their causes. Postmortem examinations are impossible because families are advised to bury the baby immediately. Additionally, many health facilities lack the capacity to conduct advanced investigations.”

Women blamed for stillbirths

A major reason for secrecy is fear of blame. Women are often marginalized and held responsible for stillbirths.

“It is commonly believed that women who have stillbirths are cursed or possessed by evil spirits,” Chebet says. “Some believe they are being punished by God for immoral behavior or for disobeying elders before marriage.”

This stigma is intensified by the cultural view of marriage, where its primary purpose is to produce children.

“When a woman does not give birth to a living child, she may be considered useless or cursed.”

Because the groom’s family pays a bride price, they expect children in return. When this does not happen, women experience severe mental stress and are often mistreated by spouses and in-laws.

“Some women end up in broken marriages and are denied care and support, leading to long-term psychological effects such as depression and post-traumatic stress.”

Empowering women and communities

While the scale of the problem is evident, solutions remain unclear. Chebet says the study’s aim is to first identify and expose the issue, before exploring effective interventions.

One important step is community sensitization—not only in the study areas, but across Uganda.

“The key is to emphasize the biomedical nature of stillbirths,” he says.

In the long term, Chebet believes empowering women through education is essential.

“We have seen differences across regions. In northern Uganda, people are more open to biomedical explanations, partly due to greater exposure to education and Western influences.”

He believes that educating women will help communities better understand stillbirths as medical conditions.

“Equally important is continued documentation of the problem so authorities recognize its magnitude. Health workers must also stay connected to communities and continue spreading awareness,” Chebet concludes.