National Vital
Statistics Reports
Volume 72, Number 8 July 26, 2023
Fetal Mortality: United States, 2021
by Elizabeth C.W. Gregory, M.P.H., Claudia P. Valenzuela, M.P.H., and Donna L. Hoyert, Ph.D.
Abstract
Objectives—This report presents 2021 fetal mortality data
by maternal race and Hispanic origin, age, tobacco use during
pregnancy, and state of residence, as well as by plurality, sex,
gestational age, birthweight, and selected causes of death.
Trends in fetal mortality are also examined.
Methods—Descriptive tabulations of data are presented and
interpreted for all fetal deaths reported for the United States for
2021 with a stated or presumed period of gestation of 20 weeks
or more. Cause-of-fetal-death data are restricted to residents
of the 41 states and the District of Columbia, where cause of
death was based on the 2003 fetal death report revision and less
than 50% of deaths were attributed to Fetal death of unspecified
cause (P95).
Results—A total of 21,105 fetal deaths at 20 weeks of
gestation or more were reported in the United States in 2021.
The 2021 U.S. fetal mortality rate was 5.73 fetal deaths at 20
weeks of gestation or more per 1,000 live births and fetal deaths,
which was essentially unchanged from the rate of 5.74 in 2020.
The fetal mortality rate in 2021 for deaths occurring at 20–27
weeks of gestation was 2.95, essentially unchanged from
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
National Vital Statistics System
NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.
Figure 1. Fetal mortality rate: United States, 1990–2021
0
5
6
7
8
2021201520102005200019951990
Rate per 1,000 live births and fetal deaths
NOTE: Fetal mortality rate is the number of fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
2 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
2020 (2.97). For deaths occurring at 28 weeks of gestation or
more, the rate in 2021 (2.80) was not significantly different
from 2020 (2.78). In 2021, the fetal mortality rate ranged from
3.94 for non-Hispanic, single-race Asian women to 9.89 for
non-Hispanic, single-race Black women. Fetal mortality rates
were highest for females under age 15 and aged 40 and over,
for women who smoked during pregnancy, and for women with
multiple gestation pregnancies. Five selected causes accounted
for 89.9% of fetal deaths in the 41-state and District of Columbia
reporting area.
Keywords: fetal death • stillbirth • pregnancy loss • National
Vital Statistics System
Introduction
Fetal mortality—the intrauterine death of a fetus at any
gestational age—is a major but often overlooked public health
issue. Much of the public concern surrounding reproductive loss
has focused on infant mortality, due in part to lesser knowledge
of the incidence, etiology, and prevention strategies for fetal
mortality. This report presents detailed data on numbers and
rates of fetal deaths for the United States for 2021. Data are
presented by maternal race and Hispanic origin, age, tobacco use
during pregnancy, and state of residence, as well as by plurality,
sex, gestational age at delivery, birthweight, and selected causes
of death. Trends in fetal mortality are also examined.
In addition to the tabulations included in this report, more
detailed analysis of fetal mortality is possible by using the annual
fetal death public-use file. The data file may be downloaded from:
https://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm.
The public-use file does not include geographic detail; a file with
this information may be available upon request (see the Division
of Vital Statistics data release policy: https://www.cdc.gov/
nchs/nvss/dvs_data_release.htm). Fetal death data may also be
accessed via the Centers for Disease Control and Prevention’s
Wide-ranging Online Data for Epidemiologic Research
(WONDER). WONDER is a web-based data query system that
makes the Centers for Disease Control and Prevention's data
available to public health professionals and the public (1).
Methods
Data sources
Data in this report are drawn from two National Center
for Health Statistics vital statistics data files: the 2021 fetal
death data set (for fetal deaths) and the 2021 birth data set
(for births). The 2021 fetal death data set contains information
from all reports of fetal death filed in the 50 states, the District
of Columbia, Guam, and Puerto Rico (American Samoa did not
report data for 2021, and data for the Northern Marianas and the
U.S. Virgin Islands were excluded to protect confidentiality due
to the small number of events reported) (2). The 2021 birth data
set contains information from all Certificates of Live Birth filed
in the 50 states, the District of Columbia, Guam, the Northern
Marianas, Puerto Rico, and the Virgin Islands (American Samoa
did not report data for 2021). Tables showing data by jurisdiction
also provide separate information for Guam and Puerto Rico;
however, these data are not included in U.S. totals.
Fetal mortality
Fetal death refers to the intrauterine death of a fetus prior
to delivery (see Technical Notes). Fetal mortality is generally
divided into three periods based on gestational age: less than
20 completed weeks of gestation, 20–27 weeks of gestation
(early fetal deaths), and 28 weeks of gestation or more (late fetal
deaths). Although the vast majority of fetal deaths occur early in
pregnancy, most U.S. states only require the reporting of fetal
deaths at 20 weeks of gestation or more (2), and fetal mortality
data from the National Vital Statistics System are usually
presented for fetal deaths at 20 weeks of gestation or more.
Therefore, only fetal deaths reported at 20 weeks of gestation
or more are included in this report. Numbers and rates for early
and late fetal deaths are shown separately for selected variables.
Statistics on fetal death exclude data for induced terminations
of pregnancy. Fetal mortality rates in this report are computed
as the number of fetal deaths at 20 weeks of gestation or more
per 1,000 live births and fetal deaths at 20 weeks or more (see
Technical Notes).
Data limitations
Variation exists among states in reporting requirements
and possibly in completeness of reporting of fetal death data,
and these variations can have implications for data quality and
completeness (see Technical Notes). Correct interpretation of
fetal death data should include an evaluation of the completeness
of reporting of fetal deaths, as well as an evaluation of the
completeness of reporting for the specific variables of interest
(3–5). The percentage of not-stated responses for fetal death
data varies markedly among variables and states; see “User
Guide to the 2021 Fetal Death Public Use File” (2).
Birthweight data for Hawaii for 2021 are excluded from
tabulations shown in this report due to a high percentage of
unknown responses (56.9%).
2003 revision of U.S. Standard Report of Fetal
Death
Starting in 2018, all 50 states, the District of Columbia,
Guam, the Northern Marianas, Puerto Rico, and the Virgin
Islands reported data based on the 2003 U.S. Standard Report
of Fetal Death.
Data on items such as mother’s date of birth, race, Hispanic
origin, level of education, tobacco use during pregnancy, and
place of residence are recommended to come from the mother
(see the “Patient’s Worksheet” [6]). Data on items such as
prenatal care, medical risk factors, maternal morbidity, plurality,
sex of fetus, gestational age, birthweight, and cause of death
are recommended to come from the medical records (see the
"Facility Worksheet” [7]). Detailed definitions for data items that
are collected from the Facility Worksheet are in the “Guide to
the Facility Worksheet” (8). Further information on fetal death
National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023 3
reporting is available in the eLearning training, “Applying Best
Practices for Reporting Medical and Health Information on Birth
Certificates,” available from: https://www.cdc.gov/nchs/training/
BirthCertificateElearning.
This report uses the latest fetal death data to present
information on fetal deaths and fetal death rates by race and
Hispanic origin, maternal age, tobacco use during pregnancy,
plurality, sex of fetus, gestational age, birthweight, state of
residence, and selected causes of death.
Race and Hispanic origin
The 2003 revision of the U.S. Standard Report of Fetal Death
allows the reporting of more than one race (multiple races) for
the mother (9) according to the revised standards issued by
the Office of Management and Budget in 1997 (10). Starting
in 2018, all 50 states and the District of Columbia, Guam, the
Northern Marianas, Puerto Rico, and the Virgin Islands reported
race data according to these 1997 Office of Management and
Budget standards, which require the reporting of a minimum
of five race categories and allow for reporting of race by either
single race (reported alone) or in combination (more than one
race or multiple races) (10). The race and Hispanic-origin groups
shown in this report follow the 1997 standards and differ from
the bridged-race categories shown in reports before 2018 (11).
The current categories are American Indian or Alaska Native
non-Hispanic single race, Asian non-Hispanic single race,
Black or African American non-Hispanic single race, Native
Hawaiian or Other Pacific Islander non-Hispanic single race,
White non-Hispanic single race, and Hispanic (for brevity in text,
references to the race groups omit “non-Hispanic single race.”)
Race and Hispanic origin are reported independently on the
report of fetal death. Most tables in this report show data for the
categories of Black, White, and Hispanic. Selected tables also
include data for the categories American Indian or Alaska Native,
Asian, and Native Hawaiian or Other Pacific Islander. Data are
also presented in some tables for Hispanic subgroups: Central
and South American, Cuban, Dominican, Mexican, Puerto
Rican, and Other and unknown Hispanic. Data were presented
separately for Dominican women for the first time beginning with
the 2018 data year. Data for this subgroup had previously been
included in the category Other and unknown Hispanic.
Fetal deaths by state
Comparisons of fetal mortality rates by state can be affected
by differences in reporting requirements for fetal deaths among
registration areas, particularly for fetal deaths occurring at
gestational ages early in the reporting period (see Technical
Notes). Additionally, the small numbers of fetal deaths in some
states by year can result in lack of reliability for state-specific
fetal mortality rates. To try to address these issues, in addition
to showing fetal mortality rates at 20 weeks or more by state for
2021, this report also presents fetal deaths and fetal mortality
rates by state for fetal deaths at 24 weeks of gestation or more
for the latest combined 3-year period (2019–2021).
Cause of death
The National Center for Health Statistics codes the cause
of fetal death reported by the certifier using the International
Classification of Diseases, 10th Revision (12). In this report, the
five most frequently reported causes of death shown, including
unspecified cause, are drawn from 45 causes in the List of 124
Selected Causes of Fetal Death, as defined in Instruction manual,
part 9 (13), and ranked according to the number of fetal deaths.
Data on the 5 causes of death are included for the 41 states
and the District of Columbia that reported cause of death based
on the 2003 revision of the U.S. Standard Report of Fetal Death
and met the reporting requirement of having less than 50% of
records assigned to unspecified cause (P95). This reporting
area includes 15,212 fetal deaths, representing 72.1% of all fetal
deaths in 2021. These statistics based on a subnational area
are not generalizable to the entire United States. In tables and
figures, the five selected causes are shown in descending order
according to the number of deaths assigned to each cause.
Statistical significance
Statements in this report have been tested for statistical
significance. A statement that a given mortality rate is higher or
lower than another rate indicates that the rates are significantly
different unless otherwise noted. For information on the methods
used to test for statistical significance, as well as more detailed
information on the collection, interpretation, and availability of
fetal death data, see the 2021 User Guide (2).
Results
Trends in fetal mortality
• In 2021, 21,105 fetal deaths occurring at 20 weeks of
gestation or more were reported in the United States, an
increase of 1% from 2020 (20,854) (Table 1, Figure 1).
• The fetal mortality rate was 5.73 fetal deaths at 20 weeks of
gestation or more per 1,000 live births and fetal deaths in
2021, which was essentially unchanged from the 2020 rate
of 5.74. With minor fluctuations, the total U.S. fetal mortality
rate has declined 23% since 1990 (7.49) but has remained
essentially stable since 2019 (5.70).
• The early fetal mortality rate (20–27 weeks of gestation)
was essentially unchanged from 2020 (2.97) to 2021 (2.95).
This rate declined 7% from 2014 (3.16) to 2021.
• The late fetal mortality rate (28 weeks of gestation or more)
was 2.80 in 2021, which was not significantly different from
the 2020 rate of 2.78. Despite minor fluctuations, the late
fetal mortality rate has been essentially unchanged since
2014 (2.83).
4 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
Race and Hispanic origin
• From 2020 to 2021, the fetal mortality rate declined
4% for Black women (10.34 to 9.89) (Table 2, Figure 2).
No significant changes in fetal mortality rates were observed
for American Indian or Alaska Native (7.84 to 7.48), Asian
(3.93 to 3.94), Native Hawaiian or Other Pacific Islander
(10.59 to 9.87), White (4.73 to 4.85), or Hispanic (4.86 to
4.82) women.
• Among Hispanic-origin subgroups, from 2020 to 2021, no
significant changes in fetal mortality rates were seen for
Central and South American (4.49 to 4.61), Cuban (5.23 to
4.81), Dominican (4.41 to 4.39), Mexican (4.79 to 4.77),
Puerto Rican (4.98 to 5.11), and Other and unknown
Hispanic (5.87 to 5.41) women (Table 3).
• In 2021, fetal mortality rates continued to vary by race and
Hispanic origin; rates ranged from 3.94 for Asian women to
7.48 for American Indian or Alaska Native women, 9.87 for
Native Hawaiian or Other Pacific Islander women, and 9.89
for Black women.
• Among Hispanic-origin subgroups in 2021, rates ranged
from 4.39 for Dominican women to 5.41 for Other and
unknown Hispanic women; however, differences among the
groups were generally not significant.
Maternal age
• Fetal mortality rates vary by maternal age (Table 4, Figure 3).
In 2021, the rate was 13.14 for females under age 15, then
declined for women aged 15–19 (7.19) through 30–34 (5.13).
Rates then rose for women aged 35–39 (6.28) through 45
and over (11.36).
• The fetal mortality rate for teenagers aged 15–17 (7.46) was
45% higher and the rate for teenagers aged 18–19 (7.11)
was 39% higher than the rate for women aged 30–34 (5.13).
• Age-specific rates for Black women were higher than those
for White women for those aged 15 and over. Rates for
Black women were higher than those for Hispanic women
for those aged 15–44; rates for women aged 45 and over
in the two groups were not significantly different. The
number of events was too small (fewer than 20 events in the
numerator) to calculate reliable rates for females under age
15 for all three race and Hispanic-origin groups.
Figure 2. Fetal mortality rates, by race and Hispanic origin of mother: United States, 2020 and 2021
0
2
4
6
8
10
12
1
People of Hispanic origin may be of any race.
NOTE: Fetal mortality rate is the number of fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths in specified group.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
BlackAsian
Hispanic
1
American Indian
or Alaska Native
Non-Hispanic
Rate per 1,000 live births and fetal deaths in specified group
7.84
7.48
3.93
3.94
10.34
9.89
White
4.73
4.85
Native Hawaiian or
Other Pacific Islander
10.59
9.87
4.86
4.82
2021
2020
National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023 5
Tobacco use during pregnancy
• The fetal mortality rate for women who smoked during
pregnancy (9.62) was more than one and one-half times
higher than that for women who did not smoke during
pregnancy (5.08) (Table 5).
• The pattern was similar for the three largest race and
Hispanic-origin groups. The fetal mortality rate for women
who smoked during pregnancy compared with those who
did not was more than one and one-half times higher for
Black women (15.75 and 9.04, respectively), and twice as
high for White (8.62 and 4.25) and Hispanic (8.93 and 4.46)
women. See Table 5 for fetal mortality rates by tobacco use
during pregnancy by age.
Plurality
• The fetal mortality rate for twins (12.37) was more than
twice that for singletons (5.49) (Table A). The rate for triplet
or higher-order deliveries (27.84) was five times that for
singletons.
• The pattern was similar for the three largest race and
Hispanic-origin groups. For example, the fetal mortality rate
for twins compared with singletons was more than twice as
high for White (10.26 and 4.64, respectively) and Hispanic
(12.41 and 4.62) women, and nearly twice as high for Black
women (18.06 and 9.52).
Sex of fetus
• In 2021, the fetal mortality rate for male fetuses was 5.83,
which was 4% higher than the rate for female fetuses (5.62)
(Table A).
• The fetal mortality rate for male fetuses compared with
female fetuses was 9% higher for Black women (10.31 and
9.46, respectively). No significant difference was seen for
White (4.88 and 4.81) and Hispanic (4.93 and 4.70) women.
Figure 3. Fetal mortality rates, by age of mother: United States, 2021
Rate per 1,000 live births and fetal deaths in specified group
NOTE: Fetal mortality rate is the number of fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths in specified group.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
0
2
4
6
8
10
12
14
45 and over40–4435–3930–3425–2920–2415–19Under 15
13.14
7.19
5.83
5.37
5.13
6.28
8.52
11.36
6 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
Period of gestation
• In 2021, just over one-half (51.3%) of all fetal deaths at 20
weeks of gestation or more occurred at 20–27 weeks (early
fetal deaths) and 48.7% occurred at 28 weeks of gestation
or more (late fetal deaths) (Table B).
• The fetal mortality rate was highest at 20–23 weeks of
gestation (538.73), declined to a low of 0.59 at 39–40
weeks, and then increased to 5.54 at 42 weeks of gestation
or more.
Birthweight
• In 2021, in the 49-state and District of Columbia reporting
area, more than one-third (35.3%) of fetal deaths at 20
weeks of gestation or more weighed less than 500 grams
(1 lb. 1 oz.) at delivery, and nearly one-half (47.1%) weighed
less than 750 grams (1 lb. 12 oz.) (Table 6).
• The fetal mortality rate was highest for fetuses weighing
less than 500 grams (598.92) and decreased with
increasing birthweight to a low of 0.60 for fetuses weighing
3,500–3,999 grams. Fetal mortality rates then increased
slightly for fetuses weighing 4,000 grams or more (1.22).
Fetal mortality rates by state
• For combined years 2019–2021, the U.S. fetal mortality rate
for fetal deaths at 24 weeks or more was 3.66 per 1,000 live
births and fetal deaths (Table C).
• For combined years 2019–2021, fetal mortality rates were
highest (above 5.00) in the District of Columbia (5.38),
Arkansas (5.54), Alabama (5.60), and Mississippi (6.38),
and lowest (below 3.00) in New Mexico (2.60), Connecticut
Table A. Fetal mortality rates, by selected characteristics and race and Hispanic origin of mother: United States, 2021
Fetal mortality rates
1
Fetal deaths Live births
Non-Hispanic,
single race
2
Non-Hispanic,
single race
2
Non-Hispanic,
single race
2
Characteristic
All races
and origins
3
Black White Hispanic
4
All races
and origins
3
Black White Hispanic
4
All races
and origins
3
Black White Hispanic
4
Plurality . . . . . . . . . . . . . 5.73 9.89 4.85 4.82 21,105 5,173 9,196 4,290 3,664,292 517,889 1,887,656 885,916
Single . . . . . . . . . . . . . 5.49 9.52 4.64 4.62 19,591 4,771 8,507 4,009 3,547,198 496,418 1,824,456 863,961
Twin . . . . . . . . . . . . . . 12.37 18.06 10.26 12.41 1,430 387 637 269 114,161 21,047 61,438 21,401
Triplet or higher . . . . . 27.84 * 28.67 * 84 15 52 12 2,933 424 1,762 554
Sex of fetus . . . . . . . . . . 5.73 9.89 4.85 4.82 21,105 5,173 9,196 4,290 3,664,292 517,889 1,887,656 885,916
Male . . . . . . . . . . . . . . 5.83 10.31 4.88 4.93 10,992 2,736 4,752 2,235 1,873,416 262,679 968,370 450,807
Female . . . . . . . . . . . . 5.62 9.46 4.81 4.70 10,113 2,437 4,444 2,055 1,790,876 255,210 919,286 435,109
Male–female ratio . . . . 1.04 1.09 1.01 1.05 … … … … … … … …
* Estimate does not meet National Center for Health Statistics standards of reliability or precision; based on fewer than 20 fetal deaths in the numerator.
… Category not applicable.
1
Rate per 1,000 live births and fetal deaths in specified group.
2
Race and Hispanic origin are reported separately on the report of fetal death; people of Hispanic origin may be of any race. In this table, non-Hispanic women are classified by race. Race
categories are consistent with the 1997 Office of Management and Budget standards; see Technical Notes in this report. Single race is defined as only one race reported on the report of fetal
death.
3
Includes fetal deaths to race and Hispanic-origin groups not shown separately.
4
Includes all people of Hispanic origin of any race; see Technical Notes in this report.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
Table B. Fetal deaths and mortality rates, by gestational age
and race and Hispanic origin of mother: United States, 2021
Gestational age
(weeks)
All races
and origins
2
Non-Hispanic, single race
1
Hispanic
3
Black White
Rate
4
Total . . . . . . . . . . . . . . 5.73 9.89 4.85 4.82
20–23 . . . . . . . . . . . 538.73 476.27 604.24 500.16
24–27 . . . . . . . . . . . 170.3 147.98 191.89 150.24
28–31 . . . . . . . . . . . 73.52 78.79 76.23 59.12
32–33 . . . . . . . . . . . 32.04 37.95 29.97 30.72
34–36 . . . . . . . . . . . 9.23 12.06 8.96 7.58
37–38 . . . . . . . . . . . 1.86 2.17 1.83 1.59
39–40 . . . . . . . . . . . 0.59 0.73 0.55 0.54
41 . . . . . . . . . . . . . . 0.77 1.22 0.68 0.73
42 or more . . . . . . . 5.54 * 4.02 *
Not stated . . . . . . . . … … … …
Number of deaths
Total . . . . . . . . . . . . . . 21,105 5,173 9,196 4,290
20–23 . . . . . . . . . . . 7,469 1,977 3,052 1,550
24–27 . . . . . . . . . . . 3,278 842 1,392 660
28–31 . . . . . . . . . . . 2,756 739 1,205 504
32–33 . . . . . . . . . . . 1,481 377 644 319
34–36 . . . . . . . . . . . 2,618 619 1,225 512
37–38 . . . . . . . . . . . 1,957 363 935 421
39–40 . . . . . . . . . . . 1,216 187 602 268
41 . . . . . . . . . . . . . . 130
22 67 27
42 or more . . . . . . . 50 9 24 9
Not stated . . . . . . . . 150 38 50 20
* Estimate does not meet National Center for Health Statistics standards of reliability or
precision; based on fewer than 20 fetal deaths in the numerator.
... Category not applicable.
1
Race and Hispanic origin are reported separately on reports of fetal death; people of
Hispanic origin may be of any race. In this table, non-Hispanic women are classified by
race. Race categories are consistent with the 1997 Office of Management and Budget
standards. Single race is defined as only one race reported on the report of fetal death.
²Includes fetal deaths to race and Hispanic-origin groups not shown separately.
3
Includes all people of Hispanic origin of any race.
4
Rate per 1,000 live births and fetal deaths in specified group.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023 7
• The five most common selected causes of fetal death and
the top two causes were the same for Black, White, and
Hispanic women, while the ranking of the other causes
differed (Table 8, Figure 4).
• Unspecified cause and placental, cord and membrane
complications were the two most common of the
selected causes for all three groups.
• Among Black women, maternal complications was
the third most common cause of fetal death, maternal
conditions unrelated to pregnancy was fourth, and
congenital malformations was fifth.
• Among White women, maternal conditions unrelated
to pregnancy was the third most common cause of
fetal death, followed by congenital malformations and
maternal complications.
• Among Hispanic women, maternal complications was
the third most common cause of fetal death, congenital
malformations was fourth, and maternal conditions
unrelated to pregnancy was fifth.
(2.60), Texas (2.68), and Massachusetts (2.94).
• See Table 7 for fetal deaths at 20 weeks of gestation or more
by state and territory for 2021.
Selected causes of fetal death
• The five most common selected causes of fetal death
accounted for 89.9% of fetal deaths in the 41-state and
District of Columbia reporting area (Table 8, Figure 4).
By order of frequency, these were: 1) Fetal death of
unspecified cause (unspecified cause); 2) Fetus affected by
complications of placenta, cord and membranes (placental,
cord and membrane complications); 3) Fetus affected
by maternal conditions that may be unrelated to present
pregnancy (maternal conditions unrelated to pregnancy);
4) Fetus affected by maternal complications of pregnancy
(maternal complications); and 5) Congenital malformations,
deformations and chromosomal abnormalities (congenital
malformations).
Area Fetal deaths Fetal mortality rate
1
New Jersey . . . . . . . . . . . 1,060 3.53
New Mexico . . . . . . . . . . 173 2.60
New York . . . . . . . . . . . . 2,280 3.54
North Carolina . . . . . . . . 1,405 3.93
North Dakota . . . . . . . . . 120 3.90
Ohio . . . . . . . . . . . . . . . . 1,531 3.88
Oklahoma . . . . . . . . . . . . 569 3.90
Oregon . . . . . . . . . . . . . . 414 3.37
Pennsylvania . . . . . . . . . 1,461 3.66
Rhode Island . . . . . . . . . 113 3.66
South Carolina . . . . . . . . 756 4.43
South Dakota . . . . . . . . . 128 3.78
Tennessee . . . . . . . . . . . . 1,018 4.21
Texas . . . . . . . . . . . . . . . 3,008 2.68
Utah . . . . . . . . . . . . . . . . 483 3.46
Vermont . . . . . . . . . . . . . 53 3.33
Virginia . . . . . . . . . . . . . . 922 3.19
Washington . . . . . . . . . . 804 3.18
West Virginia . . . . . . . . . 191 3.61
Wisconsin . . . . . . . . . . . . 658 3.53
Wyoming . . . . . . . . . . . . 81 4.26
American Samoa . . . . . . --- ---
Guam . . . . . . . . . . . . . . . 88 10.13
Northern Marianas . . . . . --- ---
Puerto Rico . . . . . . . . . . 353 5.99
U.S. Virgin Islands . . . . . --- ---
Area Fetal deaths Fetal mortality rate
1
Total . . . . . . . . . . . . . . . . . . 40,506 3.66
Alabama . . . . . . . . . . . . . 982 5.60
Alaska . . . . . . . . . . . . . . . 114 3.96
Arizona . . . . . . . . . . . . . . 954 4.06
Arkansas . . . . . . . . . . . . . 600 5.54
California . . . . . . . . . . . . 4,279 3.31
Colorado . . . . . . . . . . . . . 595 3.17
Connecticut . . . . . . . . . . 269 2.60
Delaware . . . . . . . . . . . . . 122 3.87
District of Columbia . . . . 144 5.38
Florida . . . . . . . . . . . . . . 2,854 4.40
Georgia . . . . . . . . . . . . . . 1,835 4.90
Hawaii . . . . . . . . . . . . . . . 174 3.60
Idaho . . . . . . . . . . . . . . . 220 3.32
Illinois . . . . . . . . . . . . . . . 1,425 3.50
Indiana . . . . . . . . . . . . . . 856 3.56
Iowa . . . . . . . . . . . . . . . . 358 3.23
Kansas . . . . . . . . . . . . . . 383 3.65
Kentucky . . . . . . . . . . . . . 628 3.99
Louisiana . . . . . . . . . . . . 612 3.51
Maine . . . . . . . . . . . . . . . 122 3.44
Maryland . . . . . . . . . . . . 856 4.12
Massachusetts . . . . . . . . 604 2.94
Michigan . . . . . . . . . . . . . 1,180 3.71
Minnesota . . . . . . . . . . . . 663 3.41
Mississippi . . . . . . . . . . . 689 6.38
Missouri . . . . . . . . . . . . . 836 3.95
Montana . . . . . . . . . . . . . 107 3.22
Nebraska . . . . . . . . . . . . 223 3.02
Nevada . . . . . . . . . . . . . . 465 4.52
New Hampshire . . . . . . . 132 3.63
--- Data not available.
1
Rate per 1,000 live births and specified fetal deaths.
NOTES: Fetal deaths with not-stated period of gestation are proportionally distributed to less than 24 weeks and 24 weeks or more; see Technical Notes in this report. Numbers may not add to
totals due to rounding.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
Table C. Fetal deaths at 24 weeks of gestation or more and fetal mortality rates, by state or territory: United States, 2019–2021
8 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
References
1. Centers for Disease Control and Prevention. CDC WONDER:
Fetal deaths information. Available from: https://wonder.
cdc.gov/fetal.html.
2. National Center for Health Statistics. User guide to the
2021 fetal death public use file. 2023. Available from:
https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_
Documentation/DVS/fetaldeath/2021fetaluserguide.pdf.
3. Makelarski JA, Romitti PA, Caspers KM, Puzhankara
S, McDowell BD, Piper KN. Use of active surveillance
methodologies to examine over-reporting of stillbirths on
fetal death certificates. Birth Defects Res A Clin Mol Teratol
91(12):1004–10. 2011.
4. Heuser CC, Hunn J, Varner M, Hossain S, Vered S, Silver RM.
Correlation between stillbirth vital statistics and medical
records. Obstet Gynecol 116(6):1296–301. 2010.
5. Lydon-Rochelle MT, Cárdenas V, Nelson JL, Tomashek KM,
Mueller BA, Easterling TR. Validity of maternal and perinatal
risk factors reported on fetal death certificates. Am J Public
Health 95(11):1948–51. 2005.
6. National Center for Health Statistics. Patient’s worksheet
for the report of fetal death. 2019. Available from: https://
www.cdc.gov/nchs/data/dvs/fetal-death-mother-worksheet-
english-2019-508.pdf.
7. National Center for Health Statistics. Facility worksheet for the
report of fetal death. 2019. Available from: https://www.cdc.
gov/nchs/data/dvs/fetal-death-facility-worksheet-2019-508.
pdf.
8. National Center for Health Statistics. Guide to completing
the facility worksheets for the Certificate of Live Birth and
Report of Fetal Death (2003 revision). National Center for
Health Statistics. 2019. Available from: https://www.cdc.
gov/nchs/data/dvs/GuidetoCompleteFacilityWks.pdf.
9. National Center for Health Statistics. 2003 revision of the
U.S. Standard Report of Fetal Death. Available from: https://
www.cdc.gov/nchs/data/dvs/FDEATH11-03finalACC.pdf.
10. Office of Management and Budget. Revisions to the
standards for the classification of federal data on race and
ethnicity. Fed Regist 62(210):58782–90. 1997.
11. MacDorman MF, Gregory ECW. Fetal and perinatal mortality:
United States, 2013. National Vital Statistics Reports; vol 64
Figure 4. Percent distribution of fetal deaths, by selected causes of death and race and Hispanic origin of mother:
41 states and the District of Columbia, 2021
Hispanic
1
11.9
11.8
13.7
10.4
21.9
30.2
Black
10.1
6.3
14.8
14.8
24.8
29.2
Total
10.1
9.9
11.9
12.6
24.2
31.3
0
20
40
60
80
100
Percent
1
People of Hispanic origin may be of any race.
NOTES: Codes in parentheses are cause-of-death codes as classified by the International Statistical Classification of Diseases, 10th Revision. Totals may not add to 100 due to rounding.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
Non-Hispanic
All others
Maternal complications
(P01)
Placental, cord and
membrane complications
(P02)
Maternal conditions
unrelated to pregnancy
(P00)
Congenital malformations
(Q00–Q99)
Unspecified cause (P95)
White
9.2
11.1
9.6
12.3
24.9
32.9
National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023 9
no 8. Hyattsville, MD: National Center for Health Statistics.
2015.
12. World Health Organization. International statistical
classification of diseases and related health problems, 10th
revision. 2009.
13. National Center for Health Statistics. Instruction manual,
part 9: ICD–10 cause-of-death lists for tabulating mortality
statistics (updated September 2020 to include WHO updates
to ICD–10 for data year 2019). Available from: https://
www.cdc.gov/nchs/data/dvs/Part9InstructionManual
2019-508.pdf.
14. National Center for Health Statistics. Model State Vital Statistics
Act and Regulations, 1992 Revision. Public Health Service.
PHS 94–1115. 1994. Available from: https://www.cdc.gov/
nchs/data/misc/mvsact92b.pdf.
15. Kowaleski J. State definitions and reporting requirements
for live births, fetal deaths, and induced terminations of
pregnancy (1997 revision). National Center for Health
Statistics. 1997. Available from: https://www.cdc.gov/nchs/
data/misc/itop97.pdf.
16. National Center for Health Statistics. Report of the Panel to
Evaluate the U.S. Standard Certificates. 2000.
17. Hoyert DL. Perinatal mortality in the United States, 1985–91.
National Center for Health Statistics. Vital Health Stat 20(26).
1995. Available from: https://www.cdc.gov/nchs/data/series/
sr_20/sr20_026.pdf.
18. Martin JA, Osterman MJK, Kirmeyer SE, Gregory ECW.
Measuring gestational age in vital statistics data: Transitioning
to the obstetric estimate. National Vital Statistics Reports; vol
64 no 5. Hyattsville, MD: National Center for Health Statistics.
2015.
19. National Center for Health Statistics. Editing specifications
for fetal death records [unpublished]. 2020.
20. National Center for Health Statistics. User guide
to the 2017 fetal death public use file. 2019.
Available from: https://ftp.cdc.gov/pub/Health_Statistics/
NCHS/Dataset_Documentation/DVS/fetaldeath/2017
FetalUserGuide.pdf.
21. National Center for Health Statistics. User guide to
the 2018 fetal death public use file. 2020. Available
from: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/
Dataset_Documentation/DVS/fetaldeath/2018Fetal
UserGuide.pdf.
List of Detailed Tables
1.
Table 1. Table 1.
Number of fetal deaths and births and fetal mortality rates
for 1990–2021 and early and late fetal deaths and fetal
mortality rates for 2014–2021: United States ........... 10
2.
Table 2.
Fetal deaths and mortality rates, by race and Hispanic origin
of mother: United States, 2018–2021 ................. 11
3.
Table 3.
Fetal deaths and mortality rates, by Hispanic origin of
mother: United States, 2018–2021 ................... 12
4.
Table 4.
Total, early, and late fetal deaths and mortality rates, by
age and race and Hispanic origin of mother: United States,
2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5.
Table 5.
Fetal mortality rates, by tobacco use during pregnancy,
age, and race and Hispanic origin of mother: United States,
2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
6.
Table 6.
Fetal deaths and mortality rates, by birthweight, gestational
age, and race and Hispanic origin of mother: 49 states and
the District of Columbia, 2021 ....................... 15
7.
Table 7.
Fetal deaths at 20 weeks of gestation or more and fetal
mortality rates: United States and each state and territory,
2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
8.
Table 8.
Fetal deaths and percentage of total deaths for the five
selected causes, by race and Hispanic origin of mother:
41 states and the District of Columbia, 2021 ............ 18
10 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
Table 1. Number of fetal deaths and births and fetal mortality rates for 1990–2021 and early and late fetal deaths and fetal
mortality rates for 2014–2021: United States
Fetal deaths Fetal mortality rate
1
Year Total
2
20–27 weeks
3
28 weeks or more
3
Live births Total
2
20–27 weeks
3
28 weeks or more
3
2021. . . . . . . . . . . . . 21,105 10,824 10,281 3,664,292 5.73 2.95 2.80
2020. . . . . . . . . . . . . 20,854 10,764 10,090 3,613,647 5.74 2.97 2.78
2019. . . . . . . . . . . . . 21,478 11,216 10,262 3,747,540 5.70 2.98 2.73
2018. . . . . . . . . . . . . 22,459 11,844 10,615 3,791,712 5.89 3.11 2.79
2017. . . . . . . . . . . . . 22,827 11,861 10,966 3,855,500 5.89 3.07 2.84
2016. . . . . . . . . . . . . 23,880 12,486 11,394 3,945,875 6.02 3.15 2.88
2015. . . . . . . . . . . . . 23,776 12,407 11,369 3,978,497 5.94 3.11 2.85
2014
4
. . . . . . . . . . . . 23,980 12,652 11,328 3,988,076 5.98 3.16 2.83
2013. . . . . . . . . . . . . 23,595 --- --- 3,932,181 5.96 --- ---
2012. . . . . . . . . . . . . 24,073 --- --- 3,952,841 6.05 --- ---
2011. . . . . . . . . . . . . 24,289 --- --- 3,953,590 6.11 --- ---
2010. . . . . . . . . . . . . 24,258 --- --- 3,999,386 6.03 --- ---
2009. . . . . . . . . . . . . 24,872 --- --- 4,130,665 5.99 --- ---
2008. . . . . . . . . . . . . 26,335 --- --- 4,247,726 6.16 --- ---
2007. . . . . . . . . . . . . 26,593 --- --- 4,316,233 6.12 --- ---
2006. . . . . . . . . . . . . 25,972 --- --- 4,265,593 6.05 --- ---
2005. . . . . . . . . . . . . 25,894 --- --- 4,138,573 6.22 --- ---
2004. . . . . . . . . . . . . 26,001 --- --- 4,112,055 6.28 --- ---
2003. . . . . . . . . . . . . 26,004 --- --- 4,090,007 6.32 --- ---
2002. . . . . . . . . . . . . 25,943 --- --- 4,021,825 6.41 --- ---
2001. . . . . . . . . . . . . 26,373 --- --- 4,026,036 6.51 --- ---
2000. . . . . . . . . . . . . 27,003 --- --- 4,058,882 6.61 --- ---
1995. . . . . . . . . . . . . 27,294 --- --- 3,899,589 6.95 --- ---
1990. . . . . . . . . . . . . 31,386 --- --- 4,158,445 7.49 --- ---
--- Data not available.
1
Number of fetal deaths in specified group per 1,000 live births and fetal deaths.
2
Fetal deaths with stated or presumed period of gestation of 20 weeks or more.
3
Not stated gestational age proportionally distributed.
4
Beginning with the 2014 data year, the obstetric estimate of gestation at delivery replaced the measure based on the date of last normal menses as the standard for measuring gestational age;
see Technical Notes in this report.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023 11
Table 2. Fetal deaths and mortality rates, by race and Hispanic origin of mother: United States, 2018–2021
Non-Hispanic, single race
1
Year
All races and
origins
2
American Indian
or Alaska Native Asian Black
Native Hawaiian
or Other Pacific
Islander White Hispanic
3
Rate
4
2021. . . . . . . . . . . . . 5.73 7.48 3.94 9.89 9.87 4.85 4.82
2020. . . . . . . . . . . . . 5.74 7.84 3.93 10.34 10.59 4.73 4.86
2019. . . . . . . . . . . . . 5.70 7.47 4.02 10.41 10.03 4.71 4.79
2018. . . . . . . . . . . . . 5.89 6.25 4.26 10.64 9.93 4.89 5.06
Number of deaths
2021. . . . . . . . . . . . . 21,105 197 846 5,173 95 9,196 4,290
2020. . . . . . . . . . . . . 20,854 212 864 5,536 103 8,753 4,231
2019. . . . . . . . . . . . . 21,478 214 963 5,766 99 9,067 4,264
2018. . . . . . . . . . . . . 22,459 183 1,029 5,938 95 9,621 4,510
1
Race and Hispanic origin are reported separately on reports of fetal death; people of Hispanic origin may be of any race. In this table, non-Hispanic women are classified by race. Race
categories are consistent with the 1997 Office of Management and Budget standards. Single race is defined as only one race reported on the report of fetal death.
2
Includes fetal deaths to race and Hispanic-origin groups not shown separately.
3
Includes all people of Hispanic origin of any race.
4
Number of fetal deaths in specified group per 1,000 live births and fetal deaths.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
12 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
Table 3. Fetal deaths and mortality rates, by Hispanic origin of mother: United States, 2018–2021
Year Total
Central and
South American Cuban Dominican Mexican Puerto Rican
Other and
unknown Hispanic
Rate
1
2021. . . . . . . . . . . . . 4.82 4.61 4.81 4.39 4.77 5.11 5.41
2020. . . . . . . . . . . . . 4.86 4.49 5.23 4.41 4.79 4.98 5.87
2019. . . . . . . . . . . . . 4.79 4.12 4.71 4.75 4.86 5.17 5.29
2018. . . . . . . . . . . . . 5.06 4.90 4.16 5.09 5.19 5.07 4.90
Number of deaths
2021. . . . . . . . . . . . . 4,290 825 118 147 2,325 363 512
2020. . . . . . . . . . . . . 4,231 766 122 140 2,312 349 542
2019. . . . . . . . . . . . . 4,264 683 112 155 2,427 369 518
2018. . . . . . . . . . . . . 4,510 726 98 164 2,587 365 570
1
Number of fetal deaths in specified group per 1,000 live births and fetal deaths.
NOTE: In this table, Hispanic women are classified only by place of origin; non-Hispanic women are not shown.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023 13
Table 4. Total, early, and late fetal deaths and mortality rates, by age and race and Hispanic origin of mother: United States,
2021
Race and Hispanic origin
and age of mother
Fetal deaths Fetal mortality rate
1
Total 20–27 weeks
2
28 weeks or more
2
Total 20–27 weeks
2
28 weeks or more
2
All races and origins
3
. . . . . . . . . . . . . . . . 21,105 10,824 10,281 5.73 2.95 2.80
Under 15 . . . . . . . . . . . . . . . . . . . . . . . 25 17 8 13.14 * *
15–19 . . . . . . . . . . . . . . . . . . . . . . . . . . 1,065 575 490 7.19 3.90 3.32
15–17. . . . . . . . . . . . . . . . . . . . . . . . 267 139 128 7.46 3.90 3.59
18–19. . . . . . . . . . . . . . . . . . . . . . . . 798 436 362 7.11 3.90 3.24
20–24 . . . . . . . . . . . . . . . . . . . . . . . . . . 3,802 1,868 1,934 5.83 2.87 2.97
25–29 . . . . . . . . . . . . . . . . . . . . . . . . . . 5,532 2,722 2,810 5.37 2.65 2.74
30–34 . . . . . . . . . . . . . . . . . . . . . . . . . . 5,747 2,989 2,758 5.13 2.67 2.47
35–39 . . . . . . . . . . . . . . . . . . . . . . . . . . 3,741 2,010 1,731 6.28 3.38 2.91
40–44 . . . . . . . . . . . . . . . . . . . . . . . . . . 1,085 585 500 8.52 4.61 3.94
45 and over . . . . . . . . . . . . . . . . . . . . . 108 58 50 11.36 6.13 5.29
Non-Hispanic, single race
4
:
Black . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,173 2,840 2,333 9.89 5.45 4.48
Under 15 . . . . . . . . . . . . . . . . . . . . . . 5 4 1 * * *
15–19 . . . . . . . . . . . . . . . . . . . . . . . . 337 186 151 10.68 5.92 4.81
15–17 . . . . . . . . . . . . . . . . . . . . . . 76 44 32 9.42
5.47 3.99
18–19 . . . . . . . . . . . . . . . . . . . . . . 261 142 119 11.11 6.07 5.10
20–24 . . . . . . . . . . . . . . . . . . . . . . . . 1,096 594 502 9.23 5.02 4.25
25–29 . . . . . . . . . . . . . . . . . . . . . . . . 1,388 727 661 9.27 4.88 4.44
30–34 . . . . . . . . . . . . . . . . . . . . . . . . 1,281 727 554 9.70 5.53 4.22
35–39 . . . . . . . . . . . . . . . . . . . . . . . . 802 454 348 11.32 6.44 4.94
40–44 . . . . . . . . . . . . . . . . . . . . . . . . 235 135 100 13.03 7.53 5.59
45 and over . . . . . . . . . . . . . . . . . . . . 29 13 16 19.19 * *
White . . . . . . . . . . . . . . . . . . . . . . . . . . 9,196 4,468 4,728 4.85 2.36 2.50
Under 15 . . . . . . . . . . . . . . . . . . . . . . 6 4 2 * * *
15–19 . . . . . . . . . . . . . . . . . . . . . . . . 359 193 166 7.10 3.83 3.30
15–17 . . . . . . . . . . . . . . . . . . . . . . 86 44 42 8.42 4.32 4.13
18–19 . . . . . . . . . . . . . . . . . . . . . . 273 149 124 6.77 3.70 3.08
20–24 . . . . . . . . . . . . . . . . . . . . . . . . 1,473 646 827 5.12 2.25 2.88
25–29 . . . . . . . . . . . . . . . . . . . . . . . . 2,437 1,119 1,318 4.56 2.10 2.47
30–34 . . . . . . . . . . . . . . . . . . . . . . . . 2,753 1,363 1,390 4.33 2.15 2.19
35–39 . . . . . . . . . . . . . . . . . . . . . . . . 1,692 900 792 5.24 2.80 2.46
40–44 . . . . . . . . . . . . . . . . . . . . . . . . 438 221
217 7.20 3.65 3.58
45 and over . . . . . . . . . . . . . . . . . . . . 38 22 16 8.91 5.18 *
Hispanic
5
. . . . . . . . . . . . . . . . . . . . . . . . . 4,290 2,220 2,070 4.82 2.50 2.33
Under 15 . . . . . . . . . . . . . . . . . . . . . . . 8 6 2 * * *
15–19 . . . . . . . . . . . . . . . . . . . . . . . . . . 274 145 129 4.93 2.62 2.33
15–17 . . . . . . . . . . . . . . . . . . . . . . . . 80 39 41 5.38 2.63 2.76
18–19 . . . . . . . . . . . . . . . . . . . . . . . . 194 106 88 4.77 2.61 2.17
20–24 . . . . . . . . . . . . . . . . . . . . . . . . . . 899 455 444 4.48 2.27 2.22
25–29 . . . . . . . . . . . . . . . . . . . . . . . . . . 1,090 560 530 4.23 2.18 2.06
30–34 . . . . . . . . . . . . . . . . . . . . . . . . . . 1,020 544 476 4.60 2.46 2.15
35–39 . . . . . . . . . . . . . . . . . . . . . . . . . . 722 366 356 5.96 3.03 2.95
40–44 . . . . . . . . . . . . . . . . . . . . . . . . . . 255 133 122 8.30 4.35 3.99
45 and over . . . . . . . . . . . . . . . . . . . . . 22 13 9 11.20 * *
* Estimate does not meet National Center for Health Statistics standards of reliability or precision; based on fewer than 20 fetal deaths in the numerator.
1
Rate per 1,000 live births and fetal deaths in specified group.
2
Fetal deaths with gestational age not stated were proportionally distributed; see Technical Notes in this report.
3
Includes fetal deaths to race and Hispanic-origin groups not shown separately.
4
Race and Hispanic origin are reported separately on reports of fetal death; people of Hispanic origin may be of any race. In this table, non-Hispanic women are classified by race. Race
categories are consistent with the 1997 Office of Management and Budget standards; see Technical Notes in this report. Single race is defined as only one race reported on the report of
fetal death.
5
Includes all people of Hispanic origin of any race.
NOTES: Fetal deaths with not-stated period of gestation were proportionally distributed to less than 28 weeks and 28 weeks or more for each age group; see Technical Notes in this report.
Numbers may not add to totals due to rounding.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
14 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
Table 5. Fetal mortality rates, by tobacco use during pregnancy, age, and race and Hispanic origin of mother: United States,
2021
Tobacco use during pregnancy and
race and Hispanic origin of mother
Fetal
deaths All ages Under 20 20–24 25–29 30–34 35–39 40–54 Not stated
All races and origins
1
Number Fetal mortality rate
2
Number
Total . . . . . . . . . . . . . . . . . . . . . . . . .
21,105 5.73 7.27 5.83 5.37 5.13 6.28 8.71 1,697
Yes . . . . . . . . . . . . . . . . . . . . . . . 1,632 9.62 6.18 7.43 8.82 10.86 12.37 17.51 …
No . . . . . . . . . . . . . . . . . . . . . . . . . 17,776 5.08 6.77 5.28 4.70 4.51 5.51 7.84 …
Non-Hispanic, single race
3
Black:
Total . . . . . . . . . . . . . . . . . . . . . . .
5,173 9.89 10.66 9.23 9.27 9.70 11.32 13.51 336
Yes . . . . . . . . . . . . . . . . . . . . . .
313 15.75 * 12.89 14.83 15.82 20.97 * …
No . . . . . . . . . . . . . . . . . . . . . . .
4,524 9.04 10.07 8.60 8.37 8.83 10.17 12.50 …
White:
Total . . . . . . . . . . . . . . . . . . . . . . . 9,196 4.85 7.15 5.12 4.56 4.33 5.24 7.31 604
Yes . . . . . . . . . . . . . . . . . . . . . . 1,096 8.62 6.14 6.77 8.10 9.93 10.32 14.87 …
No . . . . . . . . . . . . . . . . . . . . . . . 7,496 4.25 6.82 4.61 3.93 3.75 4.64 6.50 …
Hispanic
4
Total . . . . . . . . . . . . . . . . . . . . . . . . . 4,290 4.82 5.01 4.48 4.23 4.60 5.96 8.48 286
Yes . . . . . . . . . . . . . . . . . . . . . . . . 96 8.93 * 8.21 7.49 8.39 * * …
No . . . . . . . . . . . . . . . . . . . . . . . . . 3,908 4.46 4.66 4.09 3.94 4.29 5.46 7.92 …
… Category not applicable.
* Estimate does not meet National Center for Health Statistics standards of reliability or precision; based on fewer than 20 fetal deaths in the numerator.
1
Includes fetal deaths to race and Hispanic-origin groups not shown separately.
2
Rate per 1,000 live births and fetal deaths in specified group.
3
Race and Hispanic origin are reported separately on the report of fetal death; people of Hispanic origin may be of any race. In this table, non-Hispanic women are classified by race. Race
categories are consistent with the 1997 Office of Management and Budget standards; see Technical Notes in this report. Single race is defined as only one race reported on the report of
fetal death.
4
Includes all people of Hispanic origin of any race; see Technical Notes in this report.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023 15
See footnotes at end of table.
Table 6. Fetal deaths and mortality rates, by birthweight, gestational age, and race and Hispanic origin of mother: 49 states and the District of Columbia, 2021
Birthweight (grams) and race
and Hispanic origin of mother Total
Gestational age (weeks)
Fetal
mortality rate
1
20–23 24–27 28–31 32–33 34–36 37–38 39–40 41 42 or more Not stated
All races and origins
2
. . . . . . . . . . . 20,996 7,423 3,262 2,745 1,473 2,606 1,949 1,212 130 50 146 5.72
Less than 500 . . . . . . . . . . . . . . . 6,896 5,574 1,016 202 26 32 18 6 – – 22 598.92
500–749 . . . . . . . . . . . . . . . . . . . 2,305 898 1,078 258 29 22 3 3 – 1 13 212.23
750–999 . . . . . . . . . . . . . . . . . . . 1,366 142 665 445 57 32 10 4 – – 11 121.38
1,000–1,249 . . . . . . . . . . . . . . . . 1,034 39 181 616 126 52 8 3 1 – 8 80.16
1,250–1,499 . . . . . . . . . . . . . . . . 926 20 42 503 197 131 20 7 1 – 5 56.64
1,500–1,999 . . . . . . . . . . . . . . . . 1,770 17 39 455 571 522 127 26 3 1 9 28.05
2,000–2,499 . . . . . . . . . . . . . . . . 1,647 – 16 77 301 836 297 96 7 4 13 8.21
2,500–2,999 . . . . . . . . . . . . . . . . 1,468 – 11 25 59 527 571 234 25 7 9 2.09
3,000–3,499 . . . . . . . . . . . . . . . . 1,215 – – 14 26 217 488 418 32 14 6 0.86
3,500–3,999 . . . . . . . . . . . . . . . . 566 – – – 3 73 188 263 29 8 2 0.60
4,000 or more . . . . . . . . . . . . . . 332 – – – 5 42 147 102 21 11 4 1.22
Not stated . . . . . . . . . . . . . . . . . . 1,471 733 214 150 73 120 72 50 11 4 44 …
Fetal mortality rate
1
. . . . . . . . . . 5.72 538.05 170.17 73.53 32.01 9.23 1.86 0.59 0.77 5.59 … …
Non-Hispanic, single race
3
:
Black . . . . . . . . . . . . . . . . . . . . . . 5,171 1,977 842 739 376 618 363 187 22 9 38 9.89
Less than 500 . . . . . . . . . . . . . 1,902 1,549 278 58 5 5 – 1 – – 6 537.29
500–749 . . . . . . . . . . . . . . . . . 638 244 300 72 10 4 1 1 – 1 5 180.02
750–999 . . . . . . . . . . . . . . . . . 342 31 148 130 20 11 1 – – – 1 100.88
1,000–1,249 . . . . . . . . . . . . . . 280 5 37 176 40 14 3 – 1 – 4 76.80
1,250–1,499 . . . . . . . . . . . . . . 255 4 5 128 71 40 4 1 – – 2 59.03
1,500–1,999 . . . . . . . . . . . . . . 430 3 9 108 134 145 23 5 – – 3 27.76
2,000–2,499 . . . . . . . . . . . . . . 393 – 5 22 53 214 69 24 2 1 3 8.52
2,500–2,999 . . . . . . . . . . . . . . 290 – 1 5 14 109 112 41 4 1 3 2.15
3,000–3,499 . . . . . . . . . . . . . . 183 – – 4 5 36 78 56 2 2 – 0.95
3,500–3,999 . . . . . . . . . . . . . . 74 – – – 2 9 27 30 4 1 1 0.81
4,000 or more . . . . . . . . . . . . . 71 – – – - 7 34 21 7 1 1 3.31
Not stated . . . . . . . . . . . . . . . . 313 141 59 36 22 24 11 7 2 2 9 …
Fetal mortality rate
1
. . . . . . . . . 9.89 476.39 148.14 78.83 37.89 12.05 2.17 0.73 1.22 * … …
White . . . . . . . . . . . . . . . . . . . . . 9,187 3,048 1,392 1,205 643 1,224 934 601 67 24 49 4.85
Less than 500 . . . . . . . . . . . . . 2,846 2,282 424 87 14 18 10 3 – – 8 659.56
500–749 . . . . . . . . . . . . . . . . . 938 350 454 107 9 13 1 2 – – 2 244.65
750–999 . . . . . . . . . . . . . . . . . 559 55 289 171 22 13 4 1 – – 4 131.72
1,000–1,249 . . . . . . . . . . . . . . 443 18 82 264 45 25 4 2 – – 3 86.39
1,250–1,499 . . . . . . . . . . . . . . 402 11 26 236 66 51 8 2 – – 2 59.10
1,500–1,999 . . . . . . . . . . . . . . 808 7 16 216 262 230 63 8 2 – 4 29.53
2,000–2,499 . . . . . . . . . . . . . . 729 – 7 28 147 374 131 35 2 1 4 8.34
2,500–2,999 . . . . . . . . . . . . . . 713 – 7 13 28 269 271 108 12 3 2 2.29
3,000–3,499 . . . . . . . . . . . . . . 651 – – 10 16 117 253 227 19 6 3 0.90
3,500–3,999 . . . . . . . . . . . . . . 308 – – – - 42 95 148 17 5 1 0.56
4,000 or more . . . . . . . . . . . . . 143 – – – 4 16 61 44 10 7 1 0.84
Not stated . . . . . . . . . . . . . . . . 647 325 87 73 30 56 33 21 5 2 15 …
Fetal mortality rate
1
. . . . . . . . . 4.85 604.28 192.03 76.32 29.97 8.97 1.83 0.55 0.68 4.06 … …
16 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
Table 6. Fetal deaths and mortality rates, by birthweight, gestational age, and race and Hispanic origin of mother: 49 states and the District of Columbia, 2021—Con.
Birthweight (grams) and race
and Hispanic origin of mother Total
Gestational age (weeks)
Fetal
mortality rate
1
20–23 24–27 28–31 32–33 34–36 37–38 39–40 41 42 or more Not stated
Hispanic
4
. . . . . . . . . . . . . . . . . . 4,283 1,550 658 502 318 512 420 267 27 9 20 4.83
Less than 500 . . . . . . . . . . . . . 1,416 1,158 202 37 5 6 4 1 – – 3 581.28
500–749 . . . . . . . . . . . . . . . . . 476 210 204 47 8 5 – – – – 2 196.61
750–999 . . . . . . . . . . . . . . . . . 302 36 147 94 13 7 1 2 – – 2 119.51
1,000–1,249 . . . . . . . . . . . . . . 206 11 41 115 29 8 – 1 – – 1 71.85
1,250–1,499 . . . . . . . . . . . . . . 188 4 9 92 45 27 7 4 – – – 51.55
1,500–1,999 . . . . . . . . . . . . . . 349 6 12 74 119 96 27 12 1 1 1 25.34
2,000–2,499 . . . . . . . . . . . . . . 346 – 2 21 70 157 61 28 3 1 3 7.75
2,500–2,999 . . . . . . . . . . . . . . 298 – 3 4 11 98 121 52 7 2 – 1.72
3,000–3,499 . . . . . . . . . . . . . . 257 – – – 4 48 107 89 5 3 1 0.72
3,500–3,999 . . . . . . . . . . . . . . 112 – – – – 20 42 43 6 1 – 0.50
4,000 or more . . . . . . . . . . . . . 85 – – – 1 17 38 25 3 1 – 1.44
Not stated . . . . . . . . . . . . . . . . 248 125 38 18 13 23 12 10 2 – 7 …
Fetal mortality rate
1
. . . . . . . . .
4.83 500.65 150.16 59.05 30.73 7.61 1.59 0.54 0.73 * … …
– Quantity zero.
... Category not applicable.
* Estimate does not meet National Center for Health Statistics standards of reliability or precision; based on fewer than 20 fetal deaths in the numerator.
1
Rate per 1,000 live births and fetal deaths in specified group.
2
Includes fetal deaths to race and Hispanic-origin groups not shown separately.
3
Race and Hispanic origin are reported separately on the report of fetal death; people of Hispanic origin may be of any race. In this table, non-Hispanic women are classified by race. Race categories are consistent with the 1997 Office of Management
and Budget standards; see Technical Notes in this report. Single race is defined as only one race reported on the report of fetal death.
4
Includes all people of Hispanic origin of any race; see Technical Notes in this report.
NOTE: Excludes data for Hawaii; see Technical Notes in this report.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023 17
Area Fetal deaths
1
Fetal mortality rate
2
Total . . . . . . . . . . . . . . . . . . 21,105 5.73
Alabama . . . . . . . . . . . . . 510 8.71
Alaska . . . . . . . . . . . . . . . 57 6.05
Arizona . . . . . . . . . . . . . . 485 6.19
Arkansas . . . . . . . . . . . . . 304 8.38
California . . . . . . . . . . . . 2,243 5.30
Colorado . . . . . . . . . . . . . 312 4.93
Connecticut . . . . . . . . . . 162 4.52
Delaware . . . . . . . . . . . . . 54 5.13
District of Columbia . . . . 65 7.45
Florida . . . . . . . . . . . . . . 1,594 7.32
Georgia . . . . . . . . . . . . . . 1,016 8.12
Hawaii . . . . . . . . . . . . . . . 109 6.93
Idaho . . . . . . . . . . . . . . . 112 4.97
Illinois . . . . . . . . . . . . . . . 795 5.98
Indiana . . . . . . . . . . . . . . 426 5.30
Iowa . . . . . . . . . . . . . . . . 164 4.43
Kansas . . . . . . . . . . . . . . 195 5.59
Kentucky . . . . . . . . . . . . . 329 6.26
Louisiana . . . . . . . . . . . . 302 5.23
Maine . . . . . . . . . . . . . . . 67 5.55
Maryland . . . . . . . . . . . . 457 6.65
Massachusetts . . . . . . . . 290 4.18
Michigan . . . . . . . . . . . . . 601 5.69
Minnesota . . . . . . . . . . . . 349 5.39
Mississippi . . . . . . . . . . . 355 10.00
Missouri . . . . . . . . . . . . . 388 5.56
Montana . . . . . . . . . . . . . 39 3.46
Nebraska . . . . . . . . . . . . 99 4.01
Nevada . . . . . . . . . . . . . . 280 8.24
New Hampshire . . . . . . . 73 5.75
New Jersey . . . . . . . . . . . 612 5.99
New Mexico . . . . . . . . . . 84 3.91
New York . . . . . . . . . . . . 1,285 6.06
North Carolina . . . . . . . . 652 5.38
North Dakota . . . . . . . . . 52 5.12
Ohio . . . . . . . . . . . . . . . . 759 5.81
Oklahoma . . . . . . . . . . . . 269 5.53
Oregon . . . . . . . . . . . . . . 187 4.55
Pennsylvania . . . . . . . . . 777 5.82
Rhode Island . . . . . . . . . 56 5.32
Area Fetal deaths
1
Fetal mortality rate
2
South Carolina . . . . . . . . 323 5.62
South Dakota . . . . . . . . . 76 6.64
Tennessee . . . . . . . . . . . . 537 6.53
Texas . . . . . . . . . . . . . . . 1,457 3.88
Utah . . . . . . . . . . . . . . . . 309 6.57
Vermont . . . . . . . . . . . . . 27 4.99
Virginia . . . . . . . . . . . . . . 493 5.12
Washington . . . . . . . . . . 451 5.35
West Virginia . . . . . . . . . 93 5.38
Wisconsin . . . . . . . . . . . . 321 5.17
Wyoming . . . . . . . . . . . . 53 8.43
American Samoa . . . . . . --- ---
Guam . . . . . . . . . . . . . . . 31 11.68
Northern Marianas . . . . . --- ---
Puerto Rico . . . . . . . . . . 242 12.38
U.S. Virgin Islands . . . . . --- ---
--- Data not available.
1
Fetal deaths with stated or presumed period of gestation of 20 weeks or more.
2
Number of fetal deaths per 1,000 live births and fetal deaths.
NOTES: American Samoa did not report data for 2021. Data for the Northern Marianas and
the U.S. Virgin Islands were excluded due to small numbers.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
Table 7. Fetal deaths at 20 weeks of gestation or more and fetal mortality rates: United States and each state and territory, 2021
18 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
Table 8. Fetal deaths and percentage of total deaths for the five selected causes, by race and Hispanic origin of mother: 41 states
and the District of Columbia, 2021
Rank Cause and race and Hispanic origin of mother Deaths Percent
All races and origins
1
… All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,212 100.0
1 Fetal death of unspecified cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P95) 4,765 31.3
2 Fetus affected by complications of placenta, cord and membranes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P02) 3,688 24.2
3 Fetus affected by maternal conditions that may be unrelated to present pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . (P00) 1,915 12.6
4 Fetus affected by maternal complications of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P01) 1,804 11.9
5 Congenital malformations, deformations and chromosomal abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Q00–Q99) 1,503 9.9
… All other causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,537 10.1
Non-Hispanic, single-race Black
2
… All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,813 100.0
1 Fetal death of unspecified cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P95) 1,114 29.2
2 Fetus affected by complications of placenta, cord and membranes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P02) 946 24.8
3 Fetus affected by maternal complications of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P01) 566 14.8
4 Fetus affected by maternal conditions that may be unrelated to present pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . (P00) 564 14.8
5 Congenital malformations, deformations and chromosomal abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Q00–Q99) 239 6.3
… All other causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384 10.1
Non-Hispanic, single-race White
2
… All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,288 100.0
1 Fetal death of unspecified cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P95) 2,396 32.9
2 Fetus affected by complications of placenta, cord and membranes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P02) 1,818 24.9
3 Fetus affected by maternal conditions that may be unrelated to present pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . (P00) 899 12.3
4 Congenital malformations, deformations and chromosomal abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Q00–Q99) 806 11.1
5 Fetus affected by maternal complications of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P01) 697 9.6
… All other causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 672 9.2
Hispanic
3
… All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,624 100.0
1 Fetal death of unspecified cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P95) 793 30.2
2 Fetus affected by complications of placenta, cord and membranes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P02) 575 21.9
3 Fetus affected by maternal complications of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P01) 360 13.7
4 Congenital malformations, deformations and chromosomal abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Q00–Q99) 310 11.8
5 Fetus affected by maternal conditions that may be unrelated to present pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . (P00) 273 10.4
… All other causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313 11.9
… Category not applicable.
1
Includes fetal deaths to race and Hispanic-origin groups not shown separately.
2
Race and Hispanic origin are reported separately on the report of fetal death; people of Hispanic origin may be of any race. In this table, non-Hispanic women are classified by race. Race
categories are consistent with the 1997 Office of Management and Budget standards; see Technical Notes in this report. Single race is defined as only one race reported on the report of
fetal death.
3
Includes all people of Hispanic origin of any race; see Technical Notes in this report.
NOTES: Findings exclude data for jurisdictions (Arizona, Georgia, Hawaii, Mississippi, New York [including New York City], North Dakota, Vermont, and Wisconsin) for which the cause of
death was unspecified (P95) for 50% or more of records. Also excludes data for California, which did not report cause of death based on the 2003 revision of the U.S. Standard Report of
Fetal Death.
SOURCE: National Center for Health Statistics, National Vital Statistics System.
National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023 19
In this report, birthweight data for Hawaii are excluded due to a
high percentage of unknown responses (56.9%).
2003 revision of U.S. Standard Report of Fetal
Death
Data for 2018–2021 presented in this report are based on
the 2003 revision of the U.S. Standard Report of Fetal Death;
data for earlier years are based on both the 1989 and the 2003
fetal death report revisions. The 2003 revision is described in
detail elsewhere (16).
Computation of rates
Fetal mortality rates in this report are computed as the
number of fetal deaths at 20 weeks of gestation or more per
1,000 live births and fetal deaths at 20 weeks or more. The
denominators for all fetal mortality rates are live births plus fetal
deaths in the specified gestational age group, thus representing
the population at risk of the event.
In each case, the fetal deaths included in the denominator
of each rate mirror the fetal deaths included in the numerator.
A previous report (17) contains information on the historical
development of various perinatal measures. An asterisk (*) is
shown in place of any rate based on fewer than 20 fetal deaths
in the numerator.
Hispanic origin and race
Hispanic origin
Hispanic origin and race are reported separately on the
report of fetal death. Data are presented in some tables for
specific Hispanic subgroups: Central and South American,
Cuban, Dominican, Mexican, Puerto Rican, and Other and
unknown Hispanic. Data are presented separately for Dominican
women beginning in 2018. Data for this subgroup had previously
been included in the category Other and unknown Hispanic. In
tabulations of fetal death data by race and Hispanic origin, data
for people of Hispanic origin are not further classified by race
because most fetal deaths to Hispanic women are reported
as White.
Race
This report presents data on race and Hispanic origin based
on the 1997 Office of Management and Budget standards (10).
The 2003 revision of the U.S. Standard Report of Fetal Death
requires the reporting of a minimum of five race categories
and allows for the reporting of race either alone (single race)
or in combination (more than one race or multiple races) for
the mother (9), according to the Office of Management and
Budget’s 1997 revised standards (10). The five categories for
Fetal mortality rate =
Fetal deaths at 20 weeks
of gestationn or more
Live births and fetal deaths at
20 weeks or more
•• 1,000
Technical Notes
Definition of fetal death
Fetal death means death prior to the complete expulsion or
extraction from its mother of a product of human conception,
irrespective of the duration of pregnancy and which is not an
induced termination of pregnancy. The death is indicated by the
fact that after such expulsion or extraction, the fetus does not
breathe or show any other evidence of life such as beating of
the heart, pulsation of the umbilical cord, or definite movement
of voluntary muscles. Heartbeats are to be distinguished
from transient cardiac contractions; respirations are to be
distinguished from fleeting respiratory efforts or gasps.
This definition (14) has been adopted by the Centers for
Disease Control and Prevention, National Center for Health
Statistics as the nationally recommended standard and is based
on the definition published by the World Health Organization in
1950 and revised in 1988. The term fetal death is defined on
an all-inclusive basis to end confusion arising from the use of
such terms as stillbirth, spontaneous abortion, and miscarriage.
All U.S. states and registration areas have definitions similar to
the standard definition, except for Puerto Rico and Wisconsin,
which have no formal definition (15). Fetal deaths do not include
induced terminations of pregnancy.
Reporting requirements for fetal death data
Variation exists among states in reporting requirements (2)
and possibly in completeness of reporting for fetal death data,
and this can have important implications for comparisons of fetal
mortality rates by state. All jurisdictions require reporting of fetal
deaths of at least 20 weeks of gestation or more, or a minimum
birthweight of 350 grams (roughly equal to 20 weeks), or some
combination of the two. However, six states, New York City,
American Samoa, and the U.S. Virgin Islands require reporting
of fetal deaths at all periods of gestation, two states require
reporting beginning at 12 weeks of gestation, and one state
requires reporting beginning at 16 weeks of gestation. Areas
that report fetal deaths at all periods of gestation appear to have
a higher percentage of fetal deaths occurring at 20–27 weeks
of gestation than those that begin reporting at later gestational
ages. Table C presents fetal mortality rates for fetal deaths at
24 weeks of gestation or more for a combined 3-year period to
better account for state differences in reporting requirements
and to improve on the reliability of rates based on smaller
numbers. Aside from this exception, this report presents data on
fetal deaths with a stated or presumed period of gestation of 20
weeks or more.
Percentage of unknown responses
In the tables in this report, unknown responses are shown
in frequencies tables but are excluded from the computation
of percent distributions and fetal mortality rates. As a result,
rates published in this report by variables with a substantial
percentage of unknown responses (such as birthweight) may
understate the true rates of fetal mortality for that characteristic.
20 National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
race specified in the revised standards are: American Indian or
Alaska Native, Asian, Black or African American, Native Hawaiian
or Other Pacific Islander, and White.
Beginning in 2018, all states and the District of Columbia,
in addition to Guam, the Northern Marianas, Puerto Rico, and
the Virgin Islands were reporting race on fetal death reports
according to the 1997 revised Office of Management and Budget
standards. In 2021, 2.1% of women in the United States reported
more than one race. Before 2018, the number of states that
reported multiple-race information varied widely, increasing from
1 state in 2003 to all 50 states, the District of Columbia, Guam,
the Northern Marianas, Puerto Rico, and the Virgin Islands
in 2018.
Period of gestation
Beginning with the 2014 data year, the National Center for
Health Statistics began using the obstetric estimate of gestation
at delivery as the primary measure for estimating gestational
age (18). The obstetric estimate of gestation at delivery data
are edited for gestational ages that are clearly inconsistent with
birthweight. If the obstetric estimate of gestation at delivery
is not reported, or is inconsistent with birthweight, the last
menstrual period-based gestational age is used (0.5% of fetal
death records and 0.1% of live birth records in 2021). These
procedures are described in more detail elsewhere (19).
See the “User Guide to the 2017 Fetal Death Data File” for
a more detailed description of the transition and Table 1 of the
“User Guide to the 2018 Fetal Death Data File” for trends in
total, early, and late fetal mortality based on both the obstetric
estimate of gestation at delivery- and last menstrual period-
based measures (20,21).
Gestational age not stated
Fetal deaths with not-stated gestational age are presumed to
be 20 weeks of gestation or more if the state requires reporting
of all fetal deaths at 20 weeks or more, or if the fetus weighed
350 grams or more in those states requiring reporting of all
fetal deaths regardless of gestational age. In Tables 1 and 4,
fetal deaths with not-stated gestational age are allocated to the
20–27 week and 28 weeks or more categories according to
the proportion of fetal deaths with stated gestational age that
fall into each category (proportional distribution). Similarly,
for Table C, fetal deaths with not-stated gestational age are
proportionally distributed into the 20–23 week and 24 weeks or
more categories. Proportional distribution is not performed for
data in tables that show more detailed gestational age categories
(Tables B and 6). The allocation of not-stated gestational age
for fetal deaths is made individually for each maternal age, race
and Hispanic-origin group, and state in the computation of fetal
mortality rates.
Cause of death
Cause-of-death data are included for the 41 states and the
District of Columbia that reported cause of death based on the
2003 revision of the U.S. Standard Report of Fetal Death and met
the reporting requirement of having less than 50% of records
assigned to unspecified cause (P95) (cause-of-death data did
not meet these requirements for Arizona, California, Georgia,
Hawaii, Mississippi, New York [including New York City], North
Dakota, Vermont, and Wisconsin).
Random variation in fetal mortality
Please see the “User Guide to the 2021 Fetal Death Public
Use File” (2) for more detailed information and formulas.
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National Vital Statistics Reports, Vol. 72, No. 8, July 26, 2023
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Suggested citation
Gregory ECW, Valenzuela CP, Hoyert DL. Fetal
mortality: United States, 2021. National Vital
Statistics Reports; vol 72 no 8. Hyattsville, MD:
National Center for Health Statistics. 2023. DOI:
https://dx.doi.org/10.15620/cdc:129432.
Copyright information
All material appearing in this report is in
the public domain and may be reproduced
or copied without permission; citation as to
source, however, is appreciated.
National Center for Health Statistics
Brian C. Moyer, Ph.D., Director
Amy M. Branum, Ph.D., Associate
Director for Science
Division of Vital Statistics
Steven Schwartz, Ph.D., Director
Andrés A. Berruti, Ph.D., M.A., Associate
Director for Science
Acknowledgments
This report was prepared in the Division of Vital Statistics under the general
direction of Steven Schwartz, Director, Division of Vital Statistics; Isabelle Horon,
Branch Chief, Reproductive Statistics Branch; and Joyce A. Martin, Team Lead,
Reproductive Statistics Branch Birth Team.
Contents
Abstract .......................................................1
Introduction ....................................................2
Methods .......................................................2
Data sources ..................................................2
Fetal mortality .................................................2
Data limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2003 revision of U.S. Standard Report of Fetal Death ..................2
Race and Hispanic origin ........................................3
Fetal deaths by state ............................................3
Cause of death ................................................3
Statistical significance ..........................................3
Results ........................................................3
Trends in fetal mortality .........................................3
Race and Hispanic origin ........................................4
Maternal age ..................................................4
Tobacco use during pregnancy ....................................5
Plurality .....................................................5
Sex of fetus ..................................................5
Period of gestation .............................................6
Birthweight ...................................................6
Fetal mortality rates by state ......................................6
Selected causes of fetal death ....................................7
References .....................................................8
List of Detailed Tables ............................................9
Technical Notes ................................................19
