Methodological Notes – Reproductive Outcomes Module

Updated: January 2019

Concepts and Definitions

An important measure of reproductive outcome, the survival of the fetus while still in utero and also shortly after birth, is the number and rate of perinatal deaths. International comparisons of perinatal mortality have been hampered by variable definitions across national jurisdictions.

WHO defines the perinatal period as commencing at 22 completed weeks (154 days) of gestation, and ending at 7 completed days after birth. This definition dates from ICD-10 and is recommended in its guidelines for reproductive health indicators

A perinatal death is thus a death (of a fetus or a neonate) within this perinatal period. WHO also specifies that the fetus should weigh at least 500 grams or has a crown-heel length of 25 cm or more. A neonate who dies between birth and 7 completed days (called early neonatal death) clearly had to be born alive first, and counted originally as a livebirth. An alternative definition of perinatal death includes fetal deaths of 28 weeks or more gestation (called late fetal deaths) and early neonatal deaths.

The WHO definition of a fetal death:

Death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation 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.

Fetal death is the preferred term, and should replace others such as “stillbirth”, “miscarriage” or “spontaneous abortion”. Fetal deaths do not include induced terminations of pregnancy (induced abortions).

CircHOB reports two sets of perinatal mortality rates based on the two definitions, PMR-1 and PMR-2:

PMR-1 = (fetal deaths of 22+ weeks gestation) + (early neonatal deaths <7 days) in year X) / (sum of livebirths and fetal deaths in year X)
PMR-2 = (fetal deaths of 28+ weeks gestation) + (early neonatal deaths <7 days) in year X) / (sum of livebirths and fetal deaths in year X)

Both rates are expressed as per 1000 total births. Region of residence refers to that of the mother. WHO’s “22+ weeks” definition is adhered to by the Nordic countries, Greenland and Faroe Islands. Canada and the United States report fetal deaths from 20 weeks and also from 28 weeks. Russia changed from the 28+ weeks definition to the 22+ weeks one in 2012. In general PMR-1 tend to be higher than PMR-2 due to the longer period and larger number of fetal deaths

Other commonly used indicators of reproductive outcomes include the distribution of livebirths by birthweight (low birth weight and high birth weight) and gestational age. CircHOB has discontinued monitoring these indicators due to gaps in the availability of publicly accessible data, especially for the regions.


Data Sources and Limitations

In calculating rates and proportions, the number of livebirths used in this module of CircHOB may differ from those reported in the fertility module, derived from the various national statistical agencies. In the case of the United States and Canada, these agencies are also the source of information on perinatal deaths, and hence the livebirth counts are identical. For the other jurisdictions, the medical births registry or office of the chief medical officer is used as the source of both the number of livebirths and the number of perinatal deaths. The livebirth counts from these sources differ from those of their national statistical agencies in that the birth registries tend to record and report only on births occurring within the country, whereas the national statistical agencies record and report on births to mothers who are citizens/permanent residents regardless of the place of delivery. Because of incomplete data capture from health care institutions, the livebirth counts in the medical births registry also tend to be lower than the counts reported by the national statistical agencies.

United States

Perinatal mortality data are available from CDC Wonder Mortality > Fetal deaths; Mortality > Infant deaths; Births Fetal deaths of 20+ weeks and 28+ weeks are reported. The database reports data only from 2005 onwards. Data for 2000-04 were obtained by special request to the National Center of Health Statistics. CircHOB uses the 20+ weeks data in place of 22+ weeks in calculating PMR-1.


Data on perinatal deaths to calculate PMR-1 and PMR-2 are available from Statistics Canada. It is 20+weeks data rather than 22+ weeks that are used in calculating PMR-1.

Late fetal deaths (28+weeks) and early neonatal deaths are reported in the table on perinatal mortality (13-10-0714-01, formerly CANSIM 102- 0508) Fetal deaths (20+ weeks and 28+ weeks) are available from the table on stillbirths (13-10-0427-01, formerly CANSIM 102-4514)

Livebirths data are from Table 13-10-0416-01 (formerly CANSIM 102-4503)


Perinatal mortality data (PMR-1) are reported in the annual report of the Chief Medical Officer of the Chief Medical Officer (Landslægeembedet), Landslægeembedet > Udgivelser > Landslægeembedets Årsberetninger, various years

Faroe Islands

Perinatal mortality data (PMR-1) are provided by the Chief Medical Officer in the annual report Sundhedsberetning


PMR-1 data are from the report Nordic Perinatal Statistics PMR-2 data are from Statistics Iceland Deaths > Deaths > Infant mortality and late fetal deaths MAN05321


PMR-1 data are obtained from the report Nordic Perinatal Statistics compiled by the National Institute of Health and Welfare of Finland PMR-2 data are obtained from OECD Health > Health status > Maternal and infant mortality


PMR-1 data are available from the Medical Births Registry of the Norwegian Institute of Public Health PMR-2 data are available only for Norway nationally from OECD Health > Health status > Maternal and infant mortality


PMR-1 data are from the Medical Births Registry at the National Board of Health and Welfare (Socialstyrelsen) PMR-2 data are available only for Sweden nationally from OECD Health > Health status > Maternal and infant mortality


National data on perinatal mortality (PMR-1) are available from the THL report Perinatal Statistics Sexual and reproductive health > Parturients, deliveries and births > Perinatal statistics

Regional data for 2000-05 are from the report Parturients, Deliveries and Births, various years, and 2006-14 data are from the biennial report Newborns, various years

PMR-2 data for Finland nationally only are obtained from OECD Health > Health status > Maternal and infant mortality

Russian national and regional data were from the Demographic Yearbook, various years

Note that Russia changed the definition from PMR-2 to PMR-1 in 2012 but subsequent reports did not revise old data using PMR-2. For the years 2010-14, CircHOB presents both PMR-2 (based on 2010-11 data) and PMR-1 (based on 2012-14 data).