Count the Kicks Research

BJOG: An International Journal of Obstetrics and Gynaecology published research that shows a more than 30% reduction in Iowa’s stillbirth rate in the first 10 years of the Count the Kicks stillbirth prevention program at a time when America’s stillbirth rate remained stagnant. The results have led researchers to call for urgent action to address the stillbirth crisis in the U.S. and to study Count the Kicks on a national level.

Dr. Alexander Heazell, global stillbirth researcher at the Tommy’s Research Centre at the University of Manchester, England, and his team of statisticians looked at Iowa’s stillbirth rate from 2005 (before the introduction of Count the Kicks) through 2018 (the end of the first decade of implementation) and compared it to three neighboring states that did not have a comprehensive stillbirth prevention program during the same time period.

The report, “Information about fetal movements and stillbirth trends: analysis of time series data,” that was published in February 2023, found the stillbirth rate in Iowa went down 1% every three months for a decade (2008-2018) while stillbirth rates in neighboring Illinois, Minnesota, and Missouri, remained relatively stagnant during that time frame. The research also shows that the stillbirth rate in Iowa went down sharply despite confounding factors like obesity, maternal age, high blood pressure and diabetes all increasing during the same timeframe. 

Dr. Heazell Shares His Findings

“To be able to demonstrate that we have a rate going down at 1% every three months in Iowa, which is much faster than the U.S. population average, that tells us that something is happening in Iowa that is not happening in the rest of the United States.” -Dr. Alexander Heazell, global stillbirth researcher at the Tommy’s Research Centre at the University of Manchester, England

Stillbirth in the U.S.

Every year in the U.S. more than 21,000 babies are born still, according to the CDC. The U.S. has one of the highest rates of stillbirth of high-income countries, and also one of the lowest rates of improvement. For U.S. parents, 1 in every 177 pregnancies ends in stillbirth. Stillbirth data broken down by state can be found here. Racial disparities persist, and expectant parents in racial or ethnic minorities have a greater risk of enduring a stillbirth. According to the CDC: 

• 1 in 97 Native Hawaiian or Other Pacific Islander pregnancies end in stillbirth
• 1 in 100 Black pregnancies end in stillbirth
• 1 in 139 American Indian or Alaska Native pregnancies end in stillbirth
• 1 in 216 Hispanic pregnancies end in stillbirth
• 1 in 223 White pregnancies end in stillbirth
• 1 in 270 Asian pregnancies end in stillbirth

“The U.S. ranked 27th out of 49 high income countries in 2015 with a low annual rate of reduction in stillbirth. Thus, identification of effective strategies to reduce stillbirth are urgently needed,” Dr. Heazell said.

In addition to Heazell’s research, data from the Iowa Barriers to Prenatal Care survey shows that 78% of Iowa moms learn about how to monitor changes in their baby’s activity during pregnancy from their provider. Systemic change is happening throughout the state and kick counting has become more commonplace in Iowa than in the rest of the country. In June of 2018, toward the end of the study period, the state of Missouri adopted Count the Kicks.

About Count the Kicks

Count the Kicks, which started in Iowa in 2008, was developed by Healthy Birth Day, Inc. as an empowering stillbirth prevention program for expectant parents to get to know their baby’s normal movement patterns in the third trimester and to speak up if they notice a change. Decades of research, including this study out of Norway, shows paying attention to movement is a non-invasive way for expectant parents to monitor their baby’s health and that babies can in fact be saved when parents speak up and providers act on their concerns.

The program teaches expectant parents the method for tracking fetal movement during the third trimester of pregnancy through a network of providers, birthing hospitals and maternal health champions using printed educational materials, a free mobile app, health worker training and mom-to-mom outreach. 

Healthy Birth Day, Inc. CEO Emily Price discusses the history and research behind our Count the Kicks stillbirth prevention program on Season 4 of the Maternal Health Innovation podcast. Emily shares her personal connection to Count the Kicks and how the campaign has evolved to save both babies and birthing peoples’ lives.