Women’s perspectives on fetal movement monitoring in high and low stillbirth settings: a mixed-methods study

BACKGROUND: Maternal fetal movement monitoring during pregnancy is commonly advised to assess fetal wellbeing. However, qualitative research exploring how women perceive and implement such advice is lacking, particularly in regions with the highest burden of stillbirth. This study investigates women's experiences of, and opinions on fetal movement monitoring during pregnancy across both high and low stillbirth rate settings. METHODS: A convergent parallel mixed-methods design was used to explore women's perspectives on fetal movement monitoring. Participants (n = 234) from three low stillbirth rate countries and five high stillbirth rate countries were recruited through social media advertisements using non-probability self-selection between December 2024 and April 2025. Quantitative and qualitative data were collected with an online survey (n = 234) and follow-up semi-structured interviews (n = 15). Survey responses and interview transcripts were analysed using inductive thematic analysis and non-parametric statistics. FINDINGS: The nature and extent of fetal movement monitoring advice varied considerably by country, encompassing active monitoring methods including kick counting, pattern awareness and movement presence detection, as well as guidance on responding to fetal movement concerns. Notably, 33% (37/112) of women in high-stillbirth countries and 8% (10/122) in low-stillbirth countries reported a lack of any fetal movement monitoring advice. Globally, half of women rated the advice easy to follow, while one-third experienced difficulty understanding their healthcare provider's guidance. Key facilitators of following advice included having an active baby and a clear understanding and confidence in the advice, whereas barriers included a lack of clarity and understanding, difficulty perceiving movements, competing time demands, and challenges in identifying patterns of movements. Maternal anxiety was particularly prevalent, with 78% of participants reporting at least occasional anxiety about fetal movements during pregnancy. CONCLUSION: Wide variation in the type and consistency of fetal movement monitoring advice across countries indicates the need for further research into the effectiveness of current recommendations, particularly in settings with high stillbirth rates. High rates of maternal anxiety worldwide highlight the importance of providing support to women navigating fetal movement monitoring.