OBJECTIVE: The objective of this study was to estimate the rates and determinants of stillbirth in an urban African obstetric population. METHODS: In this retrospective cohort study we reviewed vital outcomes of newborns whose mothers received antenatal care delivery care or both antenatal and delivery care in the Lusaka Zambia public sector between February 2006 and March 2009. We excluded newborns weighing less than 1000 g those whose mothers died before delivery and those born outside Lusaka. RESULTS: There were 100454 deliveries that met criteria for inclusion. The median maternal age at the initial visit was 24 years (interquartile range 21-29) and the median gestational age was 22 weeks (interquartile range 19-26). The median gestational age at birth was 38 weeks (interquartile range 36-40) and the median neonatal birth weight was 3000 g (interquartile range 2750-3300). A total of 2109 fetuses were stillborn (crude rate 21 per 1000 live births 95% confidence interval 20.1 per 1000 to 21.9 per 1000). This included 1049 (49.7%) stillbirths classified as "recent" (presumed to have occurred within 12 hours of delivery) and 1060 (50.3%) classified as "macerated" (presumed to have occurred more than 12 hours before delivery). In adjusted analysis increasing maternal age baseline body mass index greater than 26 history of stillbirth placental abruption maternal untreated syphilis cesarean delivery operative vaginal delivery assisted breech delivery and extremes of neonatal birth weight were all significantly associated with stillbirth. CONCLUSION: Stillbirth is a major contributor to poor perinatal outcomes in Lusaka. Many deaths appear avoidable through investment in antenatal screening and better labor monitoring. Stillbirth should be adopted as a routine health indicator by the World Health Organization.