Objective. We determined the stillbirth rate and associated factors among women who delivered in rural hospitals in The Gambia. Method. A cross-sectional retrospective case review of all deliveries between July and December 2008 was undertaken. Maternity records were reviewed and abstracted of the mother’s demographic characteristics, obstetric complications and foetal outcome. Main Outcome Measure: The stillbirth rate was calculated as deaths per 1000 births. Results. The hospital-based stillbirth rate was high, 156 (95% CI 138–174) per 1000 births. Of the 1,519 deliveries, there were 237 stillbirths of which 137 (57.8%) were fresh. Severe obstetric complication, birth weight <2500 g, caesarean section delivery, and referral from a peripheral health facility were highly significantly associated with higher stillbirth rates, OR = 6.68 (95% CI 3.84–11.62), 4.47 (95% CI 3.04–6.59), 4.35 (95% CI 2.46–7.69), and 3.82 (95% CI 2.24–6.51), respectively. Half (50%) of the women with stillbirths had no antenatal care OR = 4. 46(95% CI 0.84–23.43). Conclusion. We observed an unacceptably high stillbirth rate in this study. As most of the stillbirths were fresh, improved intrapartum care supported by emergency transport services and skilled personnel could positively impact on perinatal outcomes in rural hospitals in The Gambia.