New Delhi: Uttar Pradesh and Bihar together accounted for half of India’s total stillbirths in 2023, according to an analysis published in The Lancet Regional Health Southeast Asia.
Estimates also suggest that about 5,65,900 and 3,47,300 stillbirths occurred in India in 2023, corresponding to stillbirth rates of 25.9 and 16.1 at a gestation period of 22 weeks or later and 28 weeks or later, respectively.
Researchers forming the India State-Level Disease Burden Initiative Stillbirth Collaborators said the country’s true stillbirth burden is markedly underestimated using the 28-week or later definition.
The stillbirth rate estimate for India at beyond 22 weeks’ of gestation was found to be 1.6 times higher than at beyond 28 weeks’ of gestation, the definition most used for international comparison.
Addressing the stillbirth burden in India would therefore require an improved surveillance, tracking stillbirths by the 22-week or later threshold, and an integration of stillbirth prevention within broader maternal and newborn health initiatives, they said.
The team compiled and analysed data from 122 sources, including surveys, published studies and sample registration systems.
“SBR (stillbirth rate) for both definitions varied four-fold between states, from 9.3 in Mizoram to 38.2 in Uttar Pradesh, with the latter and Bihar together accounting for nearly half of India’s total stillbirths,” the authors wrote.
They also found a modest inverse correlation between stillbirth rates and SDG3 index score developed by the NITI Aayog, where SDG3 refers to the United Nations’ Sustainable Development Goal 3 of ‘good health and well-being’.
Deferred and referred deliveries, preeclampsia or eclampsia, severe postpartum and antepartum haemorrhage, are among the risk factors for stillbirths, along with multiple births and a previous history of stillbirth and preterm birth, the researchers said.
Further meaningful reduction in stillbirths can be achieved by focussing on the risk factors across the continuum of maternal care services, they said.
The team added that national data sources, including the Sample Registration System (SRS) and National Family Health Surveys (NFHS) have been primarily looked at for previous analyses of stillbirths in India.
The World Health Organization defines stillbirth as a foetal death at 22 weeks’ gestation or longer.
However, few countries, including India, routinely collect or report data below the 28-week threshold due to inconsistencies in surveillance systems and the limited availability of gestational-age-specific data, the researchers said.
Conducted as part of the Global Burden of Disease study 2023, the analysis produces the first state-level estimates of stillbirths in India at both 22 weeks and beyond and 28 weeks and beyond gestation period, they said.
“These findings demonstrate the urgent need for coordinated multi-sectoral action to strengthen antenatal, intrapartum, and emergency obstetric care, alongside improved data collection and reporting mechanisms,” the team added.
