What is stillbirth awareness week in India?

Stillbirth Awareness Week in India

India does not have an officially designated national "Stillbirth Awareness Week" comparable to international observances, though the country faces the world's highest absolute burden of stillbirths and has implemented the India Newborn Action Plan (INAP) targeting reduction to <10 stillbirths per 1,000 births by 2030. 1

Current Stillbirth Burden in India

• India contributes approximately 500,000 stillbirths annually, representing the largest absolute number globally 2
• The national stillbirth rate is 12.2 per 1,000 births, though hospital-based surveillance data from North India shows rates as high as 29.3 per 1,000 births 2, 3
• State-level data from Bihar shows an annualized stillbirth incidence of 21.2 per 1,000 births, with higher rates in rural areas 1
• Regional variation exists across India's 21 states and Union Territories, though comprehensive national data remains limited 4

India Newborn Action Plan (INAP) Framework

• The Indian government adopted INAP with a specific target of <10 stillbirths per 1,000 births by 2030 1
• INAP emphasizes systematic documentation of stillbirths in a standardized manner to bridge knowledge gaps and enable appropriate interventions 1
• The plan calls for strengthening stillbirth audits along with registry systems to identify modifiable factors and delays for country-specific preventive strategies 4

Major Contributing Factors in India

Maternal Conditions:

• Hypertension accounts for 18.2% of stillbirths 5
• Preterm labor contributes to 25.7% of antepartum stillbirths 3
• Anemia, fever during labor, and hypertension represent the most common maternal complications in the last 3 months of pregnancy 1
• Diabetes increases stillbirth risk by 74% (AOR 1.74,95% CI 1.14-2.67) 2
• Hypertension increases stillbirth risk by 50% (AOR 1.50,95% CI 1.16-1.95) 2

Fetal Causes:

• Fetal growth restriction accounts for 31.2% of antepartum stillbirths 3
• Congenital malformations contribute to 7% of stillbirths 3
• Approximately 20% of stillbirths remain classified as unknown or unexplained 4

Healthcare System Gaps:

• Nearly 50% of women who experienced stillbirths received no antenatal care 3
• Only 55.9% of women reported at least one antenatal care visit 1
• 33% of women did not consume iron folic acid tablets during pregnancy 1
• Only 6.1% of women underwent syphilis testing 1

Timing and Classification

• Antepartum stillbirths comprise 75.7% of cases, while intrapartum stillbirths account for 24.3% 3
• Approximately two-thirds of stillbirths occur antepartum, with the remaining one-third occurring intrapartum 4
• A critical limitation is the lack of uniformity in stillbirth definitions and classification systems across Indian studies 4

Critical Healthcare Provider Issues

• Three major themes identified through verbal autopsy narratives relate to healthcare providers: lack of timely attention, poor clinical skills (knowledge or implementation), and reluctance to deliver a stillborn baby 1
• Uterine rupture and eclampsia account for 11% and 8.3% of intrapartum stillbirths respectively, highlighting inadequate skilled care during delivery 3
• Obstetric complications and excessive bleeding during delivery contribute to nearly 30% of stillbirths as possible risk factors 1

Advocacy and Awareness Needs

• The Lancet Global Health calls for widespread awareness-raising, drawing lessons from advocacy success stories like the International Day to End Obstetric Fistula 6
• Successful advocacy requires framing stillbirth as a health and human rights issue, SDG target-setting, generating prevalence data, and implementing national policy with global estimates 6
• Amplifying voices of women, representative organizations, patient advocacy, and community-led groups is essential 6
• Women and families should have access to evidence-based information on prevalence, prevention, and management of stillbirth 6

Recommended Interventions for India

Antenatal Care Strengthening:

• Routine symphysio-fundal height measurements should be implemented 3
• Mandatory third-trimester ultrasounds are needed 3
• Better screening and management of diabetes and hypertension pre- and during pregnancy is crucial 2
• Integrated care for metabolic conditions (diabetes and hypertension) must be prioritized given their synergistic effect (AOR 1.58,95% CI 1.25-1.99) 2

Intrapartum Care Improvements:

• Partograph use should be mandatory to reduce intrapartum stillbirths 3
• Enhanced skilled care during delivery is essential, as obstetric complications contribute significantly to stillbirths 1
• Better maternity ante-natal and intra-natal care is required to achieve single-digit stillbirth rates 5

Data and Research Priorities:

• Greater investment in epidemiological, interventional, and implementation research is needed 6
• Community-based surveillance systems must be established, as hospital data underestimates true burden 3
• Standardized definitions and classification systems for stillbirths should be adopted nationally 4
• Research should engage with and be driven by key stakeholders in affected communities 6

Targeted Interventions:

• Mothers belonging to scheduled caste categories face higher stillbirth risk (AOR 1.30,95% CI 1.10-1.53) and require targeted interventions 2
• Smaller household size is a risk factor (AOR 1.2,95% CI 1.1-1.3), suggesting need for social support interventions 5