India: Uttar Pradesh and Bihar together accounted for nearly half of India’s total stillbirths in 2023, according to a new analysis published in The Lancet Regional Health – Southeast Asia. Researchers said the country’s actual stillbirth burden is likely much higher than current estimates suggest and called for improved surveillance, earlier reporting standards and stronger maternal healthcare services to reduce preventable pregnancy losses.
The study, conducted as part of the Global Burden of Disease (GBD) Study 2023, provides the first state-level estimates of stillbirths in India using both the 22-week and 28-week gestation definitions.
Study estimates over 5.65 lakh stillbirths
Researchers estimated that approximately 5,65,900 stillbirths occurred in India in 2023 using the World Health Organization’s definition of foetal death at 22 weeks of gestation or later.
Using the more commonly reported threshold of 28 weeks or later, the study estimated 3,47,300 stillbirths during the same period.
This corresponds to:
- 25.9 stillbirths per 1,000 births at 22 weeks or later
- 16.1 stillbirths per 1,000 births at 28 weeks or later
The researchers noted that relying only on the 28-week definition significantly underestimates India’s actual stillbirth burden.
UP records highest stillbirth rate
The analysis found significant differences in stillbirth rates across Indian states.
According to the researchers, stillbirth rates varied nearly four-fold, ranging from 9.3 per 1,000 births in Mizoram to 38.2 per 1,000 births in Uttar Pradesh.
Uttar Pradesh and Bihar together accounted for almost 50 per cent of all stillbirths recorded in India during 2023, highlighting the disproportionate burden borne by the two populous states.
Researchers call for improved reporting
The study emphasised that India’s current surveillance systems often record stillbirths only after 28 weeks of gestation, whereas the World Health Organization (WHO) defines stillbirth as foetal death occurring at 22 weeks or later.
Researchers found that stillbirth estimates using the 22-week threshold were 1.6 times higher than estimates based on the 28-week definition.
They argued that adopting the WHO definition for routine reporting would provide a more accurate understanding of the country’s stillbirth burden and help strengthen public health interventions.
Analysis based on 122 data sources
The study was carried out by the India State-Level Disease Burden Initiative Stillbirth Collaborators.
Researchers compiled and analysed information from 122 different sources, including:
- National surveys
- Published scientific studies
- Sample Registration System (SRS) data
- Other health databases
The analysis also examined links between stillbirth rates and broader health indicators across Indian states.
Link found with health development indicators
The researchers identified a modest inverse relationship between stillbirth rates and the Sustainable Development Goal 3 (SDG-3) Index developed by NITI Aayog.
SDG-3 focuses on ensuring good health and well-being.
States with stronger overall health performance generally recorded lower stillbirth rates, suggesting that improvements in healthcare systems can contribute to better pregnancy outcomes.
Key risk factors identified
The study highlighted several major risk factors associated with stillbirths, including:
- Delayed or referred deliveries
- Preeclampsia and eclampsia
- Severe antepartum and postpartum haemorrhage
- Multiple pregnancies
- Previous history of stillbirth
- Previous preterm birth
Researchers said addressing these risks throughout pregnancy and childbirth could significantly reduce stillbirths.
Strengthening maternal healthcare is key
The authors stressed that meaningful reductions in stillbirths would require improvements across the entire continuum of maternal healthcare.
They recommended:
- Strengthening antenatal care services
- Improving intrapartum monitoring during labour
- Expanding access to emergency obstetric care
- Enhancing surveillance and reporting systems
- Recording stillbirths from 22 weeks of gestation onwards
The researchers also noted that existing national datasets, including the Sample Registration System (SRS) and National Family Health Survey (NFHS), have traditionally been the primary sources for analysing stillbirths in India.
Conclusion
The study concludes that India’s stillbirth burden remains substantially underestimated under current reporting practices. By adopting the WHO definition, improving surveillance systems and strengthening maternal and newborn healthcare services, policymakers could better identify at-risk pregnancies and implement targeted interventions.
Researchers said coordinated action involving healthcare providers, governments and public health agencies will be essential to reducing preventable stillbirths and improving maternal and neonatal outcomes across the country.