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Burden, Differentials and Causes of Stillbirths in India: A Systematic Review and Meta Analysis

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Abstract

India contributes the highest absolute number of stillbirths in the world. This systematic review and meta-analysis was conducted to synthesize the burden, timing and causes of stillbirths in India. Forty-nine reports from 46 studies conducted in 21 Indian states and Union Territories were included. It was found that there was no uniformity/standardization in the definition of stillbirths and in the classification system used to assign the cause. The share of antepartum stillbirths was estimated to be two-third while remaining were intrapartum stillbirths. Maternal conditions and fetal causes were found to be the leading cause of stillbirth in India. The maternal condition was assigned as the commonest cause (25%) followed by fetal (14%), placental cause (13%), congenital malformation (6%) and intrapartum complications (4%). Approximately 20% of the stillbirths were assigned as unknown or unexplained. This review demonstrates that there is a paucity of quality stillbirth data in India. Other than the state level differences in stillbirth rates, no other data is available on inequities in stillbirths in India. There is an urgent need for strengthening availability and quality of stillbirth data in India on both stillbirth rates as well as the causes. There is a need to conduct additional research to know the timing of the stillbirths, causes of death and actual burden. India needs to strengthen stillbirth audits along with registry to find out the modifiable factors and delays for making country specific preventive strategies. The policy makers, academic community and researchers need to work together to ensure accelerated and equitable reduction in stillbirths in India.

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Acknowledgements

The authors thank Dr. Susannah Leisher for the inputs and suggestions on this manuscript. Special thanks to Balaji Susindran at data and evidence team of the Foundation for people-centric Health Systems, New Delhi and Dr. Shruti Verma at Foundation for People-centric Health Systems, New Delhi for inputs and technical support at various stages of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India

    Bharti Sharma & Neelam Aggarwal

  2. Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-centric Health Systems, New Delhi, 110029, India

    Chandrakant Lahariya & Sapna Yadav

  3. SD Gupta School of Public Health, The IIHMR University, Jaipur, 302029, India

    Chandrakant Lahariya

  4. Department of Community Medicine, Sri Venkateshwara Medical College Hospital & Research Center, Puducherry, India

    Marie Gilbert Majella

  5. Director- Projects, Human Capital Lighthouse Consulting Pvt Ltd, New Delhi, 110029, India

    Anita Upadhyay

  6. Department of Public Health, Survival for Women & Children (SWACH) Foundation, Panchkula, Haryana, India

    Ankit Raina

  7. Department of Obstetrics & Gynecology, Aligarh Muslim University, Aligarh, U.P, India

    Tamkin Khan

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Contributions

BS, CL & NA conceived the idea of systematic review, and metanalysis. Review of literature, analysis was done by BS, MGM & CL with inputs from NA, TK, AU, AR and SY. The first draft was prepared by BS and CL provided detailed and comprehensive inputs on the analysis and wrote the discussion. All authors reviewed and provided their inputs and approved the final version of manuscript. CL and NA will act as guarantor for this manuscript.

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Correspondence to Bharti Sharma.

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Sharma, B., Lahariya, C., Majella, M.G. et al. Burden, Differentials and Causes of Stillbirths in India: A Systematic Review and Meta Analysis. Indian J Pediatr 90 (Suppl 1), 54–62 (2023). https://doi.org/10.1007/s12098-023-04749-9

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