Stillbirth is a compounding effect of several contributing factors that may include maternal, fetal, placental, and environmental factors. On a global scale, stillbirth is the 5th leading cause of death, and many cases are considered unexplained stillbirth (76%). The limited knowledge about the pathophysiology associated with stillbirths tops the rank. Low- and middle- income countries show higher stillbirth cases compared to high-income countries, inferring a lack of suitable maternal health care delivery.
The estimation of stillbirth rates (SBR) also varies across countries. The major hurdles for SBR estimation between and within countries are due to two factors:
- Deficient collection of stillbirth data
- Lack of uniformity in the definition of stillbirth gestational threshold
The lack of access to proper maternal health care, along with awareness among people regarding maternal care and health policies, contributes to the incomplete data collection on stillbirth. There is also a range of regional variations among and within countries regarding the gestational threshold for stillbirth definition. Many countries follow the SBR estimation at a late-gestation definition, i.e., >28 weeks. On the other hand, the World Health Organization (WHO) definition says that death of a fetus at the gestational age of 22 weeks or more is stillbirth. However, the Global Burden of Diseases (GBD) study has also utilized the data of stillbirths at the gestational age of >20 weeks. The assessment of SBR at >20 weeks and >22 weeks has allowed a comprehensive analysis of the magnitude of this problem.
Stillbirth issue in India
A recent report published in The Lancet Regional Health Southeast Asia has shown the lack of proper attention to stillbirth issues in India. The GBD study has shown that the SBR in India is much higher when the gestational threshold is >20 weeks and >22 weeks as compared to >28 weeks. India also shows a major regional disparity in SBR estimation as two northern states, UP and Bihar, account for nearly 50% of India’s total SBR in 2023. The report shows Mizoram has the lowest SBR (9.3 per 1,000 total births) and UP accounted for the highest SBR (38.2 per 1,000 total births). Envisioning UP along with Bihar to be high priority areas for the planning and execution of maternal health programs.
Stillbirth is an agonizing issue and has a huge emotional, psychological, and social impact on the mother and the families undergoing such trauma. In India, stillbirth is mainly associated with –
- High population density,
- Lack of proper maternal healthcare service delivery
- Maternal anemia
- Lack of awareness among women about their health issues
- Delayed hospital referral
Besides other major maternal and fetal health problems that can lead to stillbirths are-
- High Blood Pressure/ Hypertension
- Diabetes Mellitus
- Obesity
- Substance abuse (Alcohol, tobacco, or illicit drug consumption)
- Placental and/or umbilical cord abnormalities
- Congenital defects
- Change in amniotic fluid index (Polyhydramnios and Oligohydramnios)
- Autoimmune diseases
- Infections during pregnancy
- Antiphospholipid syndrome
In the Indian scenario, the reduction in SBR requires a comprehensive approach starting with procuring accurate data (with a lower gestational threshold) to effective health policy-making and its execution on a larger scale and improving antenatal health care. Early identification and management of maternal health factors like anemia and hypertension would further help to minimize SBR in India.
Please share your thoughts regarding maternal anemia and SBR in India!
MBH/PS