Late gestation stillbirth epidemiology: findings from a nationally representative mortality survey of one million population sample in India

BACKGROUND: We report on late gestation stillbirth rate (SBR) and impact of COVID-19 pandemic in a nationally representative mortality survey in nine Indian states. METHODS: Detailed verbal autopsy (VA) interviews using PHMRC VA tool were undertaken for stillbirths reported between 2019 and 2022 from the adult most knowledgeable about the circumstances in a nationally representative population sample of one million. Late gestation stillbirth was defined as a fetal death with gestation period of ≥ 7 months where the fetus did not show any sign of life. We estimated overall SBR, and pre-, during and post-COVID-19 periods per 1000 births for India. We also report on stillbirth registration, last rites, and whether the mother was able to see and hold her baby. RESULTS: We identified 878 stillbirths in 59,639 births from 240,975 households (87.1% participation) covering an average population of 1,002,098. The annualised SBR between 2019 and 2022 was 14.7 (95% CI 13.8–15.7) per 1,000 births. The SBR in post-COVID-19 period (18.3; 95% CI 16.1–20.8) was significantly higher than pre-COVID-19 period (12.7; 95% CI 11.2–14.4) and COVID-19 period (14.4; 95% CI 13.0-15.9). The annualised antepartum SBR was estimated at 6.1 (95% CI 5.5–6.7) and intrapartum SBR at 5.0 (95% CI 4.5–5.6) per 1,000 births. Stillbirth certificate was available for only 8 stillbirths; last rites were performed for nearly all stillbirths (98.9%) and burial was the most commonly reported practice (90.9%). Only 187 (25.5%) mothers had seen and held their stillborn baby, 194 (26.4%) had only seen their baby, and 353 (48.1%) had neither seen nor held their baby. CONCLUSIONS: This study documents an increase in SBR post COVID-19 pandemic as compared with the pre- and pandemic periods in India. Findings could contribute to monitoring of SBR, development of bereavement guidelines, and strengthening of stillbirth registration to address the burden of stillbirths in India.