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A landmark national study has uncovered a alarming 44% rise in India’s stillbirth rates in the post-COVID period, jumping from 12.7 to 18.3 per 1,000 births between 2019 and 2022, signaling persistent breakdowns in maternal healthcare even after pandemic restrictions lifted.
Researchers from the Public Health Foundation of India (PHFI), backed by the Indian Council of Medical Research (ICMR), analyzed data from nearly one million people across nine states, highlighting how disrupted antenatal care and referral delays fueled preventable fetal deaths, particularly in rural areas and late pregnancy.
Study Key Findings
The research, published in BMC Pregnancy and Childbirth, tracked stillbirths—defined as fetal deaths after 22 weeks gestation—via a mortality survey in Assam, Gujarat, Haryana, Jharkhand, Kerala, Maharashtra, Odisha, Tamil Nadu, and Uttar Pradesh. Rates climbed from 12.7 per 1,000 births pre-COVID (2019), to 14.4 during the pandemic, then spiked to 18.3 post-COVID (2021-2022), with rural areas hitting nearly 20 per 1,000 versus 14 in urban settings.
Of 745 documented stillbirth cases, over half occurred at nine months or later, often days before delivery, underscoring lapses in third-trimester monitoring like fetal movement checks and Doppler ultrasounds. Facility breakdowns showed 44.7% in public hospitals, 39.2% in private ones, and 16.1% at home, varying by state—for instance, private facilities dominated in Kerala (66.7%) while public ones led in Odisha (72.6%). Nearly 20% involved inter-facility referrals during labor, and just 1% were officially registered despite mandates.
Expert Insights
Dr. Renu Gupta, Director of Obstetrics & Robotic Gynaecology at Sri Balaji Action Medical Institute in Delhi, attributed the surge to inconsistent late-pregnancy surveillance post-COVID: “Third-trimester monitoring—blood pressure, fetal growth and movement, Doppler studies—has become inconsistent, especially in overstretched public hospitals. Referral delays, staff shortages and weak transport systems mean warning signs are often missed.”
Dr. Sutapa B. Neogi, Director at the International Institute of Health Management Research (IIHMR) Delhi, who has studied maternal health cohorts, emphasized systemic gaps: “While delivery volumes recovered, quality hasn’t—overburdened systems fail to catch risks in high-need rural areas.” These voices, independent of the study team, stress that many losses are avoidable with better resource allocation.
Pre-Pandemic Context
India long bore the world’s highest stillbirth burden, with 397,300 cases in 2021 per Global Burden of Disease estimates, at about 13.9 per 1,000 births nationally before COVID disruptions. Progress had reduced rates from 29.6 in 2000 to 13.9 by 2019, aligning with the India Newborn Action Plan (INAP) aiming for single-digit rates by 2030.
Yet underreporting plagued data; National Family Health Surveys pegged rates 2.6 times higher than official Sample Registration System figures (9.7 vs. 3.8 per 1,000 from 2016-2020). Rural-urban divides and low registration (like the study’s 1%) masked the true scale, even pre-pandemic.
Pandemic and Post-Pandemic Impact
COVID lockdowns slashed antenatal visits and emergency services, with prior Bihar studies showing 24% overall and 69% intrapartum stillbirth rises during peaks. The national survey links post-COVID jumps to lingering effects: staff shortages, transport fears, and shifted care-seeking, pushing more births to under-equipped homes or delayed facilities.
Emotional fallout compounds tragedy—nearly half of mothers never saw or held their baby, per family or medical choices, while only one-third learned the cause. This echoes global patterns where pandemics amplified inequities, though India’s scale dwarfs others due to population size.
Public Health Implications
This surge threatens INAP’s 2030 single-digit goal, demanding urgent boosts in antenatal surveillance, referral networks, and rural staffing. For families, it means prioritizing third-trimester checks: daily fetal kick counts from 28 weeks, blood pressure monitoring, and prompt reporting of reduced movements—simple steps that detect issues early.
Policymakers must enforce stillbirth registration, train providers in timely ultrasounds, and expand ambulance services, potentially averting thousands of losses yearly. Health-conscious readers can advocate via community programs, but systemic fixes are key to equity.
Limitations and Counterpoints
The study relies on verbal autopsies from surveys, not clinical autopsies, risking recall bias, though its one-million sample size bolsters reliability across diverse states. It covers nine states, possibly underrepresenting others, and doesn’t isolate COVID infections’ direct role—some research links maternal SARS-CoV-2 to higher risks, but service disruptions dominate here.
Critics note private sector shifts in some states might reflect better reporting, not worse outcomes, yet rural spikes counter this. Vaccination studies suggest it lowered stillbirths in exposed pregnancies, highlighting prevention’s role amid disruptions. Overall, findings align with undercount trends, urging complementary hospital data.
Practical Advice for Expectant Families
Expectant parents should attend all antenatal visits, especially in the third trimester, and know danger signs: swelling, headaches, or fewer kicks. Rural families can use government schemes like Janani Shishu Suraksha Karyakram for free transport and care. Apps for kick-tracking offer accessible tools, but pair with professional follow-up.
Healthcare workers: standardize Doppler use and referral protocols to catch growth restrictions early—like spotting a silent crisis before it’s too late.
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
References
https://health.economictimes.indiatimes.com/news/industry/stillbirths-rose-44-after-covid-national-study-finds/127668087?utm_source=top_story&utm_medium=homepage
