The “Hidden” Crisis: Why Current Data Misses 40% of India’s Stillbirths

April 7, 2026

A landmark analysis of India’s national health data has revealed a significant “statistical blind spot” in how the country tracks pregnancy loss. The study, published in The Lancet Regional Health – Southeast Asia, warns that by adhering to international reporting standards that only count fetal losses after 28 weeks of pregnancy, health systems are effectively ignoring nearly two-fifths of all stillbirths.

Researchers from the Institute for Population and Social Research (Thailand) and New Delhi’s International Institute of Health Management Research, in collaboration with the Public Health Foundation of India (PHFI), found that approximately 42% of fetal losses recorded between 2019 and 2021 occurred between the 20th and 28th weeks of gestation. By failing to account for these earlier losses, policymakers may be missing critical opportunities to implement life-saving interventions in early prenatal care.

The Weight of the Definition

The discrepancy lies in the definition of a “stillbirth.” The World Health Organization (WHO) currently defines a stillbirth as a baby born with no signs of life at or after 28 completed weeks of gestation. This “late-gestation” cut-off is designed to allow for standardized comparisons between countries, particularly for the Global Every Newborn Action Plan (ENAP), which aims for single-digit stillbirth rates by 2030.

However, as this new research shows, the 28-week threshold acts as a filter that removes a massive portion of the reality on the ground.

The study re-analyzed three rounds of India’s National Family Health Survey (NFHS), covering over 542,000 women. The results show a stark “sliding scale” of loss based on where the line is drawn:

“When we only look at the 28-week mark, we are seeing an incomplete picture,” explains Dr. R. Dandona, a public health researcher at PHFI who has written extensively on India’s data gaps. While the WHO target is useful for global tracking, Dandona notes it risks diverting focus from earlier losses that are often tied to preventable causes like maternal anemia and infection.

A Fragmented Data Landscape

The study also shines a light on India’s “data paradox.” Currently, multiple government systems track birth outcomes, but they rarely agree:

• The Civil Registration System (CRS): Reports a rate of 6.6 per 1,000.

• The Health Management Information System (HMIS): Reports 12.4 per 1,000.

• The Sample Registration System (SRS): Consistently yields lower figures than both the NFHS and global estimates.

These inconsistencies are often the result of incomplete reporting in rural areas, misclassification (where a stillbirth is mistakenly recorded as an early neonatal death), and the lack of facility-level audits to determine why a loss occurred. Without knowing if a loss was due to placental issues, hypertension, or labor complications, health officials cannot design targeted local interventions.

Public Health Implications: Progress or Illusion?

On paper, India’s progress looks remarkable. Between 2005 and 2016, the country saw a 36.3% decline in stillbirth rates. By 2021, more than half of India’s states had already achieved single-digit stillbirth rates based on the 28-week criteria.

However, the authors argue that this narrative of success is skewed. If 40% of losses are occurring before the 28-week mark, those gains may be less robust than they appear. The study suggests that to truly protect maternal and fetal health, India must:

1. Adopt Multi-level Reporting: Track losses at 20, 24, and 28 weeks simultaneously.

2. Strengthen Facility Audits: Ensure every loss is recorded with an accurate gestational age and cause of death.

3. Target High-Burden Areas: Use geospatial mapping to identify “hotspots” where factors like low maternal education and poor access to skilled birth attendants are prevalent.

What This Means for Expectant Parents

For families, the study is a call for increased vigilance rather than alarm. Experts emphasize that many stillbirths—both early and late—are preventable through consistent antenatal care.

“The message for pregnant individuals is the importance of the first and second trimesters,” says one maternal health specialist. “Early screening can identify chronic conditions like diabetes or hypertension that, if left unmanaged, significantly increase the risk of loss later in pregnancy.”

Key preventive measures include:

• Early Enrollment: Beginning antenatal check-ups as soon as a pregnancy is confirmed.

• Monitoring Fetal Movement: Learning to recognize changes in a baby’s activity levels.

• Managing Infections: Timely treatment for reproductive and systemic infections.

• Nutritional Support: Addressing iron deficiencies and anemia early on.

Limitations and Counterarguments

While the study provides a vital correction to current data, it has limitations. Because it relies on survey-recall data (asking women to remember details of past pregnancies), there is a risk of “recall bias.” In regions where formal gestational dating (like early ultrasounds) is unavailable, women may struggle to accurately pinpoint exactly when a loss occurred.

Furthermore, some experts caution against “medicalizing” early pregnancy loss too aggressively. They argue that moving the official cut-off to 20 weeks could lead to over-intervention in cases where a loss was biologically inevitable, potentially causing unnecessary psychological or physical strain on the mother. However, the consensus among the Lancet researchers is that better data—not necessarily more intervention—is the primary goal.

The Path Forward

The “hidden” stillbirths occurring between 20 and 28 weeks represent a significant public health challenge and a personal tragedy for thousands of families. By harmonizing national data systems and recognizing that a loss at 22 weeks is as statistically and clinically significant as one at 29 weeks, India can move toward a healthcare system that leaves no pregnancy uncounted.

References

• https://www.ndtv.com/health/counting-only-late-gestation-stillbirths-may-miss-nearly-two-fifths-of-the-total-analysis-11318040

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.