Stillbirth in India: Epidemiology, Risk Factors, and Preventive Strategies – A Narrative Review

Abstract

Background: Stillbirth remains a major public health concern globally, particularly in low- and middle-income countries. India contributes substantially to the global burden of stillbirths despite improvements in maternal and neonatal healthcare services. Multiple maternal, fetal, socioeconomic, and healthcare-related factors continue to influence stillbirth occurrence across the country.

Objectives: This narrative review aimed to identify the major risk factors associated with stillbirth in India and to explore evidence-based preventive strategies within the Indian public health system.

Methods: A narrative review of literature published between 2000 and 2025 was conducted using PubMed, Scopus, Web of Science, and ProQuest databases. Keywords including “stillbirth,” “risk factors,” “preventive strategies,” “maternal health,” and “India” were used for the search. A total of 117 articles were initially identified. After applying inclusion and exclusion criteria, 18 relevant studies were included in the final review. The selected studies comprised observational studies, systematic reviews, hospital-based studies, and policy reports related to stillbirth in the Indian context.

Results: The review identified several major risk factors associated with stillbirth in India, including maternal complications such as anemia, hypertensive disorders, gestational diabetes, and infections. Fetal conditions including congenital anomalies and intrauterine growth restriction were also significant contributors.

Health system-related factors such as inadequate antenatal care, delayed referral services, poor emergency obstetric care, and shortage of skilled healthcare professionals further increased stillbirth risk. Socioeconomic determinants including poverty, low maternal education, rural residence, and limited healthcare accessibility were strongly associated with adverse pregnancy outcomes.

Preventive strategies identified in the review included strengthening antenatal care services, improving skilled birth attendance, enhancing community-based interventions through ASHA workers, promoting institutional deliveries, and improving perinatal surveillance and health system capacity.

Conclusion: Multiple preventable maternal, fetal, socioeconomic, and healthcare-related factors influence Stillbirth in India. Strengthening maternal healthcare services, improving quality antenatal and obstetric care, enhancing community awareness, and implementing evidence-based public health interventions are essential for reducing stillbirth rates in India. Further research focusing on regional disparities and implementation challenges is recommended to support targeted policy and program development.