Risk factors for stillbirths: how much can a responsive health system prevent?
Open accessAbstract
BACKGROUND: The stillbirth rate is an indicator of quality of care during pregnancy and delivery. Good quality care is supported by a functional heath system. The objective of this study was to explore the risk factors for stillbirths, particularly those related to a health system. METHODS: This case-control study was conducted in two districts of Bihar, India. Information on cases (stillbirths) were obtained from facilities as reported by Health Management Information System; controls were consecutive live births from the same population as cases. Data were collected from 400 cases and 800 controls. The risk factors were compared using a hierarchical approach and expressed as odds ratio, attributable fractions and population attributable fractions. RESULTS: Of all the factors studied, 22 risk factors were independently associated with stillbirths. Health system-related factors were: administration of two or more doses of oxytocics to augment labour before reaching the facilities (OR 1.6; 95% CI 1.2-2.1), any complications during labour (OR 2.3;1.7-3.1), >30 min to reach a facility from home (OR 1.4;1.05-1.8), >10 min to attend to the pregnant woman after reaching the facility (OR 2.8;1.7-4.5). In the final regression model, modifiable health system-related risk factors included: >10 min taken to attend to women after they reach the facilities (AOR 3.6; 95% CI 2.5-5.1), untreated hypertension during pregnancy (AOR 2.9; 95% CI 1.5-5.6) and presence of any complication during labour, warranting treatment (AOR 1.7; 95% CI 1.2-2.4). Among mothers who reported complications during labour, time taken to reach the facility was significantly different between stillbirths and live births (2nd delay; 33.5 min v/s 25 min; p < 0.001). Attributable fraction for any complication during labour was 0.56 (95% CI 0.42-0.67), >30 min to reach the facility 0.48 (95% CI 0.31-0.60) and institution of management 10 min after reaching the facility 0.68 (95% CI 0.58-0.75). Reaching a facility within 30 min, initiation of management within 10 min of reaching the facility and timely management of complications during labour could have prevented 17%, 37% and 20% of stillbirths respectively. CONCLUSION: A pro-active health system with accessible, timely and quality obstetric services can prevent a considerable proportion of stillbirths in low and middle income countries.
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Stillbirth rate in Karnataka witnessed a notable decrease from 1971 to 2011.
“In 2018, the registered births and deaths in Karnataka revealed a continuous increase with minor fluctuations from 1971 to 2011, and the stillbirth rate witnessed a notable decrease during the same period indicating positive development.10”
From Mapping stillbirth and infant mortality rates: a district-wise exploration using civil registration system reports of Karnataka (2025) · cites this paper as [10]
The Background reports stillbirth rates for India and Bihar, but not a historical trend for Karnataka. Searches for Karnataka, 1971–2011, and a decline in stillbirth rates found no passage addressing the claimed decrease. (LLM, conf=0.77)
Experimental — accuracy not yet measuredRegistered births and deaths in Karnataka increased continuously with minor fluctuations from 1971 to 2011.
“In 2018, the registered births and deaths in Karnataka revealed a continuous increase with minor fluctuations from 1971 to 2011, and the stillbirth rate witnessed a notable decrease during the same period indicating positive development.10”
From Mapping stillbirth and infant mortality rates: a district-wise exploration using civil registration system reports of Karnataka (2025) · cites this paper as [10]
The Methods section describes a case-control study in two districts of Bihar, and the Background discusses Bihar stillbirth data from 2015. Searches for Karnataka, registered births and deaths, and the 1971–2011 trend found no passage in our copy addressing the claimed increase. (LLM, conf=0.75)
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- Authors
- Neogi, S. B., Sharma, J., Negandhi, P., Chauhan, M., Reddy, S., & Sethy, G.
- Affiliations
- Public Health Foundation of India (IN)
- United Nations Children's Fund India (IN)
- Corresponding author
- Neogi, Sutapa Bandyopadhyay
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2018-01-18
- Volume
- 18
- Issue
- 1
- Pages
- 33-33
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC5774063
- OpenAlex
- W2788900947
- Cited by
- 53
- References
- 41
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 9 · 2023: 5 · 2022: 4 · 2021: 10 · 2020: 4 · 2019: 4 · 2018: 2
- FWCI
- 5.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- UNICEF Bihar
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- stillbirth, risk factors, health system responsiveness, labor complications, maternal hypertension, maternity care quality, population attributable fraction, Bihar, maternal mortality reduction, health care financing, health information systems, health governance, health monitoring and evaluation, health research capacity, health workforce recruitment
- MeSH terms
- Adult, Female, Health Services Accessibility, Humans, India, Obstetric Labor Complications, Poverty, Pregnancy, Prenatal Care, Quality of Health Care, Regression Analysis, Risk Factors, Case-Control Studies, Stillbirth, Time-to-Treatment
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