India's Stillbirth Dilemma: A Tragedy In Need Of Prevention

Stillbirths, defined as the death of a baby in the womb after 28 weeks of pregnancy, are a silent tragedy that remains largely unnoticed in India, despite progress in various health indicators. According to the World Health Organization (WHO), India witnessed an estimated 4,79,000 stillbirths in 2019, accounting for a staggering 25 per cent of the global stillbirth burden.

United Nations International Children’s Emergency Fund (UNICEF) estimates that India has the highest number of stillbirths in the world, with one stillbirth occurring every 17 seconds.

The impact of stillbirths can be devastating for families, both emotionally and financially. Parents who experience a stillbirth often grieve for years, and may also experience guilt, anger, and confusion. Stillbirths can also have a financial impact on families, as parents may have to pay for medical expenses, funeral expenses, and lost income due to time taken off work. 

"Stillbirths can have a devastating emotional and financial impact on families and strain the healthcare system," says Dr Seema Jain, Director, Obstetrics And Gynaecology, Robotic Surgery, Max Super Speciality Hospital,Shalimar Bagh. Understanding the various reasons, and misconceptions behind stillbirths is essential to address this preventable tragedy.

Misconceptions About Stillbirth 

Dr Aruna Kalra, Director of the Department of Obstetrics and Gynaecology at CK Birla Hospital, debunks a common belief. Many expectant mothers think that foetal movement decreases in the final trimester, but Dr Kalra emphasises the importance of monitoring these movements throughout the day, including morning, afternoon, and evening, for a complete picture of foetal health.  

According to clinicians prevalent misconception pertains to stillbirth prevention. Some individuals mistakenly assume that if they don't have high-risk conditions like diabetes, heart disease, or high blood pressure, stillbirth can be prevented. 

Dr Jain and Dr Kalra stress that this belief is inaccurate, emphasising that preventive measures are essential for all expectant mothers. Additionally, it's crucial to dispel the notion that stillbirths only occur during labour. 

While a significant percentage does happen during labour, early pregnancy stillbirths can also transpire due to various factors such as congenital abnormalities, pregnancy-induced hypertension, maternal age, uterine issues, and more. 

As per medical experts, with proper prenatal care, regular check-ups, and necessary tests, the risk of stillbirth can be significantly reduced, challenging the belief that prevention is impossible.

Preventing Stillbirth

Preventing stillbirth is a critical aspect of maternal healthcare, and it starts with the diligent pursuit of prenatal care.  As per clinical experts, regular prenatal visits are indispensable in this regard. During these appointments, healthcare providers closely monitor various aspects such as comorbidities, weight gain, blood pressure, and blood sugar levels to ensure the well-being of both the mother and the baby. 

In addition to routine check-ups, comprehensive testing is an integral part of prenatal care. Ensuring the health and safety of the expectant mother and her unborn child is paramount. Immunisations also play a vital role in protecting pregnant individuals from potentially harmful diseases.

Medical experts suggest that vaccinations against illnesses like the flu, diphtheria, pertussis, tetanus, and others are routinely administered. In cases of RH-negative pregnancies, anti-vaccination is also provided to mitigate risks. Monitoring the levels of amniotic fluid and the growth of the foetus is another crucial element of prenatal care, medical experts suggest. 

More than 50 per cent of stillbirths occur during delivery, underscoring the importance of delivering in a hospital setting. Access to healthcare professionals and medical facilities is essential to ensure a safe and well-supported delivery process, minimising risks to both mother and baby. India is more susceptible to a higher incidence of stillbirths due to a combination of factors, including not only misconceptions but also a range of other contributing causes.

As per clinicians, efforts to combat stillbirth are actively underway, with a particular focus on remote areas. A key aspect of this initiative involves the enhancement of hospital facilities, especially in remote regions. This entails increasing the availability of critical medical equipment, and modern machines, and ensuring a stable supply of oxygen in healthcare facilities. 

Dr Kalra highlights that although substantial progress has been made, continued efforts are needed to further reduce stillbirth rates and provide comprehensive support to those affected by this tragic phenomenon.

Other factors causing stillbirths

DrJain and Dr Kalra emphasise several factors contributing to stillbirths, including maternal health. Poor maternal health, characterised by conditions such as malnutrition, anaemia, and chronic diseases like diabetes and hypertension, poses a significant risk for stillbirths. 

Additionally, infections such as malaria, syphilis, and HIV, if left untreated during pregnancy, can lead to stillbirths. Furthermore, congenital abnormalities, whether stemming from genetic or environmental factors, can result in stillbirths. 

Some birth defects are influenced by genetic factors, while others may be caused by exposure to harmful substances during pregnancy. Problems with the placenta, such as placental abruption or placenta previa, can also restrict oxygen and nutrient supply to the baby, potentially leading to stillbirth. Moreover, lifestyle choices can increase the risk of stillbirth. 

Smoking, alcohol consumption, and drug use during pregnancy have been identified as factors that can contribute to this risk. It's important to note that while many stillbirths are preventable, there are cases where the cause remains unknown.

Importantly, stillbirths are not always the result of the mother's actions; various factors can contribute to these outcomes, and many are beyond the mother's control.

Addressing Stillbirths

Addressing stillbirths in India requires a multi-pronged approach, including improving maternal health which includes providing better access to prenatal care, nutrition, and treatment for underlying health conditions.  Furthermore raising awareness about stillbirths and their risk factors is also important and can be done through public education campaigns, school-based programs, and community engagement. 

Clinicians suggest investing in research on stillbirths and prevention strategies is essential for developing more effective interventions and reducing the burden of stillbirths. The Indian government has also taken a number of steps to address stillbirths, including the National Health Mission (NHM), the Janani Suraksha Yojana (JSY), and the Integrated Child Development Services (ICDS). 

“However, more needs to be done to raise awareness about stillbirths and to improve access to quality healthcare for pregnant women,” says Dr Jain. 

Stillbirth is a complex and deeply emotional issue that deserves our attention, understanding, and proactive prevention efforts. Addressing common misconceptions, understanding the realities, and providing support to those affected can go a long way in reducing the incidence of stillbirth and ensuring that individuals and families receive the care and compassion they need during such challenging times. 

Dr Jain says, "Preventing stillbirths doesn't necessarily require extravagant resources. Some simple steps and early interventions can significantly reduce the risk."