Stillbirth rates and its spatial patterns in India: an exploration of HMIS data

BACKGROUND: High prevalence of stillbirths is a significant concern for the health system of India. This necessitates a closer scrutiny of the prevalence, spatial pattern and the risk factors of stillbirth at both national and local level. METHODS: We analysed stillbirth data of three financial years (April 2017–March 2020) from Health Management Information System (HMIS) of India which provides majorly public facility level data for stillbirths up to the district level on a monthly basis. National and state level prevalence of stillbirth rate (SBR) were estimated. Spatial patterns of SBR at district level was identified using local indicator of spatial association (LISA). Risk factors of stillbirths were studied by triangulation of HMIS and National Family Health Survey (NFHS-4) data using bivariate LISA. FINDINGS: National average of SBR in 2017–18, 2018–2019 and 2019–2020 are 13.4 [4.2–24.2], 13.1 [4.2–22.2] and 12.4 [3.7–22.5] respectively. Districts of Odisha, Madhya Pradesh, Rajasthan and Chhattisgarh (OMRC) form a contiguous east-west belt of high SBR. Body mass index (BMI) of the mother, antenatal care (ANC), maternal anemia, iron-folic acid (IFA) supplementation and institutional delivery show significant spatial autocorrelation with SBR. INTERPRETATION: Maternal and child health programme delivery should prioritise targeted intervention in the hotspot clusters of high SBR, considering the locally significant determinants. The findings show inter alia, the need to focus on ANC to reduce stillbirth in India. FUNDING: The study is not funded.