Post-Pandemic India Witnesses Alarming 44% Rise in Stillbirths
Even as hospital deliveries resumed after the Covid-19 pandemic, India has recorded a sharp and concerning increase in babies dying just before birth during the post-pandemic period. This troubling trend emerges from a major national study analyzing births between 2019 and 2022, pointing to serious gaps in pregnancy care that often go unnoticed and are grieved in private.
Study Details and Methodology
The research, published in BMC Pregnancy and Childbirth, was conducted by experts from the Public Health Foundation of India (PHFI) with support from the Indian Council of Medical Research (ICMR). It represents one of the most comprehensive analyses of stillbirth patterns in recent years, based on a nationally representative mortality survey covering nearly one million people across nine states: Assam, Gujarat, Haryana, Jharkhand, Kerala, Maharashtra, Odisha, Tamil Nadu, and Uttar Pradesh.
Statistical Findings and Regional Disparities
The data reveals a disturbing trajectory: India's stillbirth rate increased from 12.7 per 1,000 births before Covid to 14.4 during the pandemic, then rose sharply to 18.3 per 1,000 births in the post-Covid period. This represents a 44% increase between the pre-Covid and post-Covid periods.
The increase was most pronounced in rural areas, where rates reached nearly 20 per 1,000 births, compared to about 14 in urban areas. This stark disparity highlights significant gaps in access to timely antenatal care and emergency obstetric services in India's countryside.
Based on detailed interviews of 745 stillbirths, the study found that:
- 44.7% occurred in public hospitals
- 39.2% in private hospitals
- 16.1% at home
The dominant place of delivery varied sharply across states, reflecting differences in health system utilization rather than state-wise stillbirth rates. Stillbirths were reported mostly from private hospitals in Kerala (66.7%), Gujarat (60%), and Haryana (50%), while public hospitals accounted for the majority in Odisha (72.6%), Assam (69.6%), Maharashtra (54.8%), and Tamil Nadu (54.6%).
Underlying Causes and Healthcare Challenges
Researchers attribute the rise to disrupted antenatal care, delayed referrals, and weakened pregnancy and delivery services during and after the Covid-19 pandemic. More than half of all stillbirths occurred at nine months of pregnancy or later, often just days before delivery, pointing to failures in late-pregnancy monitoring and delivery-time care.
Dr. Renu Gupta, Director of Obstetrics & Robotic Gynaecology at Sri Balaji Action Medical Institute in Delhi, explains: "The rise in late-term stillbirths points to failures in timely risk detection and action, not gaps in early pregnancy care. After Covid, third-trimester monitoring—including blood pressure checks, fetal growth and movement assessments, and Doppler studies—has become inconsistent, especially in overstretched public hospitals."
She further notes: "Referral delays, staff shortages, and weak transport systems mean warning signs are often missed. While delivery numbers have recovered, quality and continuity of care have not, leading to preventable losses just before birth."
Systemic Issues and Documentation Gaps
Delays emerged as a major contributing factor. Nearly one in five women whose babies were stillborn had been referred between facilities during labor, sometimes being sent back only to return later—a process that can prove fatal for vulnerable pregnancies.
The study also uncovered significant documentation and communication gaps. Only about one-third of mothers were told why their baby died, and despite registration being mandatory, just 1% of stillbirths were officially registered. This keeps most cases out of official records and hampers efforts to address the problem systematically.
Emotional Impact and Future Implications
The research highlighted the profound emotional toll on families. Nearly half of mothers neither saw nor held their stillborn baby, often due to family decisions or medical advice, potentially complicating the grieving process.
Researchers warn that without stronger antenatal surveillance, faster referrals, and better quality care during labor and childbirth, India may miss its target of achieving a single-digit stillbirth rate by 2030 under the India Newborn Action Plan. The findings underscore the urgent need to rebuild and strengthen maternal healthcare systems that were disrupted by the pandemic, with particular attention to rural areas and late-pregnancy monitoring.
