Counting only late-gestation stillbirths may miss nearly two-fifths of the total: Analysis

An analysis of three rounds of a large-scale national data shows stillbirth rates of 12.8 per 1,000 total births at or after 28 weeks of gestation, 16.2 at or after 24 weeks of gestation and 22 at or after 20 weeks of gestation.

Researchers from the Institute for Population and Social Research in Thailand and New Delhi’s International Institute of Health Management Research analysed data collected during National Family Health Survey (NFHS) rounds 3 (2005-06), 4 (2015-16) and 5 (2019-21).

Counting only late-gestation stillbirths could result in missing nearly two-fifths of all stillbirths, they said in the study published in The Lancet Regional Health Southeast Asia journal.

The World Health Organization (WHO) defines stillbirth rate as the number of babies born with no signs of life at or after 28 weeks of gestation per 1,000 total births.

In a January 2025 research article, published in The Lancet Regional Health Southeast Asia journal, researchers, including those from New Delhi’s Public Health Foundation of India, citing the Global Burden of Disease (GBD) Study 2021, estimated stillbirth across 204 countries and territories using three different gestation period cut-offs — at or after 20 weeks, at or after 22 weeks and at or after 28 weeks.

The stillbirth estimates with the 20 and 22 weeks’ gestation definitions are otherwise not available in the previous assessments of stillbirth estimation, they said.

Including these estimates enables a more comprehensive assessment of stillbirths in India, but also highlights limited and poor-quality data that hinder precise estimates for many locations.

The recently published Lancet study “reiterates the need for high-quality, standardised data systems till district level with accurate gestational age reporting that must be made more accessible for evidence-based decision-making.” “Analysis of 542,359 women from three survey rounds (of NFHS) showed SBR of 12.8, 16.2, and 22.0 per 1000 total births at more than equal to 28, 24, and 20 weeks of gestation, respectively,” the authors wrote.

“Counting only late-gestation stillbirths could result in missing approximately two-fifths of all stillbirths,” they said.

The team added that the largest decline in stillbirth rate of 36.3 % was noted between 2005-06 and 2015-16.

Further, 51.4 % of states and 51.9 % of districts achieved a single digit stillbirth rate during 2019-21.

However, during 2019-21, an estimated 42 % of stillbirths were reported between at or after 20 weeks of gestation period and at or before 28 weeks of gestation period, the researchers said.

Even as India accounts for about 17 % of the world’s stillbirths, the team said national data varies widely — 6.6 per 1,000 total births from the Civil Registration System (CRS) and 12.4 per 1,000 total births from the from Health Management Information System (HMIS).

Estimates from the Sample Registration System (SRS) are substantially lower than those from NFHS and global studies, “due to incomplete reporting, variable gestational-age cut-offs, and misclassification between stillbirth and early neonatal death,” they said.

Few studies assess stillbirths below 28 weeks, where preventable losses persist, and examine social and medical determinants driving inequities, the team said.