New Delhi: Even as hospital deliveries resumed after Covid, India recorded a sharp rise in babies dying just before birth in the post-pandemic period, according to a major national study analysing births between 2019 and 2022. The findings point to serious gaps in pregnancy care—losses that often go unnoticed and are grieved in private.
The rise was driven by disrupted antenatal care, delayed referrals and weakened pregnancy and delivery services during and after the Covid-19 pandemic, researchers said. The study documented a 44% increase in the stillbirth rate between the pre-Covid and post-Covid periods.
The study, published in BMC Pregnancy and Childbirth, was conducted by researchers from the Public Health Foundation of India (PHFI) with support from the Indian Council of Medical Research (ICMR). It is 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.
Data show that India’s stillbirth rate increased from 12.7 per 1,000 births before Covid to 14.4 during the pandemic, and then rose sharply to 18.3 per 1,000 births in the post-Covid period.
The increase was most pronounced in rural areas, where rates reached nearly 20 per 1,000 births, compared to about 14 in urban areas, highlighting gaps in access to timely antenatal care and emergency obstetric services.
Based on detailed interviews of 745 stillbirths, the study found that 44.7% occurred in public hospitals, 39.2% in private hospitals and 16.1% at home. The dominant place of delivery varied sharply across states: 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%), reflecting differences in health system utilisation rather than state-wise stillbirth rates.
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.
Explaining this, Dr Renu Gupta, Director (Obstetrics & Robotic Gynaecology), Sri Balaji Action Medical Institute, Delhi, said: “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—blood pressure, fetal growth and movement, Doppler studies—has become inconsistent, especially in overstretched public hospitals. 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.”
Delays were a major factor. Nearly one in five women whose babies were stillborn had been referred between facilities during labour, sometimes being sent back to return later.
Only about one-third of mothers were told why their baby died. Despite registration being mandatory, just 1% of stillbirths were officially registered, keeping most cases out of official records.
The study also highlighted the emotional toll on families. Nearly half of mothers neither saw nor held their stillborn baby, often due to family decisions or medical advice.
Researchers warned that without stronger antenatal surveillance, faster referrals and better quality care during labour and childbirth, India may miss its target of a single-digit stillbirth rate by 2030 under the India Newborn Action Plan.
