Stillbirths at 22- and 28-weeks’ gestation or longer for the states in India: findings from the Global Burden of Disease Study 2023

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), for the first time, estimated stillbirth rate (SBR) by the WHO ICD-11 definition (≥22 weeks' gestation) for 204 countries, highlighting the extent of underestimation in stillbirth burden as compared with using only the late gestation (≥28 weeks' gestation) SBR estimation to understand the stillbirth burden. Given the size of its population, India accounted for the highest global burden of stillbirths for both gestation period cut-offs. Given the extent of state-level heterogeneity in disease burden in India, state-disaggregated SBR is necessary to enable policymakers and researchers to tailor strategies that are more responsive to local needs and institutional capacities, thereby enhancing the effectiveness of interventions and related resource allocation. Methods Data were compiled from 122 sources, including surveys, published studies, and vital and sample registration systems, encompassing 2684 location-year observations. SBRs were estimated for 31 geographic units using spatiotemporal Gaussian process regression to model the ratio of SBR to neonatal mortality rate (NMR), integrating GBD 2023 fertility and all-cause neonatal mortality assessments. Estimates were produced for SBR and number of stillbirths for ≥22 and ≥28 weeks' gestation with 95% uncertainty intervals (UIs) for year 2023. Secondary analyses evaluated the relationship between SBR at the state-level with the Sustainable Development Goal 3 (SDG3; good health and wellbeing) state index score developed by the NITI Aayog and compared GBD results with India's Sample Registration System (SRS) for late gestation SBR and neonatal mortality rate (NMR) for 2023. Findings An estimated 565,900 (462,600–702,900) and 347,300 (284,600–430,000) stillbirths occurred in India in 2023, corresponding to SBRs of 25.9 (95% UI 21.3–32.0) and 16.1 (13.2–19.8) at ≥22 weeks' and ≥28 weeks of gestation, respectively. SBR for both definitions varied four-fold between states, from 9.3 (6.8–12.6) in Mizoram to 38.2 (29.0–50.8) in Uttar Pradesh, with the latter and Bihar together accounting for nearly half of India's total stillbirths. A modest inverse correlation was observed between SBR and SDG3 index score (≥22 weeks p=0.053, r=−0.350 and ≥28 weeks p=0.034, r=−0.383). Comparison with SRS 2023 revealed substantial under-reporting in SBR, with national late-gestation SBR 2.3 times lower than GBD estimates, though NMR values were consistent across systems. Interpretation India's true stillbirth burden is markedly underestimated using the ≥28-week definition. Improved surveillance, tracking stillbirths by the ≥22-week threshold, and integration of stillbirth prevention within broader maternal and newborn health initiatives are essential to address the stillbirth burden in India. Investments are also needed to improve both the availability and quality of data on the magnitude, causes, risk factors, and geographic disparities in stillbirth occurrences for appropriate action to address early gestation stillbirths in India. Funding Gates Foundation.

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Publication Details

Journal
The Lancet Regional Health - Southeast Asia
Published
2026-07-27
DOI
https://doi.org/10.1016/j.lansea.2026.100819
Primary Topic
Global Maternal and Child Health
Type
article
Field-Weighted Citation Impact
0.00

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article

Stillbirths at 22- and 28-weeks’ gestation or longer for the states in India: findings from the Global Burden of Disease Study 2023

Rizwan Suliankatchi Abdulkader, Rakhi Dandona, Sagnik Dey, Waseem Chauhan et al.
The Lancet Regional Health - Southeast Asia
Global Maternal and Child Health
article

Stillbirths at 22- and 28-weeks’ gestation or longer for the states in India: findings from the Global Burden of Disease Study 2023

Rizwan Suliankatchi Abdulkader, Rakhi Dandona, Sagnik Dey, Waseem Chauhan, Swetha Acharya, Rama Mohan Chandika, Arkadeep Dhali, Theresa A. McHugh, Gulam Saidunnisa Begum, Syed Anees Ahmed, Ajeet Singh Bhadoria, Vijay Kumar Chattu, Syed Mohammed Basheeruddin Asdaq, Ojas Prakashbhai Doshi, Hansi Bansal, Mohammad Saquib Ashraf, Senthilkumar Balakrishnan, Aqeel Ahmad, Mayank Dalakoti, Aso Mohammad Darwesh, Gururaj Arakeri, Bhavik Bansal, Razique Anwer, Kuldeep Dhama, Syed Amir Ashraf, Jasvinder Singh Bhatti, Shahina Begum, Akhilanand Chaurasia, Saheem Ahmad, Anirudh B. Acharya, Arushee Bhatnagar, Uzma Belgaumi, Haley Comfort, Nikha Bhardwaj, Saravanan Chinnaiyan, Joshua Chadwick, Priyadarshini Bhattacharjee, Pankaj Bhardwaj, Gurjit Kaur Bhatti, Dhiraj Agarwal, Viola Savy Dsouza, Om Prakash Bera, Saif Ahmed, Shivani Chopra, Mehrunnisha Sharif Ahmed, Sudip Bhattacharya, Sulagna Dutta, Giridhara R. Babu, Redolen Rose Dhar, C. J. Sanjay, Vinoth Gnana Chellaiyan Devanbu, Ashish Awasthi, Mohd Adnan, Rafat Ali, Prapti Anjana, Anis Ahmad Chaudhary, Roy Arokiam Daniel, Trupti Bodhare, Samir Bele, Prasad Hanmantrao Babar, AH Sruthi Anil Kumar, Altaf Bandy, Snehal Prakash Chavhan, Mohammad Jahoor Alam, Sonu Bhaskar, Sravana Deepthi C, Venkata Ravikanth Eddula, S Siva Prasad Dora, Irfan Ali, Amol S. Dhane, Kabilan Annadurai, G Anil Kumar, Devananda Devegowda, Baskaran Chandrasekaran, Siddhartha Dutta, Rajkumar Prakashbhai Doshi, Mohammad Daud Ali, Usha Adiga, Jesu Arockiaraj, Winniecia Dkhar, Danish Ahmad, Dhruva Dave, Monirujjaman Biswas, Raju Balaji, Mohd Akbar, Bhoomadevi A, Vaishali Aggarwal, Sheeba B, Naved Ahmad, Gaurav Acharya, Sirshendu Chaudhuri, Bijit Biswas, Devasahayam J. Christopher, Narasimha M. Beeraka, P Vineeth Daniel, Jyoti Brahmaiah, Anuradha Bhardwaj, Sadaf Anwar, Margret Beaula Alocious Sukumar, Shahnawaz Ali Bhat
article en

Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), for the first time, estimated stillbirth rate (SBR) by the WHO ICD-11 definition (≥22 weeks' gestation) for 204 countries, highlighting the extent of underestimation in stillbirth burden as compared with using only the late gestation (≥28 weeks' gestation) SBR estimation to understand the stillbirth burden. Given the size of its population, India accounted for the highest global burden of stillbirths for both gestation period cut-offs. Given the extent of state-level heterogeneity in disease burden in India, state-disaggregated SBR is necessary to enable policymakers and researchers to tailor strategies that are more responsive to local needs and institutional capacities, thereby enhancing the effectiveness of interventions and related resource allocation. Methods Data were compiled from 122 sources, including surveys, published studies, and vital and sample registration systems, encompassing 2684 location-year observations. SBRs were estimated for 31 geographic units using spatiotemporal Gaussian process regression to model the ratio of SBR to neonatal mortality rate (NMR), integrating GBD 2023 fertility and all-cause neonatal mortality assessments. Estimates were produced for SBR and number of stillbirths for ≥22 and ≥28 weeks' gestation with 95% uncertainty intervals (UIs) for year 2023. Secondary analyses evaluated the relationship between SBR at the state-level with the Sustainable Development Goal 3 (SDG3; good health and wellbeing) state index score developed by the NITI Aayog and compared GBD results with India's Sample Registration System (SRS) for late gestation SBR and neonatal mortality rate (NMR) for 2023. Findings An estimated 565,900 (462,600–702,900) and 347,300 (284,600–430,000) stillbirths occurred in India in 2023, corresponding to SBRs of 25.9 (95% UI 21.3–32.0) and 16.1 (13.2–19.8) at ≥22 weeks' and ≥28 weeks of gestation, respectively. SBR for both definitions varied four-fold between states, from 9.3 (6.8–12.6) in Mizoram to 38.2 (29.0–50.8) in Uttar Pradesh, with the latter and Bihar together accounting for nearly half of India's total stillbirths. A modest inverse correlation was observed between SBR and SDG3 index score (≥22 weeks p=0.053, r=−0.350 and ≥28 weeks p=0.034, r=−0.383). Comparison with SRS 2023 revealed substantial under-reporting in SBR, with national late-gestation SBR 2.3 times lower than GBD estimates, though NMR values were consistent across systems. Interpretation India's true stillbirth burden is markedly underestimated using the ≥28-week definition. Improved surveillance, tracking stillbirths by the ≥22-week threshold, and integration of stillbirth prevention within broader maternal and newborn health initiatives are essential to address the stillbirth burden in India. Investments are also needed to improve both the availability and quality of data on the magnitude, causes, risk factors, and geographic disparities in stillbirth occurrences for appropriate action to address early gestation stillbirths in India. Funding Gates Foundation.

The Lancet Regional Health - Southeast AsiaVol. 52
Bill and Melinda Gates Foundation
Zero hunger
Openalex Percentile: Top 6%
Global Maternal and Child Health
DOIOpen Access PDFOpenAlex
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