Northern states and Union Territories together averaged 11.397 stillbirths for every thousand deliveries in 2020, compared to 7.725 in central India, 7.029 in the east, 6.152 in the northeast, 6.792 in the west and 7.510 in the south.
Published Aug 19, 2025 | 7:00 AM ⚊ Updated Aug 19, 2025 | 10:21 AM
Ultrasound is often used to diagnose stillbirth.
Synopsis: India recorded 6.5 stillbirths per 1,000 deliveries in 2020, with the highest rates concentrated in the northern and central regions, according to a study published in The Lancet Regional Health Southeast Asia. The analysis found sharp regional disparities, with Rajasthan, Jammu and Kashmir, and Chandigarh reporting some of the country’s highest levels, while southern states such as Andhra Pradesh, Kerala, and Telangana showed significantly lower rates.
India recorded about 6.5 stillbirths for every thousand deliveries in 2020, with the highest burden in the northern and central states, according to a recent study published in The Lancet Regional Health Southeast Asia. The findings highlight one of the country’s persistent but less visible public health challenges.
Using national civil registration and health survey data, the researchers mapped district-level hotspots. The analysis showed that stillbirths were unevenly distributed across the country.
Northern states and Union Territories together averaged 11.397, compared to 7.725 in central India, 7.029 in the east, 6.152 in the northeast, 6.792 in the west and 7.510 in the south.
Rajasthan (13.709) and the Union Territories of Chandigarh (24.590) and Jammu and Kashmir (20.800) reported some of the highest rates.
In contrast, southern states such as Andhra Pradesh (1.183), Tamil Nadu (6.371), Karnataka (3.555), Kerala (4.018) and Telangana (4.637) recorded lower levels.
The study linked these regional differences to factors such as literacy, access to caesarean deliveries and overall maternal care.
Women with anaemia, low body mass index or limited access to antenatal care faced particularly high risks. Districts with better literacy levels, wider use of iron and folic acid supplements and timely caesarean deliveries recorded lower rates.
The study also noted that stillbirths were reported more often among urban mothers than rural ones, adding another layer of complexity to India’s maternal health picture.
The study found the stillbirth rate to be “6.548 per 1,000 total births” in 2020, with a slightly higher figure for male babies (6.63) compared with female babies (6.54).
It noted that while male foetuses are biologically more vulnerable, there were no significant geospatial disparities between the sexes, since both showed similar clustering patterns across Indian districts.
A key methodological contribution of the research was the use of geospatial analysis. The authors applied tools such as Moran’s I and Local Indicators of Spatial Association to detect clustering. They observed “strong spatial clustering for maternal factors,” particularly in districts where women had below-normal body mass index and low rates of iron–folic acid supplementation.
In such areas, stillbirth rates were consistently higher, suggesting that maternal nutrition is an important determinant of outcomes.
The study further highlighted how stillbirths are linked with a range of social and healthcare indicators. It found a “positive correlation with anaemia and institutional births in public facilities,” meaning that districts with high levels of maternal anaemia and greater reliance on government health institutions tended to record more stillbirths.
In contrast, there was a “negative correlation with literacy and caesarean deliveries in private facilities,” pointing to education and access to private care as protective factors.
The statistical analysis reinforced these associations. The study reported that female stillbirths were directly correlated with anaemia and institutional births in public facilities, while male stillbirths showed similar patterns with anaemia and reliance on public facilities.
At the same time, both sexes displayed a negative correlation with literacy and with caesarean deliveries in private facilities. The authors noted that “this study found no significant geospatial disparity in sex-specific stillbirth rates across Indian districts, with similar clustering patterns for both sexes.”
The authors said these patterns highlight the importance of tailoring responses to local contexts. Instead of uniform strategies, they called for “district-specific approaches guided by geospatial insights” to address stillbirth risk.
They also stressed that strengthening India’s stillbirth registration system and applying advanced spatial methods are essential steps for better monitoring and planning interventions in the years ahead.
South India records fewer stillbirths compared with northern and central regions, largely due to the strength of its maternal health infrastructure, according to Dr N Saradha, Senior Consultant in Obstetrics, Gynaecology and IVF at SIMS Hospital, Chennai.
Table 1: Prevalence distribution of stillbirth rates per 1000 live births.
She noted that “higher female literacy, better nutrition, awareness, and regular monitoring systems” have played a critical role.
Speaking to South First, she said one of the key differences is that governments in the South have assigned field workers to closely follow up with expectant mothers, even when they receive care in private hospitals.
Each pregnancy is registered with a unique number under the Reproductive and Child Health (RCH) programme, which enables primary health workers to track high-risk cases and ensure consistent antenatal care. According to her, all these measures have reduced and led to fewer stillbirths.
When asked about the study’s findings that linked anaemia, low BMI, and lack of iron–folic acid supplementation with higher risks, Dr Saradha confirmed these were factors she encountered in practice. She recalled her postgraduate training at Stanley Medical College, where anaemia was most often seen in women from lower socioeconomic backgrounds.
Today, however, she finds that “almost 50 percent of patients are borderline or moderately anaemic even in higher socioeconomic groups.”
She attributes this shift to poor dietary balance and unhealthy food habits both before and during pregnancy, underscoring that nutritional anaemia remains “the commonest cause for maternal and fetal morbidities.”
Literacy, especially female literacy, directly affects maternal outcomes, as educated women are more likely to understand and follow medical advice, according to Dr Saradha.
“They will understand their body health and the steps to improve their well-being,” she added.
On caesarean deliveries, she clarified that it is not about public or private facilities but about timely interventions, for example in cases of fetal distress or gestational diabetes. In such scenarios, a well-monitored pregnancy ensures that the decision for surgery is taken at the right moment, improving survival rates.
Asked about states such as Chandigarh, Jammu and Kashmir, and Rajasthan, which reported the highest stillbirth rates, Dr Saradha suggested that they could benefit from replicating South India’s strategies.
She pointed to structured follow-up mechanisms, where health workers track patients through local networks and even visit homes if a woman misses check-ups. “They cannot doctor-shop, the healthcare worker will go to her place and check why she is not attending,” she said, describing the accountability that has reduced stillbirth and maternal complications in the South.
Paradoxically, the study found that urban mothers showed higher stillbirth rates than rural ones. Despite the concentration of tertiary hospitals in cities, Dr Saradha observed that advanced maternal age, assisted reproductive techniques such as IVF, and lifestyle-related conditions including hypertension and diabetes have contributed to this trend.
“Because of advanced maternal age and other comorbidities, maybe that can be the reason for the higher rate still in urban mothers,” she explained.
She also cautioned that sedentary lifestyles, unbalanced diets, and heavy reliance on processed foods among urban women likely play a role in sustaining the gap.
(Edited by Dese Gowda)
