The dynamics of late fetal and neonatal mortality in the Indian context

Project Summary Stillbirths and neonatal deaths are two adverse birth outcomes of critical global health relevance. In 2021, an estimated 1.9 million babies were stillborn, and 2.3 million liveborn babies died before reaching 28 days of age. India stands out globally as the country having the largest number of stillbirths and neonatal deaths

(respectively 290,000 and 440,000 in 2021). These large numbers not only reflect the size of India’s population but also its high levels of stillbirth and neonatal mortality. Moreover, not only are India’s neonatal mortality rates high relative to other countries, but they are high relative to India’s own levels of postneonatal

mortality. This indicates the existence in India of a distorted age pattern of mortality at early ages with excess mortality at neonatal ages, impeding the country’s ability to meet Sustainable Development Goals targets. In spite of the significance of these patterns, measurement and understanding of stillbirth rates and neonatal

mortality in India are hindered by major gaps in data availability and quality. Undercount of stillbirths and neonatal deaths as well as misclassification of neonatal deaths vs. stillbirths in existing, mostly retrospective sources remain major concerns. Issues with availability and quality of information on small for gestational age,

preterm and low birthweight – three major risk factors that can play a large role in both levels and age patterns of early-age mortality – are additional gaps that further impede proper monitoring of India’s patterns of mortality during the late fetal and neonatal periods. The goal of this project is to improve our understanding of

why India stands out globally in terms of both its levels and age patterns of mortality during the late fetal and neonatal periods by collecting new prospective data in 4 surveillance sites located in different regions of India, covering a variety of contexts. While the focus of this project is on India due to the outsize role it plays in global

rates of stillbirth and neonatal mortality, results will have methodological and substantive implications for other low-income countries, including other South Asian countries and countries in Sub-Saharan Africa which, like India, are characterized by a high burden of stillbirths and neonatal mortality as well as large data gaps in

their stillbirth and neonatal mortality information.