Understanding stillbirths beyond health facilities: Surveillance & review in selected districts of Haryana, India

<h2>ABSTRACT</h2><h3>Background</h3> Globally, approximately 2 million stillbirths occur annually, and India accounts for the greatest number of stillbirths in the world. This study was conducted to evaluate stillbirths at the community level to understand the barriers/gaps in accessing optimal health care on time. <h3>Aim</h3> To understand the factors attributed to stillbirth by capturing the lived experience of the woman and her family members with stillbirth using the WHO verbal autopsy tool. <h3>Method</h3> ology: Population-based surveillance was done with the identification of all stillbirths that occurred either at home or in a health care facility in two districts of Haryana. This study employed a concurrent mixed-methods approach, combining quantitative (QUAN) and qualitative (QUAL) strategies to meet the objectives of the research. The quantitative data was collected using the WHO verbal autopsy tool, and for qualitative data, in-depth interviews were conducted to capture the lived experience. <h3>Results</h3> During the study period of four months, a total of 3651 births occurred, out of 3651 births, 66 were stillbirths (≥28 weeks of gestation) with a stillbirth rate of 18.0 per 1000 total births. Almost 2/3^rd of stillbirths were antepartum. None of the women had a delay 2 i.e., difficulty in reaching the health care facility. The main hurdle that came out predominantly was delay 1 (Perceiving own healthcare requirement) and delay 3 (Receiving adequate care). <h3>Conclusion</h3> Surveillance for stillbirths at the community level is feasible, and it can help capture the associated factors that are usually missed at the facility level of surveillance.