ObjectivesTo assess the rate of stillbirth and associated risk factors across nine states in India.DesignSecondary analysis of cross-sectional data from the Indian Annual Health Survey (2010–2013).SettingNine states in India: Madhya Pradesh, Chhattisgarh, Rajasthan, Uttarakhand, Jharkhand, Odisha, Bihar, Assam and Uttar Pradesh.Participants886 505 women, aged 15–49 years.Main outcome measuresStillbirth rate with 95% CI. Adjusted OR to examine the associations between stillbirth and (1) socioeconomic, behavioural and biodemographic risk factors and (2) complications in pregnancy (anaemia, eclampsia, other hypertensive disorders, antepartum and intrapartum haemorrhage, obstructed labour, breech presentation, abnormal fetal position).ResultsThe overall rate of stillbirth was 10 per 1000 total births (95% CI 9.8 to 10.3). Indicators of socioeconomic deprivation were strongly associated with an increase in stillbirth: rural residence (adjusted OR (aOR) 1.27, 95% CI 1.16 to 1.39), female illiteracy (aOR 1.43, 95% CI 1.17 to 1.74), low socioeconomic status (aOR 2.42, 95% CI 1.82 to 3.21), schedule caste background (aOR 1.11, 95% CI 1.04 to 1.19) and woman not in paid employment (aOR 1.15, 95% CI 1.07 to 1.24). Women from minority religious groups were at higher risk than the Hindu majority (Muslim (aOR 1.33, 95% CI 1.25 to 1.43); Christian (aOR 1.42, 95% CI 1.19 to 1.70)). While a few women smoked (<1%), around 9% reported chewing tobacco, which was associated with an increased odds of stillbirth (aOR 1.11, 95% CI 1.02 to 1.21). Adverse pregnancy and birth characteristics were also associated with stillbirth: antenatal care visits <4 (aOR 1.08, 95% CI 1.01 to 1.15), maternal age <25 years (aOR 1.29, 95% CI 1.21 to 1.37) and ≥35 years (aOR 1.16, 95% CI 1.04 to 1.29), multigravida (aOR 3.06, 95% CI 2.42 to 3.86), multiple pregnancy (aOR 1.77, 95% CI 1.47 to 2.15), assisted delivery (aOR 3.45, 95% CI 3.02 to 3.93), caesarean section (aOR 1.73, 95% CI 1.58 to 1.89), as were pregnancy complications (aOR 1.42, 95% CI 1.33 to 1.51).ConclusionIndia is an emerging market economy experiencing a rapid health transition, yet these findings demonstrate the marked disparity in risk of stillbirth by women’s socioeconomic status. Tobacco chewing and maternal and fetal complications were each found to be important modifiable risk factors. Targeting the ‘at-risk’ population identified here, improved recording of stillbirths and the introduction of local reviews would be important steps to reduce the high burden of stillbirths in India.

Background: Breastfeeding is commonly practiced by a majority of mothers in developing countries, though there are widespread misconceptions about optimal breastfeeding traditions. In addition to culturally prominent rituals and social norms, incorrect and inadequate breastfeeding knowledge is major factors for this high-risk behavior. Objectives: To assess knowledge, attitude and practices of breastfeeding among girls and women visiting a tertiary care center in India and to find out the factors, which influence the breastfeeding behaviors. Design/Methods: It is a cross-sectional, questionnaire-based study done among women attending outpatient and inpatient Department of Obstetrics & Gynecology of S.S. Hospital, Banaras Hindu University, India. A face-to-face interview using a pre-designed, self-administered, standardized questionnaire regarding knowledge, attitude, and practices of breastfeeding was conducted. The information was collected and analyzed using SPSS statistical software. Findings: Among 1000 women enrolled in the study, 89% were married, 25% were primiparous, and 52% were multiparous. More than 50% were illiterate, 91% unemployed, and 90% had hospital delivery. Of the total 770 mothers, only 55% received proper antenatal care during pregnancy, of which only 40% were counseled about breastfeeding. Regarding knowledge and attitude about breastfeeding, majority females (71.4%) considered breast milk as best food for a newborn, which was better in younger women <20 years (86%). Regarding breastfeeding behavior, only 45% mothers initiated breastfeeding within one hour of delivery, which was worse in home delivered mothers (25%). Most (82%) mothers fed colostrum to their babies but 27% of mothers gave pre-lacteal feeds. Illiterate mothers (56.3%), mothers with only primary education (70%), and unemployed mothers (53.85%) continued to do exclusive breastfeeding without initiating complementary feeds even after six months. Conclusion(s): Although breastfeeding is practiced by a majority of mothers in a developing country like India, there is a significant gap in knowledge and optimal breastfeeding behaviors. Healthy breastfeeding behavior can be encouraged among mothers by proper counseling by health care workers and organizing educational programs focusing women especially with low education and limited resources.

IntroductionUnsafe abortion is a preventable cause of maternal mortality. While studies report high number of abortions in India, the population-level rates of unsafe abortion and their risk factors are not well understood. Our objective was to analyse the rates of and risk factors for unsafe abortion and abortion-related maternal death in India.MethodsWe conducted a secondary analysis of data from 1 876 462 pregnant women aged 15–58 years from nine states in the Indian Annual Health Survey (2010–2013). We calculated the rate of unsafe abortion and abortion-related mortality with 95% CI. Multivariable logistic regression models examined the associations of sociodemographic characteristics, health seeking behaviours and family planning with unsafe abortion and abortion-related mortality.ResultsThere were 89 447 abortions among 1 876 462 pregnant women in 2007–2011 (4.8%; 95% CI 4.8 to 4.9). Of these, 58 266 were classified as unsafe (67.1%; 95% CI 66.7 to 67.5). There were 253 abortion-related maternal deaths (0.3%; 95% CI 0.2 to 0.3). Factors associated with unsafe abortion: maternal age 20–24 years (adjusted OR (aOR): 1.13; 95% CI 1.09 to 1.18), illiteracy (aOR: 1.48; 95% CI 1.39 to 1.59), rural residence (aOR: 1.26; 95% CI 1.21 to 1.32), Muslim religion (aOR: 1.16; 95% CI 1.12 to 1.22), Schedule caste social group (aOR: 1.08; 95% CI 1.04 to 1.12), poorest asset quintile (aOR: 1.45; 95% CI 1.38 to 1.53), antenatal care (aOR: 0.69; 95% CI 0.67 to 0.72), no surviving children (aOR: 1.30; 95% CI 1.16 to 1.46), all surviving children being female (aOR: 1.12; 95% CI 1.07 to 1.17), use of family planning methods (aOR: 0.69; 95% CI 0.66 to 0.71). Factors associated with abortion-related deaths: maternal age 15–19 (aOR: 7.79; 95% CI 2.73 to 22.23), rural residence (aOR: 3.28; 95% CI 1.76 to 6.11), Schedule tribe social group (aOR: 4.06; 95% CI 1.39 to 11.87).ConclusionDespite abortion being legal, the high estimated prevalence of unsafe abortion demonstrates a major public health problem in India. Socioeconomic vulnerability and inadequate access to healthcare services combine to leave large numbers of women at risk of unsafe abortion and abortion-related death.