Population-based estimates of still birth, induced abortion and miscarriage in the Indian state of Bihar

Abstract

BackgroundWe report population-based data on still birth, induced abortion and miscarriage from the Indian state of Bihar to assess the magnitude of the problem and to inform corrective action.MethodsA representative sample of women from all districts of Bihar with a pregnancy outcome in the last 12 months was obtained through multistage sampling in early 2012. Still birth rate was calculated as fetuses born with no sign of life at 7 or more months of gestation per 1,000 births. Induced abortion and miscarriage rates were defined as expulsion of dead fetuses at less than 7 months of gestation induced by any means or without inducement, respectively, per 1000 pregnancies that had an outcome. Multiple regression models were used to explore possible associations with stillbirths, induced abortions and miscarriages. Multi-level models were developed for the relatively less developed north zone and for the south zone of Bihar to examine contextual factors associated with still births, induced abortions and miscarriages.ResultsStill birth rate was estimated as 20 per 1,000 births (95% CI 15.6-24.5), and induced abortion and miscarriage rates as 8.6 (6.6-10.6), and 46 (40.8-51.3) per 1,000 pregnancies with outcome, respectively. The odds of induced abortion and miscarriage were significantly higher in the south zone (odds ratio 2.53 [95% CI 1.79-3.57] and 1.27 [95% CI 1.10-1.47], respectively). In the multi-level model for the north zone, the odds of induced abortion were higher for women with husband’s having mean years of education higher than the state mean (2.62; 95% CI 1.47-4.69). Among the nine divisions of Bihar, comprising of groups of districts, higher induced abortion rate was associated with lower neonatal mortality rate (R2 = 0.68, p = 0.01).ConclusionsThese population-based data show a significant burden of still births in Bihar, suggesting that addressing these must become an important part of maternal and child health initiatives. The higher induced abortion in the more developed districts, and the inverse trend between induced abortion and neonatal mortality rates, have programmatic implications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0413-z) contains supplementary material, which is available to authorized users.

A Prospective Study to Investigate the Relationship Between Periodontal Disease and Adverse Pregnancy Outcome Among Pregnant Women

“…It was greater in women with periodontal disease (36.4%) than those of non-periodontal disease (24%). The incidence of miscarriage in women was 9.5% which was similar to the 8% findings given by Kochar et al 8 and contrary to the results (1.3%) given by Moore et al Statistically significant association was seen between periodontal and nonperiodontal disease women for all adverse outcomes. The probable reason for higher periodontitis during pregnancy is that women are relatively immuno-compromised, resulting in their higher susceptibility to oral infections.…”

Identification of factors associated with stillbirth in the Indian state of Bihar using verbal autopsy: A population-based study

“…The sampling method for clusters is described in detail elsewhere [ 13 , 15 ], and the methods relevant to this report are detailed here. The state of Bihar is divided into 38 districts, each of which is divided into 5 to 27 blocks, giving a total of 342 blocks in the state.…”

“…We have recently reported a stillbirth rate of 20 per 1,000 births from a large-scale, population-based household survey of women who had a pregnancy outcome in the last 12 months in the Indian state of Bihar [ 13 ]. With a population of 104 million in year 2011, Bihar state is the third most populous state in India, with 11% of it urbanised [ 14 ].…”

“…With a population of 104 million in year 2011, Bihar state is the third most populous state in India, with 11% of it urbanised [ 14 ]. Using the previously used cluster-sampling frame [ 13 , 15 ], we conducted a study to estimate the causes of death using verbal autopsy. We report on stillbirths in this paper with 3 major objectives: first, to report detailed stillbirth epidemiology based on verbal autopsy in this population; second, to assess contextual information from the qualitative data regarding the interface with the health system that could allow understanding of missed opportunities within the health system; lastly, based on these data, we make recommendations for the INAP that could better inform the setting of priorities and actions to reduce stillbirths.…”

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“…18 A study performed in Bihar, India, using a stratified random sampling approach, reported that out of 15,138 women, the number of miscarriages in past 12months was 788. 19 Furthermore, the prospective study conducted on Australian women, indicated that 2544 miscarriages occurred in total of 5806 women. 20…”