{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T14:43:57Z","timestamp":1792248237971,"version":"4.4.0"},"reference-count":32,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,9,18]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the rate of stillbirth and associated risk factors across nine states in India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of cross-sectional data from the Indian Annual Health Survey (2010\u20132013).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nine states in India: Madhya Pradesh, Chhattisgarh, Rajasthan, Uttarakhand, Jharkhand, Odisha, Bihar, Assam and Uttar Pradesh.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>886\u2009505 women, aged 15\u201349 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Stillbirth 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall rate of stillbirth was 10 per 1000 total births (95%\u2009CI 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%\u2009CI 1.16 to 1.39), female illiteracy (aOR 1.43, 95%\u2009CI 1.17 to 1.74), low socioeconomic status (aOR 2.42, 95%\u2009CI 1.82 to 3.21), schedule caste background (aOR 1.11, 95%\u2009CI 1.04 to 1.19) and woman not in paid employment (aOR 1.15, 95%\u2009CI 1.07 to 1.24). Women from minority religious groups were at higher risk than the Hindu majority (Muslim (aOR 1.33, 95%\u2009CI 1.25 to 1.43); Christian (aOR 1.42, 95%\u2009CI 1.19 to 1.70)). While a few women smoked (&lt;1%), around 9% reported chewing tobacco, which was associated with an increased odds of stillbirth (aOR 1.11, 95%\u2009CI 1.02 to 1.21). Adverse pregnancy and birth characteristics were also associated with stillbirth: antenatal care visits &lt;4 (aOR 1.08, 95%\u2009CI 1.01 to 1.15), maternal age &lt;25 years (aOR 1.29, 95%\u2009CI 1.21 to 1.37) and \u226535 years (aOR 1.16, 95%\u2009CI 1.04 to 1.29), multigravida (aOR 3.06, 95%\u2009CI 2.42 to 3.86), multiple pregnancy (aOR 1.77, 95%\u2009CI 1.47 to 2.15), assisted delivery (aOR 3.45, 95%\u2009CI 3.02 to 3.93), caesarean section (aOR 1.73, 95%\u2009CI 1.58 to 1.89), as were pregnancy complications (aOR 1.42, 95%\u2009CI 1.33 to 1.51).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>India is an emerging market economy experiencing a rapid health transition, yet these findings demonstrate the marked disparity in risk of stillbirth by women\u2019s socioeconomic status. Tobacco chewing and maternal and fetal complications were each found to be important modifiable risk factors. Targeting the \u2018at-risk\u2019 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-022583","type":"journal-article","created":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T23:15:18Z","timestamp":1541718918000},"page":"e022583","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":67,"title":["Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey"],"prefix":"10.1136","volume":"8","author":[{"given":"Noon","family":"Altijani","sequence":"first","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5490-699X","authenticated-orcid":false,"given":"Claire","family":"Carson","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saswati Sanyal","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, FAA Medical College and Hospital, Barpeta, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali","family":"Rani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Ajagara, Banaras Hindu University, Varanasi, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umesh C","family":"Sarma","sequence":"additional","affiliation":[{"name":"Srimanta Sankaradeva University of Health Sciences, Assam, Narkashur Hilltop, Christian Basti Bhangagarh, Guwahati, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Knight","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0660-5054","authenticated-orcid":false,"given":"Manisha","family":"Nair","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,11,8]]},"reference":[{"key":"2025121220464927000_8.11.e022583.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00837-5"},{"key":"2025121220464927000_8.11.e022583.2","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/S0140-6736(15)00818-1","article-title":"Stillbirths: progress and unfinished business","volume":"387","author":"Fr\u00f8en","year":"2016","journal-title":"Lancet"},{"key":"2025121220464927000_8.11.e022583.3","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1016\/S2214-109X(15)00275-2","article-title":"National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis","volume":"4","author":"Blencowe","year":"2016","journal-title":"Lancet Glob Health"},{"key":"2025121220464927000_8.11.e022583.4","first-page":"58","article-title":"India newborn action plan","volume":"2","author":"Sharma","year":"2015","journal-title":"J Res Med Sci"},{"key":"2025121220464927000_8.11.e022583.5","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000258130.07476.e3"},{"key":"2025121220464927000_8.11.e022583.6","unstructured":"Ministry of Health and Family Welfare (MoHFW) GoI. 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