Bihar set to track every stillbirth online, to record why each baby was lost

The new guidelines use a clear threshold so facilities record comparable cases. A stillbirth is a baby born with no signs of life at 28 weeks or more of pregnancy. Recording it consistently matters because Bihar previously had no robust system for tracking stillbirths and their causes.

When gestational age is unavailable, staff use physical measures instead. A birth weight of 1,000 grams or more qualifies, as does a body length of 35 centimetres or more. These rules help facilities identify cases even when pregnancy records are incomplete.

The definition is the starting point for Bihar’s portal-based surveillance system. Once a case meets the criteria, the facility must report it on the MPCDSR portal, document its timing and likely cause, and include a brief case history. This creates a standard record for monthly facility reviews, district meetings and quarterly state examinations.

Bihar’s new system replaces isolated hospital record entries with structured online surveillance. The facility nodal officer must report every stillbirth within 24 hours. The doctor, nurse or ANM who conducted the delivery must complete the reporting form within seven days or before the mother leaves the facility.

A data entry operator uploads the information to the maternal, perinatal, child death surveillance and response portal. Each record includes the number of stillbirths, timing, ICD-defined cause, patient history and a case review. Specialist facilities submit detailed information, while peripheral centres provide fewer parameters.

Review happens at several levels. Facilities examine cases every month. Districts discuss them in monthly meetings. The state selects cases for quarterly review. This process can show repeated problems, such as poor antenatal care, medical risks or delays in reaching hospitals, and guide responses across Bihar’s health system.

Bihar does not yet have one agreed stillbirth estimate. Sample Registration System reports put the rate at 3 per 1,000 births in 2022, 4 in 2023 and 2 in 2024. These figures were below the national rates reported for those years, which were 5, 7 and 7 respectively.

Other sources show a much higher burden. Bihar’s Health Management Information System records 9 stillbirths per 1,000 births. Data assessed by different third-party agencies place the figure near 11, close to the United Nations estimate of 11.8 nationally in 2023. The article does not identify one source as definitive.

The wide range reflects different data sources and reporting arrangements, including official surveys, HMIS and external assessments. The new portal aims to create more consistent records by requiring every facility to report cases, causes and reviews. Better data should clarify the scale and reveal where prevention is most needed.

Reporting every stillbirth with its likely cause can make a previously incomplete problem visible. Bihar’s experts say no robust system recorded both stillbirths and causes before this effort. Reliable case information matters because prevention depends on knowing when deaths occur and what conditions surround them.

For example, the portal records timing and classifies causes using ICD codes. A facility can review a case, add a brief history and discuss it monthly. District teams can compare cases in their meetings, while the state can examine selected cases each quarter. Specialist hospitals provide detailed data; peripheral centres report key parameters.

This system could reveal repeated links with anaemia, malnutrition, hypertension, diabetes, infections, poor antenatal care or delays during labour. Officials could then strengthen services where problems recur. It may also make Bihar’s estimates more reliable and support the Sustainable Development Goal of a single-digit national stillbirth rate by 2030.

The article identifies several contributors: high-risk pregnancies, anaemia, malnutrition, poor antenatal care, hypertension, diabetes, infections and delays in reaching hospitals during labour pain. About 40% of stillbirths occur during labour. Recording these factors can help health teams distinguish medical risks from gaps in care or delays.

The guidelines use three broad categories. Antenatal causes occur during pregnancy before birth. Maternal causes relate to a condition affecting the mother. Intrapartum causes occur during labour and childbirth. Staff also record timing and use International Classification of Diseases codes for standardised medical reporting.

Some factors can overlap in a single case. For instance, maternal hypertension may complicate pregnancy, while a delay in reaching a hospital may affect labour. The required case history and review give teams more context. Monthly facility reviews and district discussions can then identify recurring causes and focus improvement efforts.

Bihar and Uttar Pradesh are central to India’s stillbirth challenge because experts say they together account for 30% of stillbirths in the country. Their performance can therefore influence the national picture, especially as India works toward the Sustainable Development Goal of a single-digit stillbirth rate by 2030.

Bihar is now building a system that can show where its losses occur and why. Its new portal will capture every reported case, timing, ICD-defined cause and case history. Facilities, districts and the state will review cases at regular intervals. The state also says 11% of its average 37 lakh annual pregnancies are high-risk.

The two states’ importance makes stronger measurement especially valuable. Bihar’s estimates range from 2 to 11 per 1,000 births, depending on the source. More consistent reporting can help officials understand the burden, compare patterns and direct services toward high-risk pregnancies, medical conditions and labour delays.

Antenatal care matters because it can identify pregnancies needing closer attention. The article lists high-risk pregnancies, anaemia, malnutrition, hypertension, diabetes and infections among important concerns. Detecting and managing these conditions during pregnancy gives health teams information before labour begins and supports closer monitoring.

Skilled management of labour matters because about 40% of stillbirths occur during labour. The article identifies poor care and delays during labour as risks. At the facility, trained doctors, nurses and ANMs conduct deliveries and document cases. Their observations can support timely action and a clearer review if a death occurs.

Timely access to hospitals is also important. The guidelines specifically identify delays in reaching hospitals during labour pain as a contributing factor. Faster access brings women to professional care sooner. Bihar’s new reporting system will not itself prevent every death, but it can show where antenatal services, labour care or referral access repeatedly fail.