Karnataka, which has been doing fairly well in managing and reducing other health indicators, has the dubious distinction of having the highest stillbirth rate — 12 deaths per 1,000 births — in the country, according to the Sample Registration Survey (SRS) 2013.
However, it’s worth noting that some States have zero stillbirths, which could indicate an absence of a proper reporting system.
The State’s perinatal mortality rate stands at 30 per 1,000 live births. This, too, is higher than the country’s average of 26 per 1,000 births. Stillbirths and perinatal mortality are the only two health indicators where Karnataka fares badly.
While this is a reflection of the poor antenatal and perinatal care in rural areas, officials said stillbirths reported from bigger State-run maternity hospitals are on the higher side.
“This is because most high-risk pregnancies are referred to these hospitals,” State Deputy Director (Child Health) M.V. Vijay Kumar said.
What’s worse is that most stillbirths occur in families belonging to low-income groups.
While State health officials attributed this to socio-cultural factors and misconceptions and taboos in society, especially in rural areas, sources said it is mainly because women face many difficulties relating to accessibility, availability, affordability and quality issues when utilising healthcare facilities during pregnancy in rural areas.
Akhila Vasan of Karnataka Janarogya Chaluvali said the higher number of stillbirths grossly indicates the low pre-natal and natal care for pregnant women in primary health centres. “Although the rate of institutional deliveries has increased over time, emergency pregnancy care and quality of pregnancy care have not improved,” she said.
State Adviser (Child Health) K. Vimochana said several efforts to recruit specialists, including offering them attractive salaries, have not been successful.
“Early neonatal deaths and stillbirths usually have obstetric causes and are largely preventable if good quality obstetric care is made available at the right time. But lack of specialists is a major problem,” she explained.
There’s also the fact that many families refuse to move to bigger hospitals because of affordability factors. Some think doctors “unnecessarily” conduct a C-section. “They prefer to wait for a normal delivery, thereby delaying treatment and resulting in death of the baby,” she added.
Hema Divakar, former president of Federation of Obstetrics and Gynaecologists (FOGSI), said women should use the facilities available for pregnancy care. “They should not refrain from taking adequate precautionary measures to sail through a safe and healthy pregnancy,” she said.
Fear factor Official sources said that Karnataka has a high stillbirth rate because doctors prefer to declare the baby stillborn rather than admit that it died after birth. They fear the wrath of bereaved parents and their families.
“Relatives of patients hold doctors responsible for any untoward incident. Most of them assault doctors, who feel threatened when they are handling complicated cases,” sources said.
Poor performing states in India/ Stillbirth rate according to SRS 2013
State | Stillbirth/1000 births |
Karnataka | 12 |
Himachal Pradesh | 11 |
Chhattisgarh | 9 |
Haryana | 8 |
Assam & Tamil Nadu | 7 |
Stillbirths reported in Karnataka
2012-2013 | 2013-2014 | 2014-2015 | 2015-2016 up to September |
13,569 | 9,886 | 9,548 | 4,728 |
Current Still birth rate (SBR) as per SRS 2013: 12 per 1,000 live births
Perinatal deaths (Still births plus early neonatal deaths – within seven days of birth)
2012-2013 | 2013-2014 | 2014-2015 | 2015-2016 up to September |
20,771 | 16,939 | 16,743 | 7,685 |
Current Perinatal Mortality Rate in Karnataka as per SRS 2013 is 30 per 1,000 births against India’s 26
Child death audit
Determined to reduce neonatal mortality, the Health Department will now take up an audit of all under-five infant deaths.
Sowjanya, State Mission Director, National Health Mission, said: “While recording all infant deaths is essential, it is equally important to find out the reasons for the deaths so that we can take necessary measures to prevent more deaths.”
“The audit will facilitate investigation of every death below the age of five by our health officers. A structured format that will capture the medical cause of the death and circumstances leading to it will be made available to the officers,” she said.
The audit will also help the department in analysing the circumstances leading to the deaths so that preventable factors can be addressed locally, she added.
Guarding their image
Some private hospitals do not report infant deaths because this would only damage their image, say officials. “Some make false claims that their hospital has “zero” neonatal and maternal mortality, which is not possible. Taking note of this, the Karnataka Medical Council has issued a warning. “Hospitals making such claims are either not handling high-risk pregnancies or are clearly lying. We are right now hearing a case pertaining to one such false claim,” said KMC president H. Veerabhadrappa.
