# Spatial Distribution and Multilevel Analysis of Pregnancy Loss in India: Examining Individual and Contextual Factors

## TL;DR

This study examines pregnancy loss in India, finding higher rates in certain regions and among older mothers and tobacco users.

## Contribution

The study identifies spatial hotspots and risk factors for pregnancy loss in India using national survey data.

## Key findings

- Pregnancy loss prevalence in India is 11.1%, with hotspots in Northern and Eastern regions.
- Older maternal age and tobacco use significantly increase pregnancy loss risk.
- Multilevel analysis reveals socio-demographic and spatial factors influencing pregnancy outcomes.

## Abstract

Background: Around 810 women die daily due to adverse pregnancy outcomes (APOs), predominantly in low- and middle-income countries. In India, despite advancements in maternal health initiatives, pregnancy loss (PL) rates remain high. This study analyzed the determinants, prevalence, and spatial distribution of PL in India.

Study Design: This study employed a cross-sectional design.

Methods: Using data from the National Family Health Survey (NFHS-5, 2019-2021), the study analyzed 255,385 pregnancies to assess the prevalence of PL. The analysis includes socio-demographic variables and spatial factors affecting PL rates.

Results: The national PL prevalence is 11.1%, comprising 7.3% miscarriages, 2.9% abortions, and 0.9% stillbirths. Higher PL rates correlated with older maternal age, urban residence, higher wealth index, and tobacco use. The spatial analysis identified 84 districts as hot spots for PL, primarily located in Northern and Eastern India, while 89 cold spots were identified in Central and North-Eastern regions. Multilevel logistic regression revealed that women aged 35-49 years (aOR=3.8, 95% CI: 1.26-1.63) and women who used tobacco (aOR: 1.28, 95% CI: 1.09-1.49) were at a significantly higher risk of PL compared to younger women (<20 years) and non-tobacco users, respectively.

Conclusion: The study highlights the need for further research to elucidate the underlying causes of PLs and recommends strengthening the health system in hot spot districts. This can be achieved through targeted interventions that address regional disparities and socio-economic determinants, ultimately improving maternal health outcomes.