# Stillbirth Definitions in Transition: A Call for Updated, Nuanced Criteria

## TL;DR

The paper discusses the need for updated stillbirth definitions in India to improve global health comparisons and reduce preventable stillbirths.

## Contribution

The paper proposes updated stillbirth criteria and highlights the importance of accurate classification for targeted interventions.

## Key findings

- India has the highest number of stillbirths but inconsistent reporting limits global comparisons.
- New legislation allows for a separate category for medical termination of pregnancy, improving data accuracy.
- Improved surveillance systems like ICMR-SPIC can provide insights into risk factors.

## Abstract

Stillbirth remains a significant, yet under-recognized, global health challenge, complicated by wide variation in definitions and reporting practices. While advances in neonatal care have shifted viability thresholds from 28 to as low as 20 weeks in some countries, inconsistent criteria continue to hinder comparisons across settings. India contributes the largest number of stillbirths worldwide and, despite a steady decline over two decades, substantial disparities in perinatal care persist. Current Indian stillbirth reporting systems have significant drawbacks that limit the accuracy and comparability to global standards. Recent changes in legislation offer an opportunity to introduce a separate category for medical termination of pregnancy, improving accuracy. Strengthening stillbirth definitions, recognizing undelivered fetal deaths, and improving surveillance systems, such as through the Indian Council of Medical Research Stillbirth Pooled India Cohort (ICMR-SPIC) cohort, can generate clearer insights into risk factors and guide targeted interventions. Accurate classification is essential for reducing preventable stillbirths and advancing national and global goals.