The factors associated with stillbirth in urban Vadodara: A population based cross-sectional study, Vadodara Municipal Corporation, Gujarat, India.

Background: Stillbirths are a neglected problem in India, and the data we have are often unreliable. This study aimed to assess stillbirth record quality in an urban setting and understand the experiences, health impacts, and perceived causes from both families and health workers. Methods: A mixed-methods study was conducted in Vadodara Municipal Corporation during January to December 2023. All reported stillbirths (>=28 weeks or >=1000 g) were reviewed. Families were interviewed at home using a standardized questionnaire, with in-depth interviews conducted with 9 families and 17 health workers (doctors, ANMs, ASHAs). Quantitative data were analysed using Excel and Jamovi; qualitative data were analysed thematically. Results: Of 61 stillbirths reported by VMC, quality audits revealed 7 errors (duplicates/misclassifications) and 2 data entry errors, yielding a true stillbirth rate of 1.7 per 1000 total births. The eastern zone recorded the most cases (21), while the southern zone had the highest rate (4.1 per 1000). Most deliveries occurred in government hospitals (64%). Common reported causes were intrauterine foetal death on routine ultrasound (26%) and premature delivery (19%). Families reported delayed care access, undertrained staff, poor facilities, and challenges accessing government scheme benefits. Health workers identified preventable factors (hypertension, diabetes, anaemia, meconium aspiration, growth restriction, birth defects) and non-preventable factors (extreme prematurity, multiple pregnancy). Interpretation & conclusions: Stillbirth data in Vadodara have serious quality problems which can be fixed. Many stillbirths could be avoided with better pregnancy monitoring, better communication, stronger referral systems and more awareness in the community.