ArticleBMC pregnancy and childbirth2025
Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study.
Article in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Stillbirths at 22- and 28-weeks' gestation or longer for the states in India: findings from the Global Burden of Disease Study 2023.The Lancet regional health. Southeast Asia · 2026Article
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8 authors.
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Abstract
backgroundStillbirth reviews provide opportunities to improve the quality of maternity care and reduce preventable stillbirths. In India, facility-based stillbirth reviews have been part of the National Health Mission since 2016, yet their implementation has been inconsistent. This study aimed to identify the facilitators and barriers to implementing and sustaining facility-based stillbirth reviews as reported by Indian healthcare professionals.
methodsA qualitative study was conducted between August to October 2023 using focus group discussions with purposively sampled healthcare professionals from eight hospitals in India, which included those that conduct stillbirth reviews and those that do not. Discussions were analysed using the Framework Method. We applied the capability, opportunity, motivation, and behaviour (COM-B) model to identify facilitators and barriers and used the Behaviour Change Wheel to link these to intervention functions.
resultsImportant factors related to capability included record-keeping skills, understanding the importance of documentation, and training on how to conduct effective stillbirth reviews. Under social opportunity, key facilitators were creating a blame-free environment for discussion, ensuring participation from all levels of the health system, and addressing cultural perceptions of stillbirth and post-mortem examinations. Facilitators related to physical opportunity included the presence of clear stillbirth definitions and the collection of minimum stillbirth data. Reflective motivation, specifically, the beliefs in the benefits of stillbirth reviews for both the facility and the community, was a notable factor in the willingness of healthcare professionals to implement and sustain stillbirth reviews despite system-level barriers.
conclusionsStrengthening the implementation and sustainability of facility-based stillbirth reviews in India requires targeted, practical interventions. Creating a blame-free environment can be supported through workshops emphasising the learning purpose of reviews, having neutral facilitators to guide discussions, and asking participants to sign a code of conduct ‘charter’ pledging their commitment to providing a safe environment for all panel members and the community, incorporating this into local stillbirth review guidelines. Clear national guidelines on stillbirth definitions, combined with training on accurate data collection and reporting, will improve consistency. Regular training and mentoring should focus on building healthcare professionals’ capability in record-keeping and effective review practices. Strengthening information technology infrastructure and providing protected time for reviews will address workload challenges. Additionally, fostering motivation through peer-led discussions and sharing positive outcomes can encourage continued commitment to stillbirth reviews.
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