Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 6;25(1):819.
doi: 10.1186/s12884-025-07912-6.

Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study

Yebeen Ysabelle Boo  1 , Rupanjali Deka  2 , Aliki Christou  3 , Uchenna Gwacham-Anisiobi  4 , Jenny Gong  4 , Monica Lakhanpaul  5   6   7 , Jennifer J Kurinczuk  4 , Manisha Nair  4   2
Affiliations

Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study

Yebeen Ysabelle Boo et al. BMC Pregnancy Childbirth. .

Abstract

Background: Stillbirth 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.

Methods: A 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.

Results: Important 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.

Conclusions: Strengthening 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.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12884-025-07912-6.

Keywords: Barriers; COM-B; Facilitators; India; MPDSR; Stillbirth review.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Clinical trial number: not applicable. This study has received ethics approval from a subcommittee of the University of Oxford Tropical Research Ethics Committee (OxTREC) (reference number: 539 − 23). Considering that this was a DPhil research, an ethics approval waiver was granted from local participating institutions: Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam; Nazareth Hospital, Shillong, Meghalaya; Dr Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh; and Sewa Bhawan Hospital Society, Chhattisgarh. Written informed consent was obtained from all participants using the consent form prior to the focus group discussions. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Coding tree representing the themes and codes that emerged as facilitators and barriers
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Chepkin S, Prince S, Johnston T, Boby T, Neves M, Smith P et al. Learning from Standardised Reviews When Babies Die. National Perinatal Mortality Review Tool: First Annual Report. Oxford: National Perinatal Epidemiology Unit; 2019. 71 p.
    1. Hug L, You D, Blencowe H, Mishra A, Wang Z, Fix MJ, et al. Global, regional, and National estimates and trends in stillbirths from 2000 to 2019: a systematic assessment. Lancet. 2021;398(10302):772–85. - PMC - PubMed
    1. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Never forgotten: the situation of stillbirth around the Globe. New York: United Nations Children’s Fund; 2023.
    1. Comfort H, McHugh TA, Schumacher AE, Harris A, May EA, Paulson KR, et al. Global, regional, and National stillbirths at 20 weeks’ gestation or longer in 204 countries and territories, 1990–2021: findings from the global burden of disease study 2021. Lancet. 2024;404(10466):1955–88. - PMC - PubMed
    1. Ministry of Health & Family Welfare Government of India. Indian Newborn Action Plan. 2014 [cited 2022 May 4]. Available from: https://nhm.gov.in/images/pdf/programmes/inap-final.pdf.

LinkOut - more resources