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

Ranjan Kumar Prusty, ICMR-National Institute for Research in Reproductive and Child Health
Mahadev M. D. Bhise, National Institute for Research in Reproductive Health (NIRRH)
Shahina Begum, ICMR-NIRRCH, Mumbai

Introduction Pregnancy carries significant risks, known as Adverse Pregnancy Outcomes (APO), including stillbirths, miscarriages, and abortions, with 810 women dying daily from APOs, mostly in low- and middle-income countries. In India, despite advancements in maternal health, the prevalence of APOs remains high. This study aims to analyze the determinants, prevalence and spatial distribution of pregnancy loss in India. Methods Using even calendar data from the National Family Health Survey (NFHS-5, 2019-2021), the study analyzes 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%, with miscarriages at 7.3%, abortions at 2.9%, and stillbirths at 0.9%. Higher PL rates correlate with older maternal age, urban residence, higher wealth index, and tobacco use. The spatial analysis identifies 84 districts as hot spots for PL, primarily located in Northern and Eastern India, while 89 cold spots are found in Central and North-Eastern regions. Multilevel logistic regression reveals that older woman 35-49 years old (aOR=3.8, 95% CI=1.26-1.63) and women who used tobacco (aOR: 1.28, 95% CI: 1.09-1.49) were significantly at higher risk of pregnancy wastage than in comparison to younger women (< 20 years) and women not using tobacco respectively. Conclusion The study identified 84 hot spot districts of pregnancy loss with a marginal increase in PL rates during 2015-2021. Therefore, it requires further research to understand individual, community level and health system factors in the identified hotspot districts to improve maternal health outcomes in these districts of India.

Keywords: Sexual and Reproductive Health and Rights, Health and Morbidity, Geographic Information Systems (GIS), Spatial Demography

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  Presented in Session 168. Diverse Pathways to Adverse Reproductive Health and General Health Outcomes