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

Ranjan Prusty, Indian Council of Medical Research (ICMR)
Mahadev M. D. Bhise, Indian Council of Medical Research (ICMR)
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 APOs in India. Methods: Using data from the National Family Health Survey (NFHS-5, 2019-2021), the study examines 255,385 pregnancies to assess APO prevalence. It considers socio-demographic and spatial factors influencing APO rates. Results: The national APO prevalence is 11.1%, with miscarriages at 7.3%, abortions at 2.9%, and stillbirths at 0.9%. Higher APO rates are associated with older maternal age, urban residence, higher wealth index, and tobacco use. Spatial analysis identifies 84 districts as hot spots for APOs, mainly in Northern and Eastern India, while 89 cold spots are in Central and North-Eastern regions. Multilevel logistic regression highlights advanced maternal age, higher parity, urban residence, and tobacco use as significant risk factors. Conclusion: The study reveals an increase in APO rates from NFHS-4 to NFHS-5, stressing the need for targeted interventions addressing regional disparities and socio-economic determinants to improve maternal health in India.

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

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