Exploring causes of and risk factors for perinatal mortality in rural Maharastra, India

The Comprehensive Rural Health Project (CRHP), a healthcare organization serving rural Maharashtra, India, made strides in reducing infant death over the past 30 years using community-based health interventions such as antenatal health visits. However, newborn deaths remain a significant cause of under-five mortality in project villages. This study aims to identify causes of and potential maternal risk factors for newborn mortality. Families that had experienced perinatal and neonatal deaths between April 1, 2007 and August 5, 2008 were identified from records of village health workers and government workers for 30 sentinel CRHP villages. A standardized verbal autopsy was administered, including questions on maternal health, socio-demographics, and health service utilization. Results of the verbal autopsies were applied to validated algorithms and reviewed by two pediatricians to identify causes of death. Of the 30 deaths (25 deaths /1000 live births), 20 (69%) were related to intrauterine or ante-partum events. These included cases of stillbirth (55%), intrauterine asphyxia (20%), premature labor (20%), and low birth weight (5%). A maternal history of hard physical labor up to the third trimester of pregnancy was present in 75% of cases and was the only notable common factor. The predominance of perinatal deaths associated with intrauterine events suggests that interventions promoting antenatal health at a household level and improving access to emergency obstetric care should be prioritized to reduced newborn mortality in CRHP, and similar, villages. Further research into maternal risk factors is warranted and will require larger, controlled studies.