Stillbirth Definitions in Transition: A Call for Updated, Nuanced Criteria

Stillbirth remains a significant, yet under-recognized, global health challenge, complicated by wide variation in definitions and reporting practices. While advances in neonatal care have shifted viability thresholds from 28 to as low as 20 weeks in some countries, inconsistent criteria continue to hinder comparisons across settings. India contributes the largest number of stillbirths worldwide and, despite a steady decline over two decades, substantial disparities in perinatal care persist. Current Indian stillbirth reporting systems have significant drawbacks that limit the accuracy and comparability to global standards. Recent changes in legislation offer an opportunity to introduce a separate category for medical termination of pregnancy, improving accuracy. Strengthening stillbirth definitions, recognizing undelivered fetal deaths, and improving surveillance systems, such as through the Indian Council of Medical Research Stillbirth Pooled India Cohort (ICMR-SPIC) cohort, can generate clearer insights into risk factors and guide targeted interventions. Accurate classification is essential for reducing preventable stillbirths and advancing national and global goals.