Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study
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 a...
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BMC
2025-08-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-025-07912-6 |
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| author | Yebeen Ysabelle Boo Rupanjali Deka Aliki Christou Uchenna Gwacham-Anisiobi Jenny Gong Monica Lakhanpaul Jennifer J. Kurinczuk Manisha Nair |
| author_facet | Yebeen Ysabelle Boo Rupanjali Deka Aliki Christou Uchenna Gwacham-Anisiobi Jenny Gong Monica Lakhanpaul Jennifer J. Kurinczuk Manisha Nair |
| author_sort | Yebeen Ysabelle Boo |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-26ccf22c063d4b0f99750710460c8d47 |
| institution | Kabale University |
| issn | 1471-2393 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj-art-26ccf22c063d4b0f99750710460c8d472025-08-20T03:46:29ZengBMCBMC Pregnancy and Childbirth1471-23932025-08-0125112010.1186/s12884-025-07912-6Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative studyYebeen Ysabelle Boo0Rupanjali Deka1Aliki Christou2Uchenna Gwacham-Anisiobi3Jenny Gong4Monica Lakhanpaul5Jennifer J. Kurinczuk6Manisha Nair7National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordSrimanta Sankaradeva University of Health SciencesInstitute of Tropical MedicineNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordPopulation, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, University College LondonNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordAbstract 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.https://doi.org/10.1186/s12884-025-07912-6Stillbirth reviewFacilitatorsBarriersIndiaMPDSRCOM-B |
| spellingShingle | Yebeen Ysabelle Boo Rupanjali Deka Aliki Christou Uchenna Gwacham-Anisiobi Jenny Gong Monica Lakhanpaul Jennifer J. Kurinczuk Manisha Nair Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study BMC Pregnancy and Childbirth Stillbirth review Facilitators Barriers India MPDSR COM-B |
| title | Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study |
| title_full | Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study |
| title_fullStr | Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study |
| title_full_unstemmed | Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study |
| title_short | Facilitators and barriers to implementing and sustaining facility-based stillbirth reviews in India: a qualitative study |
| title_sort | facilitators and barriers to implementing and sustaining facility based stillbirth reviews in india a qualitative study |
| topic | Stillbirth review Facilitators Barriers India MPDSR COM-B |
| url | https://doi.org/10.1186/s12884-025-07912-6 |
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