Submission ID 130298
| Issue/Objective | Stillbirth is a crucial indicator of maternal and child health (MCH) system effectiveness, uncovering preventable gaps in care across prenatal and intrapartum periods. Despite multiple national MCH programs in India, limitations in implementation and contextual adaptation continue to restrict effectiveness, particularly in rural and tribal areas. Traditional top-down program design approaches often fail to reflect on-ground realities. This study aimed to co-design a context-specific implementation framework for stillbirth reduction in rural areas through practical strategies that translate evidence into action. |
|---|---|
| Methodology/Approach | The first phase of implementation research was conducted in three rural and tribal blocks of Pune district, India, between September 2024 and August 2025. Mixed-methods formative research included in-depth interviews, focus group discussions, facility assessments, ANC clinic and intrapartum observations, and community surveys. These methods were used to identify barriers, facilitators, and health system gaps within existing MCH programs. Data were analyzed to formulate context-specific implementation strategies addressing identified barriers. Iterative co-design workshops and discussions were subsequently conducted with multi-level public health stakeholders, including implementers and policymakers. Proposed interventions were mapped according to impact and feasibility and prioritized using an Action Priority Matrix (APM), while the RE-AIM framework guided considerations for adoption, scalability, and sustainability. |
| Results | Twelve prioritized intervention areas were identified and structured into three integrated pathways: (i) Community level: awareness generation, nutrition support, community communication, emergency transport preparedness (ii) Primary facility level: high-risk pregnancy training, partograph use, respectful maternity care, referral protocols, digital tracking (iii) Referral/Secondary care level: stillbirth audits, public-private referral linkages, newborn stabilization capacity The primary facility-level pathway emerged as the highest-priority domain due to its critical role in intrapartum care and referral decisions. The APM enabled transparent, consensus-driven prioritization, leading to the development of "Model 1," a co-designed intervention framework integrating prioritized strategies into an implementation-ready package tailored to the local health-system context. |
| Discussion/Conclusion | This study demonstrates how structured co-design can translate implementation evidence into practical stillbirth prevention strategies. By prioritizing context-specific actions across community, primary care, and referral levels, the framework provides a scalable approach for strengthening maternal care pathways and reducing preventable stillbirths in rural settings, offering a replicable model for translating evidence into action. |
| Presenters and Affiliations | Nisha Mutalikdesai KEM Hospital Research Centre Nisha Mutalikdesai KEM Hospital Research Centre Kiran Kadam KEM Hospital Research Centre Eesha Chawan KEM Hospital Research Centre Sayali Kasture KEM Hospital Research Centre Dhiraj Agarwal KEM Hospital Research Centre Sanjay Darade Health & Family Wellness Training Centre Abhiraj Suryawanshi Health & Family Wellness Training Centre Suhas Kore Health & Family Wellness Training Centre Nitin Ambadekar Director of Health Services Reema Mukherjee Indian Council of Medical Research Sudipto Roy Indian Council of Medical Research Girish Dayma KEM Hospital Research Centre Mukta Gadgil State Health Systems Resource Centre Rutuja Patil KEM Hospital Research Centre |
