Abstract 17: Improving High-risk Pregnancy Care and Stillbirth Measurement Through Phone Based Follow-up in Uttar Pradesh, India

Abstract Introduction: Accurate data on stillbirth is critical for improving maternal and perinatal health but remains limited in India, where estimates vary widely across sources. In 2019, the UN estimated India’s stillbirth rate as 13.9 per 1,000 total births, while India’s Sample Registration System (SRS) reports rates as low as 3.0 per 1,000. Moreover, administrative systems often lack timely, comprehensive follow-up on high-risk pregnancies (HRPs), particularly in Uttar Pradesh, which has some of the country’s highest stillbirth rates. Aim: In response, we piloted a system at Autonomous State Medical College Bahraich, in partnership with Research And Action for Health in India (RAAHI), to improve both care and outcome measurement for HRPs. Methods: Between February 2024 and February 2025, we enrolled 8,451 pregnant women attending outpatient antenatal care (ANC), and identified 11% as HRP based on clinical criteria. As part of routine care, a nurse stationed in the outpatient department encouraged HRP women to continue follow-up care and facilitated referrals. While HRP women had more follow-up visits than non-HRP women, overall follow-up remained suboptimal: only 22% of HRP women completed four or more ANC visits, the WHO standard for all pregnancies. To further address this gap, we piloted phone-based reminders encouraging HRP women to return for care. We also conducted follow-up calls after due dates to document pregnancy outcomes. Among 496 attempted contacts, outcomes were ascertained for 119 women (122 pregnancies), revealing a stillbirth rate of 25.6 per 1,000 total births. Results: Though incomplete and preliminary, this rate is substantially higher than official estimates. These early findings underscore the need for innovative low-cost strategies to improve follow-up among high-risk women and stillbirth measurement. Post-ANC tracking through phone-based systems shows promise for enhancing maternal health surveillance and informing interventions.