Solid fuel combustion and adverse pregnancy outcomes: A nationwide study on stillbirth in India.

Objectives: Stillbirth is a significant public health challenge in India, accounting for a substantial portion of the global burden. Exposure to household air pollution from solid fuel combustion during pregnancy has been associated with adverse pregnancy outcomes, including stillbirth. This study aimed to investigate the association between solid fuel use and stillbirth risk in India, utilizing data from the National Family Health Survey 5 (NFHS-5).

Study Design: Nationwide cross-sectional study.

Methods: The study employed data from the NFHS-5, a nationally representative cross-sectional survey conducted in India from 2019 to 2021. The study sample consisted of 204,723 women aged 15-49 years who had a pregnancy in the past 5 years preceding the survey. Stillbirth was calculated using calendar data, providing robust estimates. Logistic regression analysis was performed to assess the relationship between solid fuel use and stillbirth, adjusting for various sociodemographic and maternal factors.

Results: The use of unclean cooking fuels was significantly associated with an increased risk of stillbirth (OR = 1.34, 95 % CI: 1.13-1.58, p < 0.001) compared to clean fuels. Other factors associated with higher stillbirth risk included rural residence, lower maternal education, belongingness to certain social categories, delivering at private healthcare facilities, limited antenatal visits, and undergoing caesarean delivery.

Conclusions: The findings highlight the detrimental impact of solid fuel use on stillbirth rates in India, underscoring the need for targeted interventions to promote cleaner cooking technologies and address socioeconomic disparities. Efforts to transition households towards cleaner energy sources and improve access to quality maternal healthcare services are crucial for reducing the burden of stillbirth in India.