The project was started in September, 2013 with the aim to improve quality of child birth and neonatal care in selected Primary Health Centres of Haryana. It was a collaborative effort between National Rural Health Mission, Haryana, SWACH Foundation, Government Medical College and Hospital, Chandigarh and All Institute of Medical Sciences, New Delhi, India. The project was funded by WHO and happened from 01-09-2013 to 31-10-2015.

The baseline observations were started in all the 15 PHCs of Haryana from 3 February 2014. By a process of randomization undertaken in WHO HQs, 3 PHCs (Majri, Khizrabad and Panjokhra) were selected and quality improvement interventions were started from May 2014. In the first week of May, the 3 PHCs were visited for orienting the staff regarding key interventions that would bring about improvement in child birth and post natal care practices. A 3 days training was then organized in Panchkula (11-14 May 2014) in which all the concerned staff participated. The meeting was facilitated by NRHM, SWACH and Ernest and Young representing AIIMS staff. Detailed discussion was done on key issues. Gaps were identified and plan was prepared for achieving the common goal of improving the quality of services related to childbirth and newborn care at the 3 PHCs. The participants were briefed about quality improvement processes, SOPs, audit tools, audit processes and the plans for implementation. The process of audit of death and adverse outcome was also explained. It was agreed that quality improvement process would include Internal Quality Assessment in the form of weekly and monthly review meetings and External Quality Assessment to be quarterly by an external team. Another lot of 3 PHCs were selected through the process of randomization by W.H.O. – HQ for intervention w.e.f. 01-08-2014. These included Chhachhrauli, Haibatpur and Burhia. PHCs under intervention and non-intervention are given in the illustration below:

In India, an estimated 0.6 million stillbirths occur every year. Preventing stillbirths along with neonatal deaths are integral strategy within the India New born Action Plan (INAP). To understand the causes of deaths, measuring and counting every stillbirth is vital. In this context, a population-based surveillance of still births is very important that covers all the still births irrespective of their place of occurrence, helps in calculating the rate of still birth and also geographical variations in addition to identifying avoidable and preventable factors. To achieve the same an effort was made through this study to adapt the WHO’s protocol for audit of perinatal deaths for investigation of still births in the community. In addition, as post bereavement counselling is an important step towards reduction of risk of repetition of perinatal adverse outcome, an attempt was made to identify important areas which need to be addressed during the same. The study was funded by WHO and was conducted between 24 December, 2018 and 09 May, 2019 in two rural districts of north India with the following

Background:

The Parent Voices Initiative (PVI) was developed by the Stillbirth Advocacy Working Group (SAWG) which is co-chaired by the International Stillbirth Alliance (ISA) and the London School of Hygiene & Tropical Medicine (LSHTM). This is funded by the Partnership for Maternal, New-born and Child Health. The purpose of the PVI is to raise the voice and participation of parents bereaved by stillbirth to strengthen advocacy for stillbirth prevention and post-stillbirth bereavement support. The India Providers Toolkit pilot project focused on improving communication between parents and health providers with the ultimate aim of fostering an environment conducive to stillbirth parents being able to advocate on their own behalf for bereavement support and stillbirth prevention. It focuses on health providers working within health facilities and communities, to provide them with information and suggested approaches for deeper and more open communication with parents after a stillbirth.

This toolkit covers breaking bad news, talking with parents about how and why their baby may have died, acknowledging their grief, making room for them to express their need for support, providing respectful bereavement care, facilitating dedicated space away from birthing women and new-borns, and discussing a safe plan for future pregnancies. The India Providers Toolkit was developed in consultation with health providers which was again revised to incorporate parent’s perspective after consultation with the parents.

The current study was planned with the objectives to understand healthcare utilization pattern, to understand the three Delays (Delay 1, Delay 2, and Delay 3) and the impact of still birth and coping mechanism, bereavement care provided to mothers and family. Data collection consisted of an in depth investigation on the cause of phenomena by means of interview method. Expectant mother mothers and family member were interviewed from six selected areas of the state of Haryana i.e Khizrabad, Bilaspur, Sadhaura, and Radaur from Yamunanagar district and Mullana and Shahzadpur from Ambala district. 40 In-depth interviews were conducted to collect data. Thematic analysis was conducted on the data. Inductive coding framework was applied to the data using NVivo 12. The interviews were transcribed into written documents, and the accuracy of these transcriptions was reviewed. Data was coded and recoded for common phrases and emerging patterns. Similar codes falling under broad themes were pooled and organized, overlapping of themes were evaluated and final themes and sub-themes were identified. Six major emergent themes based on the inductive analysis were derived from livid experience of parents and families having still birth.

Introduction

In the past decade, neonatal mortality in Haryana has decreased slowly, even though efforts have been made to reduce it through various interventions under the National Health Mission (NHM). Despite these interventions, Haryana's neonatal mortality rate is still higher than the national average. The interventions implemented include training and deployment of staff, establishment of network services for newborn care, free referral transport, Home Based Postnatal Care by ASHA, and investigation of adverse outcomes through the maternal infant death review system (MIDRS). It is crucial to investigate the causes and circumstances surrounding neonatal deaths as this information has important implications for public health management and policy.

The issue of newborn deaths is just a small part of a larger problem involving abortions and stillbirths. Stillbirths have been identified as a serious issue in India, as highlighted in the Lancet. These adverse events, including abortions, stillbirths, and neonatal deaths, are all connected to insufficient pre and peri-conception care, pregnancy care, intra partum care, and postnatal care. India has launched a newborn action plan to address the high burden of stillbirths and neonatal deaths. To reduce the occurrence of these adverse outcomes, the plan should prioritize the audit and review of deaths. Verbal autopsy, a technique for investigating child deaths, has been validated for investigating stillbirths and is recommended by WHO and endorsed by the Government of India (2014).