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Globally, stillbirth is a silent yet significant contributor to perinatal mortality. India has several national maternal and child health programs, yet, the stillbirths remain poorly reviewed, subject to suboptimal surveillance, are under-reported, and often absent from many programmatic priorities. This study aimed to explore the pathways, delays leading to stillbirths and continuum of care in postpartum phase among affected women in a rural district of North India using a social autopsy tool. This qualitative study was a component of an ongoing implementation research to reduce stillbirth in Palwal district of Haryana. In-depth interviews were conducted with 25 women who had experienced stillbirths using a specially designed social autopsy tool. Additionally, five healthcare providers were interviewed for getting a holistic insight on pathway leading to stillbirth. Thematic analysis was performed using NVivo 16 software, and both deductive (Three Delays Model framework) and inductive approaches were applied to identify delays and contextual factors influencing care-seeking, and postpartum experiences. The pathways identified as contributor stillbirths were: (i) low utilization of antenatal and delivery care, driven by cultural beliefs, low perceived risk, and gendered power dynamics; (ii) delays in accessing care due to poor transport, restrictive social norms, and infrastructural gaps; (iii) poor quality of care, characterized by disrespectful treatment, inappropriate referrals, and inadequate intrapartum management. Additionally, a complete absence of postpartum follow-up, grief support, or mental health care was found, reflecting a neglected dimension of postpartum maternal care following stillbirths. Stillbirths in this setting are the consequence of interlinked socio-cultural, health system, and gendered vulnerabilities. The implications of stillbirths extended beyond immediate consequences to include enduring mental health and social impacts, ultimately undermining women's confidence, well-being and preparedness for future pregnancies. There is an urgent need to integrate stillbirth reporting, respectful maternity care, and post-loss psychosocial support within India's maternal health programs. The primary implementation research was registered prospectively in the Clinical Trial Registry of India (CTRI): CTRI/2024/07/069796 [Registered on: 02/07/2024].

Accurate diagnosis of gestational diabetes mellitus (GDM) is important for improving the short and long-term outcomes of mothers and babies. There are different criteria to diagnose GDM. ​ Around the world, many use the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. ​ However, in India, a different method called the Diabetes in Pregnancy Study Group of India (DIPSI) criteria is more commonly used. ​ However, there is limited evidence comparing how well these two criteria work in improving pregnancy outcomes for Indian women. ​ This study aims to fill that gap by looking at the pregnancy outcomes of women who are diagnosed with GDM using the IADPSG method but are considered normal by the DIPSI method. ​ METHODOLOGY: The DECIDE (Diagnostic Evaluation and Comparison of IADPSG and DIPSI criteria for expectant mothers) study is a prospective, multicenter observational cohort study being conducted across seven sites in India, enrolling pregnant women 18 years or older and between 24 to 28 weeks of pregnancy. Two glucose tests are conducted as part of this study. ​ The first test follows the DIPSI method, which does not require fasting beforehand. ​ The second test follows the IADPSG method, which requires fasting overnight and measures blood glucose levels three times, before drinking a glucose solution, one hour after, and two hours after. ​ The results of the IADPSG test are kept blinded from the treating physician and the participant, unless the woman is found to have very high blood glucose levels (overt diabetes). ​Postdelivery, pregnancy outcomes of both the mothers and their newborns are collected using medical records and lab reports. ​ DISCUSSION: This study aims to address the ongoing debate about the effectiveness of two diagnostic criteria for gestational diabetes: DIPSI and IADPSG. ​The goal is to determine whether the higher costs and complexity of adopting the IADPSG criteria are justified by better maternal and neonatal outcomes.​ The findings are expected to provide valuable insights that could help shape national guidelines on appropriate diagnostic criteria for GDM that can help in improving the health of mothers and newborns in India.