INTRODUCTION : Among the estimated two million stillbirths globally, two thirds happen in Asia and Africa and India
alone records one tenth of it. India enacted ‘Every Newborn action plan’, proposed by ‘World Health Organization’ to count
every newborn and measure cause specific mortality and action in 2014-15. Although states like Tamil Nadu is good in
health indicators, it lacks stillbirth auditing. Various stakeholders in Health Unit Districts like Palani wanted to explore the
perceived enablers and barriers in establishing stillbirth audit system.
METHODS : We did an exploratory qualitative study in Palani Health Unit District, Dindigul district, Tamil Nadu during
January-April, 2024; interviewing various stakeholders in health department and mothers. We did a purposive sampling
with analytical framework approach using six steps of the mortality audit cycle developed by World Health Organisation.
We did In-Depth Interviews (IDI)s and Focus Group Discussions (FGDs); audio recorded, transcribed and thematic analysis
was done to identify the perceived enablers and barriers after obtaining necessary ethical and administrative approval.
RESULTS : We conducted 12 interviews, with 24 participants of median age 39 years. There were 9 IDIs and 3 FGDs.
Majority, were women participants. Enablers identified are the availability of established system processes and the
availability of a system with audit steering committee and mechanisms which are routinely doing maternal and infant death
audits which included established communication mechanisms, emotional connections with families, existing workforce,
and supportive web-based systems. Barriers included neglected notifications, cultural impediments, anger from grieving
families, information suppression, accusatory attitude, and lack of system commitment. Every stakeholder interviewed
wanted stillbirth to be audited.
CONCLUSION : Our study demonstrated the perceived need for stillbirth auditing among stakeholders and highlighted that
existing audit mechanisms for maternal and infant mortality can be efficiently utilized to include stillbirth auditing in the
district. The study also identified gaps in the existing auditing system, particularly in the approach to conducting audits,
and emphasized the need for an attitudinal shift and soft skills training for the authorities conducting the audits.