Why Are South Asian Women Still Facing Higher Pregnancy Loss?
- Jannine Nock
- 4 days ago
- 5 min read
Introduction
“At 41 weeks, Priya was told to ‘wait and see.’ Two days later, her baby had no heartbeat. No one had explained her elevated risk as a South Asian woman.”
Across the world—even in countries with universal healthcare—South Asian women continue to face alarmingly high rates of pregnancy loss. Stillbirth, neonatal death, and poor maternal outcomes disproportionately affect this group. These disparities are not only deeply personal tragedies—they’re also systemic failures.
This blog draws together global and regional research to explore what’s driving these inequities and what can be done to change the narrative.
The Numbers Are Clear—and Concerning
A major study in New Zealand found that South Asian women have a 67% higher risk of stillbirth and 51% higher risk of neonatal death than New Zealand European women (de Graaff et al., 2023). These outcomes tend to occur at extremely early and post-term stages of pregnancy, pointing to missed intervention windows.
Internationally, India alone accounts for 33% of all global stillbirths, despite contributing only 17% of the world’s births.
In the UK, the NHS Maternity Transformation Programme has started tracking ethnicity-specific perinatal outcomes to close these gaps—a model other countries could adopt.
Clinical Risks: More Than Meets the Eye
These outcomes are not always driven by age or lifestyle. Instead, South Asian women are more likely to experience:
Gestational diabetes
Thyroid disorders
Anemia
Infertility possibly linked to PCOS
These conditions often go underdiagnosed—especially when screening programs don’t consider ethnicity-based risk factors.
South Asian women tend to exhibit higher rates of insulin resistance and beta-cell dysfunction, predisposing them to gestational diabetes even at lower BMIs. Standard BMI cut-offs and glucose tolerance thresholds may fail to identify high-risk women in this population. Anemia is also prevalent due to nutritional patterns and genetic traits like thalassemia minor—conditions often left unmonitored in antenatal protocols.
In Bangladesh, research found that women with anemia were significantly more likely to deliver prematurely or experience neonatal death (Kabir et al., 2022). Yet many health systems lack standard screening for conditions like PCOS and thyroid disease in early pregnancy—particularly among South Asian patients.
Social and Structural Barriers
In New Zealand, Dawson et al. (2022) found that Asian women are 39% more likely to have poor perinatal outcomes compared to NZ Europeans. Factors include:
Low engagement with maternity care
Limited health literacy
Greater reliance on emergency services rather than preventive care
This often reflects deeper systemic issues. Immigrant women may not understand how to navigate a new health system or may not be registered with a primary care provider. There is also evidence that short, fragmented antenatal visits do not allow time for complex assessments—especially for women presenting with non-standard or culturally mediated symptoms
These challenges are not exclusive to the diaspora. In South Asia, institutional delivery remains uneven, particularly among lower-income, rural populations (Rahman et al., 2021, 2024).
Communication and Cultural Disconnect
Beyond clinical barriers, many South Asian women face cultural and communication challenges in their maternity care. In an Australian study, Vietnamese, Turkish, and Filipino women were significantly less satisfied with hospital care than locally born women, citing lack of explanation, support, and participation in decision-making (Small et al., 2002).
In qualitative interviews, women described feeling “talked over” or dismissed. Many were unaware they could request interpreters. Cultural scripts around ‘suffering in silence’ or proving one’s strength as a mother often led women to underreport symptoms of pain, distress, or confusion. These cultural nuances are rarely addressed in Western clinical environments.
Similarly, in New Zealand, Asian women reported that stigma, language barriers, and unfamiliarity with mental health services often stopped them from seeking help—even when experiencing perinatal distress (Ho et al., 2021). Only 2 of 17 Asian women interviewed had accessed specialist maternal mental health support, despite feeling emotionally overwhelmed.
Multilingual resources about perinatal mental health remain scarce in many clinics—despite being one of the simplest and most cost-effective tools for supporting help-seeking.
Better Models of Care Exist
Evidence shows that continuity of care can make a real difference. A major trial in Australia (Forster et al., 2016) found that women receiving caseload midwifery—where one primary midwife provides care throughout pregnancy, birth, and postpartum—were significantly more satisfied than those receiving standard care.
This model not only improves satisfaction—it reduces unnecessary interventions and promotes trust, especially when a woman has a known point of contact. In multi-ethnic communities, midwives trained in cultural safety can also bridge communication gaps and advocate for appropriate referrals and screening. Countries like the UK have seen early successes in scaling such models through targeted pilot programs.
What Needs to Change?
To reduce perinatal mortality and improve care for South Asian women, several changes are urgently needed:
Introduce early, ethnicity-specific screening for gestational diabetes, thyroid dysfunction, anemia, and PCOS.
Improve continuity of care through caseload midwifery models in public systems.
Train providers in cultural safety and language accessibility, especially for mental health care.
Expand data collection on key risk conditions disproportionately affecting South Asian populations.
Invest in community-based health literacy and outreach, particularly around mental wellbeing during the perinatal period
These interventions are not cost-prohibitive and can be integrated into existing frameworks. What’s needed is political and institutional will to prioritize ethnic health equity, supported by workforce training, community partnerships, and accountable monitoring systems
Final Thoughts
Perinatal loss among South Asian women is not inevitable. It reflects how health systems prioritize—or fail to prioritize—ethnic-specific needs, community voices, and structural equity.
Bibliography
Blencowe, H., Cousens, S., Oestergaard, M. Z., Chou, D., Moller, A. B., Narwal, R., … & Lawn, J. E. (2012). Born too soon: The global epidemiology of 15 million preterm births. The Lancet, 379(9832), 2162–2172. https://doi.org/10.1016/S0140-6736(12)60820-4
Dawson, P., Auvray, B., Jaye, C., Gauld, R., & Hay-Smith, J. (2022). Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand. Women’s Health, 18, 1–14. https://doi.org/10.1177/17455065221075913
de Graaff, E., Sadler, L., Lakhdhir, H., Simon-Kumar, R., Peiris-John, R., Burgess, W., … & Anderson, N. (2023). An in-depth analysis of perinatal related mortality among women of South Asian ethnicity in Aotearoa New Zealand. BMC Pregnancy and Childbirth, 23, 535. https://doi.org/10.1186/s12884-023-05840-x
Forster, D. A., McLachlan, H. L., Davey, M. A., Biro, M. A., Farrell, T., Gold, L., … & Waldenström, U. (2016). Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care. BMC Pregnancy and Childbirth, 16, 28. https://doi.org/10.1186/s12884-016-0798-y
George, K., Prasad, J., Singh, D., Minz, S., Albert, D. S., Muliyil, J., … & Kramer, M. S. (2009). Perinatal outcomes in a South Asian setting with high rates of low birth weight. BMC Pregnancy and Childbirth, 9, 5. https://doi.org/10.1186/1471-2393-9-5
Ho, E., Feng, K., & Wang, I. (2021). Supporting equitable perinatal mental health outcomes for Asian women: A report for the Northern Region District Health Boards. Asian Family Services. https://www.asianfamilyservices.nz
Kabir, M. A., Rahman, M. M., & Khan, M. N. (2022). Maternal anemia and risk of adverse maternal health and birth outcomes in Bangladesh: A nationwide population-based survey. PLOS ONE, 17(12), e0277654. https://doi.org/10.1371/journal.pone.0277654
Rahman, M. A., Rahman, M. A., Rawal, L. B., Paudel, M., Howlader, M. H., Khan, B., … & Islam, S. M. S. (2021). Factors influencing place of delivery: Evidence from three South-Asian countries. PLOS ONE, 16(4), e0250012. https://doi.org/10.1371/journal.pone.0250012
Rahman, M. A., Islam, M. A., Tohan, M. M., Muhibullah, S. M., Rahman, M. S., & Howlader, M. H. (2024). Socioeconomic inequalities in utilizing maternal health care in five South Asian countries: A decomposition analysis. PLOS ONE, 19(2), e0296762. https://doi.org/10.1371/journal.pone.0296762
Small, R., Yelland, J., Lumley, J., Brown, S., & Liamputtong, P. (2002). Immigrant women’s views about care during labor and birth: An Australian study of Vietnamese, Turkish and Filipino women. Birth, 29(4), 266–274. https://doi.org/10.1046/j.1523-536X.2002.00201.x