Many factors: Poor hygiene, poor follow up and diagnostics for pregnant women, close relative marriage, acute and chronic disease, physical abuse of women and , probably, other causes.
Answered 11/25/2017
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Risk include:: "universality of marriage, high fertility, large number of unplanned pregnancies, poor coverage of antenatal care, poor maternal nutritional status, high consanguineous marriages rate, & high carrier rate for hemoglobinopathies." per "Birth defects in India: Hidden truth, need for urgent attention" REF: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758715/
Answered 11/25/2017
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