Pregnancy-related deaths and complications have remained unacceptably high, particularly in low- and middle-income countries. Manipur is the most prevalent state for pregnancy wastage in India with an increasing trend over the last two decades.

The study aims to explore the level, pattern, spatial clustering, and determinants of pregnancy wastage in Manipur.

We utilized the NFHS-4 (2015–2016) and NFHS-5(2019–2021) data of Manipur. The Getis-OrdGi* spatial statistical tool was used to identify the hotspots clusters. Bayesian logistic regression analysis was applied to identify the determinants of pregnancy wastage.

The major hotspot clusters for pregnancy wastage were found in the valley districts, namely Imphal East, Imphal West, Thoubal, and Bishnupur. Further, a significant decline in hotspot clusters can be seen in the last five years. BMI was found to be a significant determinant for both abortion and miscarriage. Education, working status, number of antenatal care visits, wealth index and use of smokeless tobacco were associated with higher risks of having abortion among women.

The results highlight the need to develop district- centric antenatal care services to reduce the risk of pregnancy-related complications. Intervention should be tailored according to the life style choices and unique cultural practices of women in Manipur, India. It may also be beneficial to study the factors associated with declining hotspot clusters in some districts of Manipur.