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Background: COVID-19 is spreading rapidly in India and other parts of the world. Despite the Indian Government's efforts to contain the disease in the affected districts, cases have been reported in 627 (98%) of 640 districts. There is a need to devise a tool for district-level planning and prioritisation and effective allocation of resources. Based on publicly available data, this study reports a vulnerability index for identification of vulnerable regions in India on the basis of population and infrastructural characteristics. Methods: We computed a composite index of vulnerability at the state and district levels based on 15 indicators across the following five domains: socioeconomic, demographic, housing and hygiene, epidemiological, and health system. We used a percentile ranking method to compute both domain-specific and overall vulnerability and presented results spatially with number of positive COVID-19 cases in districts. Findings: A number of districts in nine large states—Bihar, Madhya Pradesh, Telangana, Jharkhand, Uttar Pradesh, Maharashtra, West Bengal, Odisha, and Gujarat—located in every region of the country except the northeast, were found to have high overall vulnerability (index value more than 0·75). These states also had high vulnerability according to most of the five domains. Although our intention was not to predict the risk of infection for a district or a state, we observed similarities between vulnerability and the current concentration of COVID-19 cases at the state level. However, this relationship was not clear at the district level. Interpretation: The vulnerability index presented in this paper identified a number of vulnerable districts in India, which currently do not have large numbers of COVID-19 cases but could be strongly impacted by the epidemic. Our index aims to help planners and policy makers effectively prioritise regions for resource allocation and adopt risk mitigation strategies for better preparedness and responses to the COVID-19 epidemic.

There is only limited evidence on whether certified and uncertified health care providers in India support reforming the Medical Termination of Pregnancy (MTP) Act to expand the abortion provider base to allow trained nurses and AYUSH physicians (who are trained in Indian systems of medicine) to provide medical abortion. To explore their views, we conducted a survey of 1,200 physicians and other health care providers in Maharashtra and Bihar states and in-depth interviews with 34 of them who had used medical abortion in their practices. Findings indicate that obstetrician-gynaecologists and other allopathic physicians were less supportive than non-physicians of nurses and AYUSH physicians providing early medical abortion. The physicians did not think that these providers would be able to assess women's eligibility for medical abortion correctly. In contrast, the majority of non-physicians found task shifting of medical abortion provision to trained nurses and AYUSH physicians acceptable, and they were confident that these providers would be able to provide medical abortion as safely and effectively as trained physicians. Assuming the reforms are passed, efforts will need to be made by government and medical professional bodies to train these new providers to undertake this role, prepare the health infrastructure to include them, and create an environment, including among physicians, that is conducive to enabling non-physicians to provide medical abortion.

This paper examines seasonal variation of births in a rural community of West Bengal, India, by exploring data from the 1992–93 National Family Health Survey. Suitable time series analyses were used to determine the seasonal pattern of births and to estimate peaks. The trigonometric regression technique was used to carry out this objective. The study attempted to link the results of the regression analysis to the atmospheric temperature of the region during 1987–91, the distribution of respondents' husbands' occupations and the marriage pattern of the community. It was found that, in the study population, conceptions were numerous in the first quarter of a calendar year and the distribution of conceptions over calendar months was negatively associated with the average monthly temperature. In addition, the marriage pattern of the community and the occupational distribution of the fathers also had a significant effect on the distribution of births over calendar months. It is hoped that the findings will boost the development of needs-based maternal and child health (MCH) and family planning programmes in the community.

This study examines mobility (short-term movement involving stays away from home) among unmarried youths in India and its association with their sexual experiences. We look at unmarried young women and men aged 15 to 24 from rural and urban areas in six states in India—Bihar, Jharkhand, Rajasthan, Andhra Pradesh, Maharashtra, and Tamil Nadu. Data are drawn from a subnationally representative study of Indian youths, in which 11,522 young men and 17,362 young women were interviewed face-to-face at their usual residences. The study finds that one-third and one-fifth of young men and women, respectively, had experienced mobility. Mobile youths were more likely than nonmobile youths to experience romantic relationships and initiate sex before marriage. Moreover, among the sexually experienced, mobile young men were more likely than others to report multiple sexual partners.

This study examines the relationship between male‐to‐female physical domestic violence and unwanted pregnancy among women in three economically and culturally diverse areas of India. A central methodological focus of the study is the examination of retrospective and prospective measures of pregnancy unwantedness, contrasting their usefulness for specifying levels of unwanted pregnancy and its relationship with domestic violence. Data from India's 1998–99 National Family Health Survey and a 2002–03 follow‐up survey for which women in four states were reinterviewed are analyzed, and the factors associated with the intersurvey adoption of contraception and the experience of an unwanted pregnancy are examined. Women who experience physical violence from their husbands are significantly less likely to adopt contraception and more likely to experience an unwanted pregnancy. A prospectively measured indicator of unwanted pregnancy identifies a higher prevalence of unwanted pregnancies than do the traditionally employed retrospective measures and is more successful in establishing a relationship between unwanted pregnancies and domestic violence. The results demonstrate a clear relationship between a woman's experience of physical violence from her husband and her ability to achieve her fertility intentions. The need to improve the measurement of pregnancy intendedness is clear, and a move toward using prospective measures as the standard is necessary.

This study examines the levels and correlates of contraceptive failure and discontinuation in Romania, together with the consequences of contraceptive method failure in terms of induced abortion. Of special interest are women who rely on the traditional method of withdrawal and the proportion of withdrawal failures resulting in abortion. Our analysis is based on multiyear calendar data concerning women's contraceptive use and monthly reproductive behaviors collected in the 1999 Romanian Reproductive Health Survey. Weibull regression models are estimated to analyze the determinants of discontinuation and failure for all methods combined and for withdrawal. Overall, 19 and 28 percent of women became pregnant within the first year of using any contraceptive method and of practicing withdrawal, respectively. About 57 and 59 percent of failures from use of all methods and from withdrawal ended in abortion, accounting for 30 percent and 22 percent, respectively, of all abortions reported between 1994 and 1999. These findings suggest that high rates of contraceptive discontinuation and failure contributed significantly to the widespread reliance on induced abortion among Romanian women during this period.

AbstractBruce's quality of care framework, developed nearly three decades ago, brought needed international attention to family planning services. Various data collection efforts exist to measure the quality of contraceptive services. Our study validates two process quality measures and tests their predictive validity related to contraceptive continuation among 2,699 married women who started to use a reversible contraceptive method in India. We assessed four process quality domains with 22 items, which were reduced to 10 items using exploratory factor analysis. Weighted additive indices were calculated for the 22‐ and 10‐item measures. Scores were trichotomized into high, medium, and low process quality received. The predictive validity of the two measures was assessed related to modern contraceptive continuation three months later. The adjusted odds of continuing a modern contraceptive three months later was nearly three times greater (AOR: 2.78; 95% CI: 1.83–4.03) for women who received high process quality at enrollment compared with low quality with the 22‐item measure, and 2.2 times greater (95% CI: 1.46–3.26) with the 10‐item measure. Results suggest that the 22‐ and 10‐item measures are valid, and while the larger 22‐item measure can be used in special studies, the 10‐item measure is more suited for routine data collection and monitoring.

This assessment of a Comprehensive Abortion Care (CAC) model was conducted by the Population Council on behalf of the Consortium for Safe Abortions in India. The goal of the Consortium is to increase access to legal, safe, and comprehensive abortion services, including post-abortion family planning, in the public health system, and especially among the rural poor. This report describes the CAC model implemented in Aurangabad district, Maharashtra, and examines the extent to which the model improved (a) the availability and quality of abortion services in public sector facilities, and (b) women's awareness and experiences with regard to abortion services. It also sheds light on progress in the achievement of such longer term objectives as a shift to public sector facilities and trained providers, and a reduction in second trimester abortions. Several lessons can be drawn from the experience of implementing the CAC model, which could be relevant for its modification and up-scaling: a focus on facility strengthening, provider training, and community awareness-building is a promising approach; and the intervention was feasible to implement and can be integrated into existing government services without much additional investment.

This report describes an assessment by the Population Council of the Comprehensive Abortion Care (CAC) model implemented in Tonk district, Rajasthan. Findings highlight that at the time of the baseline survey, the availability of abortion services was limited; also evident was the poor quality of abortion-related care. Given this context, and given the short duration of implementation, the changes achieved by the intervention are promising. The district-level CAC model succeeded in strengthening facilities, training providers, and increasing women's access to safe abortion services at the Primary Health Centre level. Community-level activities were less successful, attributable to a considerable extent to the short duration during which community engagement took place. Both the facility- and the community-based components were feasible to implement and can be integrated into existing government services without much additional investment.

The benefits of employing a rights-based approach in family planning (FP) programmes have made the client's rights to informed choices and quality care an essential part of any such programme. client-provider interaction is one of the critical components of the quality of care (QoC) framework of FP. While several studies have assessed QoC in FP services in India, very few have focused on the in-depth assessment of the interaction between the client and the provider during service delivery. The present study used the mystery client approach to assess the quality of interactions between clients and FP service providers in two of the most populous states of India: Bihar and Uttar Pradesh (UP). Findings highlighted that the providers spent very little time with the clients, gave them information on only one or two FP methods, and rarely talked about possible side-effects of the methods. Furthermore, the providers seemed hesitant to suggest any FP method other than condoms to newly married women. This study concluded that despite being a government priority, the quality of client-provider interaction in these two states was extremely poor.

Despite government commitment to universal secondary education in India, few adolescents transition to and successfully complete secondary education. In India, limited efforts have been directed at parents to promote positive attitudes toward education and school completion. Recognizing the need for identifying effective intervention strategies to engage parents and communities to promote secondary education for girls, the Population Council and partners are pilot-testing an intervention to support adolescent girls' transition to and retention in secondary education. Located in the state of Gujarat, the intervention focuses on girls in the last year of primary school and first year of secondary school and their parents as well as teachers and the wider community. The school experiences of adolescent girls, and the family, school, and community environments in which they are pursuing their studies, described in this report, draw on a baseline survey conducted in 90 villages in Gujarat. The objective was to explore school experiences of adolescent girls in the last year of primary and first year of secondary school, and assess the extent to which a supportive environment for schooling was available to them at the family, school, and community levels.