Suchergebnisse

SummaryIn India, the eight socioeconomically backward states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh, referred to as the Empowered Action Group (EAG) states, lag behind in the demographic transition and have the highest infant mortality rates in the country. Neonatal mortality constitutes about 60% of the total infant mortality in India and is highest in the EAG states. This study assesses the levels and trends in neonatal mortality in the EAG states and examines the impact of bio-demographic compared with health care determinants on neonatal mortality. Data from India's Sample Registration System (SRS) and National Family and Health Survey (NFHS-2, 1998–99) are used. Cox proportional hazard models are applied to estimate adjusted neonatal mortality rates by health care, bio-demographic and socioeconomic determinants. Variations in neonatal mortality by these determinants suggest that universal coverage of all pregnant women with full antenatal care, providing assistance at delivery and postnatal care including emergency care are critical inputs for achieving a reduction in neonatal mortality. Health interventions are also required that focus on curtailing the high risk of neonatal deaths arising from the mothers' younger age at childbirth, low birth weight of children and higher order births with short birth intervals.

Decentralized district-based health planning is essential in India because of large inter-district variations. Presently, there are 640 districts in India with an average population of two million per district. There is a need for studying the performance of family planning programs at district level. Current paper aims to explore the district-level differences in the use of modern family planning methods (mCPR) in rural areas, changes in contraceptive usage over time, and the association between changes and macro-level socio-demographic characteristics. Current paper uses data from the third round of District Level Household Survey conducted in 2007–08 (DLHS-3) and the latest round of National Family Health Survey conducted in 2015–16 (NFHS-4). The sample size for representing a district varies from 1000 to 1500 households in DLHS-3 and 836 to 1800 households in NFHS-4. Out of the total 640 districts as per Census 2011, the 506 districts which have common geographical boundary in DLHS-3 and NFHS-4 have been considered for analysis. Results show a wide variation in mCPR at district level in India. Only 91out of 506 districts have more than 64% mCPR, majority being from Andhra Pradesh, Haryana, Maharashtra, and Punjab. Six out of 10 districts have CPR below 50% and majority of them being from central, north-eastern, and eastern regions of India. Since 2007–08, there has been significant decline in them CPR among half of the districts (256/506), majority decline being in the southern and western regions of India. Only in 69 districts mCPR increased by more than 10 percentage points from 2007–08 to 2015–16. At the same time, it declined by more than 5 percentage points in onethird of the districts. Findings reveal that marginal changes in female literacy, child marriage, unmet need for spacing family planning methods, antenatal care and institutional delivery have no impact on mCPR over time, but significant changes in these contextual factors of more than 10 percentage points increase/decrease have greater impact ...

AbstractUsing detailed data from the third round of the District Level Household Survey of India, this paper examines in detail the effect of child marriage of women on contraceptive usage and access to skilled care during pregnancy and delivery. This paper particularly focuses on sixteen different outcome variables categorized under four broad sub-groups; namely, family planning and contraceptive usage, birth history, utilization of antenatal care; and finally, natal and postnatal care. The overall results presented in the paper suggest that women who marry early, i.e. before they reach the legal age of marriage are more likely to have experienced miscarriage, give birth before they turn 18 and lose children. They also lack current contraception usage and are less likely to access public health facilities during both pregnancy and childbirth. These results, however, vary widely based on the state of residence and age of the women in question.

AbstractIndia is currently one of the most demographically diverse regions of the world. Fertility and mortality rates are known to show considerable variation at the level of regions, states and districts. Little is known however, about the spatial variations of the contraceptive usage—a critical variable that is relevant to fertility as well as health policy. This paper uses data from four national population-based household surveys conducted between 1998 and 2016 to explore district-level variations in the contraceptive prevalence rate. We find no clear evidence of convergence. The gap between the best and worst performing districts is more than 70 percent across the four rounds and does not diminish over time. We also find considerable evidence of spatial clustering across districts. Districts with high prevalence concentrate in Southern states and more recently, in the Northeast of the country. Our analysis suggests that female literacy and health care infrastructure are important correlates of spatial clusters. This suggests that investments in women's human capital and health-care infrastructure play a role in expanding women's opportunities to time their births.

AbstractA growing number of studies have tested the association between intimate partner violence (IPV) and the unintendedness of pregnancy or birth, and most have suggested that unintendedness of pregnancy is a cause of IPV. However, about nine in every ten women face violence after delivering their first baby. This study examined the effects of the intendedness of births on physical IPV using data from the National Family Health Survey (2015–16). The multivariate logistic regression model analysis found that, compared with women with no unwanted births (2.9%), physical IPV was higher among those women who had unwanted births (6.9%, p<0.001), followed by those who had mistimed births (4.4 %, p<0.001), even after adjusting for several women's individual and socioeconomic characteristics. Thus, the reduction of women with mistimed and unwanted births could reduce physical IPV in India. The study highlights the unfinished agenda of family planning in the country and argues for the need to integrate family planning and Reproductive, Maternal and Child Health Care (RMNCH) services to yield multi-sectoral outcomes, including the elimination of IPV.

Background: In 2014, 16 women died following female sterilization operations in Bilaspur, a district in central India. In addition to those 16 deaths, 70 women were hospitalized for critical conditions (Sharma, Lancet 384,2014). Although the government of India's guidelines for female sterilization mandate infection prevention practices, little is known about the extent of infection prevention preparedness and practice during sterilization procedures that are part of the country's primary health care services. This study assesses facility readiness for infection prevention and adherence to infection prevention practices during female sterilization procedures in rural northern India. Method: The data for this study were collected in 2016–2017 as part of a family planning quality of care survey in selected public health facilities in Bihar (n = 100), and public (n = 120) and private health facilities (n = 97) in Uttar Pradesh. Descriptive analysis examined the extent of facility readiness for infection prevention (availability of handwashing facilities, new or sterilized gloves, antiseptic lotion, and equipment for sterilization). Correlation and multivariate statistical methods were used to examine the role of facility readiness and provider behaviors on infection prevention practices during female sterilization. Result: Across the three health sectors, 62% of facilities featured all four infection prevention components. Sterilized equipment was lacking in all three health sectors. In facilities with all four components, provider adherence to infection prevention practices occurred in only 68% of female sterilization procedures. In Bihar, 76% of public health facilities evinced all four components of infection prevention, and in those facilities provider's adherence to infection prevention practices was almost universal. In Uttar Pradesh, where only 55% of public health facilities had all four components, provider adherence to infection prevention practices occurred in only 43% of female sterilization procedures. ...