Suchergebnisse

AbstractMale involvement in maternal health care utilization is an important contributor to maternal health, especially in male-dominated societies. This study aimed to understand the variations and determinants of women's antenatal care (ANC) utilization and institutional delivery in India and three socioeconomically less-developed states (Bihar, Madhya Pradesh and Uttar Pradesh) using NFHS-4 data (2015–16). Husband's knowledge of pregnancy care and delivery, having a non-violent marital relationship and a respectful attitude towards his wife, better education and wealth, higher exposure to mass media and fewer children substantially enhanced the probability of him being present at his wife's ANC visits. Furthermore, men's presence at any ANC visit was shown to be an important factor influencing institutional delivery in India as a whole, as well as in the three less-developed states. The two major hurdles in maternal and child health care utilization in India were incorrect perception of 'unnecessary' maternal health care by families and high cost as reported by husbands. Furthermore, the proportion of husbands who received knowledge from health workers on maternal and child health was too low to achieve the maternal health SDGs by 2030. The dissemination of knowledge on maternal care among husbands, and encouraging their presence during antenatal care, may help secure better maternal health outcomes in India. It is imperative that the husband-involvement agenda is strengthened in India if the SDGs for maternal care are to be achieved.

AbstractCouple-level reports of contraceptive use are important as wives and husbands may report their use differently. Using matched couple data (N = 63,060) from India's NFHS-4 (2015–16), this study examined concordance in spousal reports of current contraceptive use and its differentials. Reporting of contraceptive use was higher among wives (59.0%) than husbands (25.2%). Concordance was low; 16.5% of couples reported the current use of the same method, while 20.4% reported the current use of any method. Many husbands did not report female sterilization as a means of contraception being used by their wives. Reconstruction of contraceptive use among men, based on the 'ever-use of sterilization' question asked to men, increased concordance by 10%. Multivariate analyses showed that concordance was low in urban and southern India, among younger women and among women with a lower wealth index. Men's control over household decision-making and negative attitudes towards contraception were associated with lower concordance. The findings highlight the importance of using couple-level data to estimate contraceptive prevalence, and the role of education programmes to inculcate positive attitudes towards contraception, fostering gender equality and involving men in family planning efforts. The results also raise the issue of data quality as the survey questions were asked differently to men and women, which might have contributed to the wide observed discordance.

The Indian health system has a poor global ranking. A new perspective on health. system planning and development is required to improve the situation and build. a health system responsive to the needs of the country. Strategic Issues and. Challenges in Health Management addresses these concerns while also highlighting. the challenges in delivering efficient and effective health services. The book discusses health sector reforms like financing, Public-Private Partnership. (PPP), higher efficiency and cost-effectiveness. It deals with national health. programmes, focusing on maternal and child h

Though the Census of India and large-scale demographic surveys have bridged the data gap on key demographic and health parameters, estimates on poverty and inequality remain deficient for the districts of India. The estimates on poverty and inequality indices across the states of India conceal large variations among districts. We use an innovative approach to provide consumption-based estimates of poverty and inequality indices in the districts of India by pooling the 66th and 68th rounds of consumption expenditure carried out by the National Sample Survey. The new official poverty line of 2009–2010 and 2011–2012 as recommended by the Rangarajan Committee and adopted by the Government of India is used in the estimation of poverty. A set of poverty and inequality indices, the poverty head count ratio, poverty gap square, the Gini index, Theil index and mean log deviation (MLD) are used to estimate poverty and inequality indices for 623 of the 640 districts in India. Estimates of poverty are obtained by pooling the estimates of 2009-10 and 2011-12. Results suggest wide variations in the level, depth and incidence of poverty among the districts of India irrespective of size, stage and governance in the states. The pattern of inequality is different from that of poverty; it is higher in districts with a higher level of development. Estimates of poverty are consistently correlated with wealth index, agricultural labour and female literacy. Among various factors, the fertility level, wealth index and the proportion of agricultural worker are significant predictors of poverty. Based on the findings, we suggest to increase the sample size to estimate consumption poverty in every alternate quinquennial survey and undertake a special round of survey in multidimensional poverty. Districts ranked low in poverty head count ratio should be accorded high priority in planning and program implementation.

India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to create awareness and change health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda needs political commitment of the highest order and the development of a people's movement.