Suchergebnisse

SummaryUttar Pradesh is India's most populous state with a population of 200 million. Any change in its fertility and mortality is bound to bring change at the national level. This study analysed the burden of disease in the state by calculating the disability-adjusted life year (DALY) for infectious and non-communicable diseases. Data were from two rounds (52ndand 60th) of the National Sample Survey Organization (NSSO) survey conducted in 1995–96 and 2004, respectively, and the Million Deaths Study (MDS) of 2001–03. Descriptive and multivariate analyses were carried out to identify the determinants of different types of self-reported morbidity and DALY. The results show that in Uttar Pradesh the prevalence of all selected self-reported infectious and non-communicable diseases increased over the study period from 1995 to 2004, and in most cases by more than two times. The highest observed increase in prevalence was in non-communicable diseases excluding CVDs, which increased from 7% in 1995 to 19% in 2004. The prevalence was higher for those aged 60 and above, females, those who were illiterate and rich across the time period and for all selected morbidities. The results were significant atp<0.001. The estimation of the DALY revealed that the burden of infectious diseases was higher during infancy, noticeably among males than females in 2002. However, females aged 1–5 years were more likely to report infectious diseases than corresponding males. The age distribution of the DALY indicated that individuals aged below 5 years and above 60 years were more susceptible to ill health. The growing incidence of non-communicable diseases, especially among the older generation, puts an additional burden on the health system in the state. Uttar Pradesh has to grapple with the unresolved problem of preventable infectious diseases on the one hand and the growth in non-communicable disease on the other.

Objectives Studies have widely documented the socioeconomic inequalities in maternal and child health related outcomes in developing countries including India. However, there is limited research on the inequalities in advice provided by public health workers on maternal and child health during antenatal visits. This paper investigates the inequalities in advice provided by public health workers to women during antenatal visits in rural India. Methods and Findings The District Level Household Survey (2007–08) was used to compute rich-poor ratios and concentration indices. Binary logistic regressions were used to investigate inequalities in advice provided by public health workers. The dependent variables comprised the advice provided on seven essential components of maternal and child health care. A significant proportion of pregnant women who attended at least four ANC sessions were not advised on these components during their antenatal sessions. Only 51%–72% of the pregnant women were advised on at least one of the components. Moreover, socioeconomic inequalities in providing advice were significant and the provision of advice concentrated disproportionately among the rich. Inequalities were highest in the case of advice on family planning methods. Advice on breastfeeding was least unequal. Public health workers working in lower level health facilities were significantly less likely than their counterparts in the higher level health facilities to provide specific advice. Conclusion A significant proportion of women were not advised on recommended components of maternal and child health in rural India. Moreover, there were enormous socioeconomic inequalities. The findings of this study raise questions about the capacity of the public health care system in providing equitable services in India. The Government of India must focus on training and capacity building of the public health workers in communication skills so that they can deliver appropriate and recommended advice to all clients, irrespective of their socioeconomic status.

The Population Council, in partnership with Child In Need Institute in Kolkata, Deepak Charitable Trust in Vadodara, and International Institute for Population Sciences, Mumbai, initiated the First-time Parents Project in India to develop and test an integrated package of health and social interventions to improve married young women's reproductive and sexual health knowledge and practices, enhance their ability to act in their own interest, and expand their social support networks. The project was formulated on the hypothesis that the periods immediately following marriage and surrounding the first pregnancy and birth offer a unique and powerful entry point for improving the situation of married young women. Findings indicate that the intervention had a significant, positive net effect on most indicators reflecting married young women's autonomy, social support networks, partner communication, and knowledge of sexual and reproductive health. However, the net effect of exposure to the intervention was mixed with regard to indicators related to gender role attitudes and attitudes toward domestic violence, as well as reproductive health practices. The experience of the intervention demonstrates that it is feasible to improve married young women's reproductive health knowledge and practices, expand their sources of social support, and involve them in activities with peers in safe spaces outside the home, and through the process empower them in their marital and familial relationships. The report suggests that this model could also be integrated into existing NGO or government services, and could be tested for implementation on a larger scale.

AbstractDespite persistent efforts, unmet need for contraceptives in India has declined only slightly from 14% to 13% between 2005–06 and 2015–16. Many women using a family planning method discontinue it without switching to another method and continue to have unmet need. This study quantified the share of current unmet need for modern contraceptive methods attributed to past users of these methods in India. Data were drawn from two rounds of the National Family Health Survey conducted in 2005–06 and 2015–16. Using information on women with current unmet need, and whether they used any modern method in the past, the share of past users with current unmet need for modern methods was calculated. Bivariate and multivariate analyses were performed. Among 46 million women with unmet need, 11 million were past users of modern methods in 2015–16. The share of current unmet need attributed to past users of modern contraceptive methods declined from 27% in 2005–06 to 24% in 2015–16. Share of current unmet need attributed to past users was associated with reversible method use. This share rose with increased use of modern reversible methods. With the Indian family planning programme's focus on increasing modern reversible method use, the share of unmet need attributed to past users of modern methods is likely to increase in the future. The programme's emphasis on continuation of contraceptive use, along with bringing in new users, could be one of the key strategies for India to achieve the FP2020 goals.