Women’s Reproductive Health in India: Connecting Government Policies and Programmes with NFHS 5 Data

The global demographic landscape is experiencing a significant transformation of declining fertility rates, which has far-reaching implications for societal development and women's well-being. The study investigates the association between declining fertility rates and women's reproductive health in India, considering socioeconomic and demographic factors as well as regional variations. The study uses data from the recent National Family Health Survey (NFHS-5) round conducted during 2019-21. A composite index called the Reproductive Health Index (RHI) is constructed by equally weighing indicators such as antenatal care, anemia, and body mass index. To evaluate the robustness of this index, a sensitivity analysis is performed. Descriptive statistics and Poisson regression models are employed to explore the association between fertility and RHI among currently married women. The findings show substantial differences in RHI scores across socio-economic, demographic groups, and geographical regions. The lowest RHI score of 4.09 is found in the Eastern region, whereas those in the Northern region exhibit the highest score of 4.42. The analysis further indicates a negative relationship between fertility and reproductive health. Women with four or more children exhibit an RHI score of 1.97 compared to 2.98 among those with one child. The Poisson regression analysis indicates that women with at least four children have lower RHI scores, even after adjusting for socio-economic and demographic factors. Women in wealthier quintiles and those with media exposure report significantly higher RHI score compared to those in the poorest wealth quintiles and no media exposure. In conclusion, this research highlights the critical need for targeted interventions to address regional and socio-economic inequities in healthcare access and reproductive health services. By exploring the intricate relationship between low fertility and reproductive health, this study contributes to the discourse on gender equality, reproductive rights, and sustainable societal development. The findings provide evidence to guide public health policies and programs designed to promote women's reproductive health.

Women's reproductive health is a crucial aspect of public health that impacts overall societal well-being and economic stability. In Haryana, India, addressing this issue involves confronting deeply ingrained societal norms and enhancing women's autonomy in health-related decisions. Utilising data from the National Family Health Survey (NFHS) reports of NFHS-4 (2015–16) and NFHS-5 (2019–21), this study evaluates the reproductive health and family planning issues among women aged 15–49 in the region. The research specifically focuses on analysing key indicators, including the total fertility rate (TFR), the impact of educational attainment on TFR, fertility preferences, birth intervals, the desired number of children, child sex preferences, and the prevalence of contraceptive use. The findings reveal significant trends and variations in these indicators, offering a comprehensive understanding of women's reproductive health in Haryana. The study tracks progress by comparing data from the NFHS-4 and NFHS-5 reports and identifying persistent gaps and areas that require attention. The insights provided by this analysis are critical for policymakers, healthcare providers, and non-governmental organisations striving to enhance reproductive health services and promote women's rights in Haryana. The study emphasises the necessity for targeted interventions that address societal attitudes and provide educational opportunities to improve family planning and reproductive health outcomes. Keywords: fertility rate, reproductive health, family planning, contraceptive prevalence, birth interval, sex preferences.

I: Historical, Social and Developmental Influences in Women's Sexual and Reproductive Health. 1. Women's Sexual and Reproductive Health: An Overview G.M. Wingood, et al. 2. Historical Influences on Women's Sexual and Reproductive Health A. Tone. 3. Adolescent Girls' Sexual Development J.A. Graver, J. Brooks-Gunn. 4. The Social Organization of Women's Sexuality J. Mahay, E.O. Laumann. 5. Cultural Influences on Women's Sexual Health H. Amaro, et al. 6. Mass Media and Adolescent Female Sexuality J.D. Brown, S.R. Stern. 7. Family Influences on Adolescent Females' Sexual Health R.A. Crosby, K.S. Miller. 8. Illicit Drug Use and Women's Sexual and Reproductive Health K. Theall, et al. 9. Alcohol Use and Women's Sexual and Reproductive Health M. Windle, R.C. Windle. II: Epidemiologic, Psychological, Prevention and Policy Issues in Women's Sexual and Reproductive Health. 10. Women's Body Images T.F. Cash. 11. Sexual Abuse G.E. Wyatt, et al. 12. Chronic Pelvic Pain A.J. Rapkin, M.L. Morgan. 13. Adolescent Pregnancy L.S. Zabin, K.M. Cardona. 14. Sexually Transmitted Infections S.O. Aral, P.M. Gorbach. 15. HIV/AIDS G.M. Wingood, R.J. DiClemente. 16. Sexual Dysfunction N. Williams, S.L. Leiblum. 17. Cervical Cancer C.M. McBride, D. Scholes. 18. Breast Cancer R.A. Smith, D. Saslow. 19. Menopause N.E. Avis, et al. III: Technological and Ethical Issues in Women's Sexual and Reproductive Health. 20. Contraceptive Technology A. Foster-Rosales, F.H. Stewart. 21. Reproductive Health Technology and Genetic Counseling J.H. Marks, M.H. Miller. 22. Legal and Ethical Issues Impacting Women's Sexual and Reproductive Health S. Loue. 23. Woman's Sexual and Reproductive Health: Theory, Research and Practice R.J. DiClemente, G.M. Wingood.

Impressive reductions of up to 29% in maternal deaths may be expected from satisfying unmet need for contraception as shown in a recent analysis covering 172 countries (Ahmed et al. 2012). Despite the cost-effectiveness of family planning (Prata et al. 2010) investments remain low (Osotimehin 2012) a concern declared under Goal 5 on the UN Millennium Development Goals website ‘Inadequate funding for family planning is a major failure in fulfilling commitments to improving women’s reproductive health.’ Alongside investment and political commitment clear indicators for the coverage and quality of family planning services are required to design and implement strategies to improve family planning. However the evidence used in planning and monitoring of family planning is often suboptimal and poses a serious problem for effective efficient responses to scale up these services. The 2012 London Summit on Family Planning signalled renewed interest in this important intervention by the global community. Large investments were pledged and ambitious targets of access to contraception for 120 million women and girls by 2020 were set. This has also prompted the Alliance for Reproductive Maternal and Newborn Health to work with WHO and development partners to facilitate a prioritisation of the family planning research agenda. With a view to informing these discussions we were commissioned by the Australian Agency for International Development (AusAID) to identify the key knowledge gaps for evidence-based planning and budgeting for family planning. As part of a multicountry initiative working with policy makers to effect a more rational use of resources for reproductive maternal newborn and child health (Jimenez-Soto et al. 2012) we collated the data necessary to inform local decision-making on scaling up family planning services. Our work highlighted major evidence gaps that have the potential to undermine efforts to plan and invest in family planning and interfere with monitoring progress. The seven leading knowledge gaps identified are outlined in this short paper and provide an essential ‘front-line’ perspective to inform research priorities for effective scaling-up of family planning. We draw on examples from our study sites in four countries: two districts and two cities in Indonesia two provinces and one city in the Philippines three clusters of districts in Nepal two districts in the Indian state of Orissa and two districts in the state of Uttar Pradesh. We believe that this view from the front line provides a much-needed link between global agendas and the realities of implementation at a local level. (excerpt)

The current state of tribal women's reproductive health in India is discussed in the study. Due to the culture of silence, there is less research and knowledge on reproductive health issues. The majority of the information on the topic is provided by government agencies and initiatives. Overall, the tribal reproductive health situation is not encouraging when it comes to morbidity and mortality, food, marriage, family planning, breastfeeding, childcare, and nutrition. There is a widespread belief that tribal people, both men and women, who live in natural settings like forests are extremely robust and healthy. Contrarily, field studies show that the majority of tribal people actually live in nearly filthy conditions, have low and insufficient access to food, high rates of malnutrition, high mortality, and disease, no prenatal or postnatal care, food taboos, and don't use contraceptives. Due to political unrest and fundamentalist activity in locations like the north-eastern states, indigenous women's health is at risk. Whether tribal or generic, this component of reproductive health difficulties and problems are only experienced by women, and it is still more or less linked to the culture of silence among men. For each tribal community, it needs to be thoroughly researched.

Starting with the initiation of democratic and market economic transitions, unsupportive policies concerning women's reproductive health were implemented in Kyrgyzstan and Poland in the period 1990–2006. These policies were expressed by (1) political decisions limiting available funding to support medical practices protecting women's reproductive health, (2) diminishing or restricted dissemination of knowledge about family planning, and (3) the implementation of new contraception and abortion policies. Could these changes be perceived as combat between democratic liberalism, cosmopolitanism, and tolerance versus traditionalism, insularism, and fundamentalism? We use analyses of policies concerning women's reproductive and maternal health to manifest rivalry between economic crisis and the push toward modernity and between traditionalism and liberalism. We demonstrate that the return to traditional gender roles and gender policies, and their practical application expressed in maternal health policies, illustrates cultural backlash toward diffusing Western liberalism in countries in political and economic transition.

In January 1990, we began working with Moni Nag and Pertti Pelto on a Ford Foundation-funded project entitled "Increasing Social Science Research Capacity for Women's Reproductive Health in India." Little research had been carried out on women's reproductive health in India, and the majority of studies that had been done were clinic-based. The one community-based epidemiological study of gynecological disease that had been published found that 92 percent of rural Indian women (in a sample of 650) had one or more gynecological or sexually transmitted diseases, with an average of 3.6 diseases per woman (R. A. Bang, A. T. Bang, M. Baitule, Y. Choudhary, S. Sarmukaddam, and O. Tale, "High Prevalence of Gynecological Diseases in Rural Indian Women," The Lancet [January 14, 1989]). In addition to the lack of epidemiological data, there was a paucity of sociocultural information on how women perceive their own health and morbidity and what factors influence care seeking by and for Indian women.

Protocol for a systematic review: Interventions addressing men, masculinities and gender equality in sexual and reproductive health: An evidence and gap map and systematic review of reviews.

BackgroundWomen’s health policy in India has had a longstanding focus on maternal health and family planning. Recent policy highlights the importance of expanding women’s access to a broader range of sexual and reproductive health services. However, there has been very limited analysis of national survey data to examine the current status of treatment utilisation, variation across states and progress over time.MethodsThis paper examines women’s treatment patterns for reproductive tract infections in India, based on data collected in the National Family Health Survey, a cross-sectional, nationally representative household survey conducted between 2015-16. The survey covered 699,686 women between the ages 15 and 49, of which 91,818 ever sexually active women responded to questions related to symptoms of reproductive tract infections. We estimate prevalence of reported symptoms and treatment-seeking, describe regional variation and utilise multivariable logistic regression to identify factors associated with women’s treatment-seeking patterns.ResultsThirty-nine percent of women who reported symptoms of reproductive tract infections sought any advice or treatment. Women’s reported treatment-seeking in India has not changed since the last national survey a decade earlier. Reported symptoms and treatment-seeking varied widely across India, ranging from 64% in Punjab to 8% in Nagaland, with no clear regional pattern that emerged. Seventeen percent of symptomatic women sought services in the public sector, an improvement from 11% in 2005–06. Twenty-two percent utilised the private sector, with wide variation by states. National-level multivariable logistic regression indicated that treatment-seeking was associated with age, higher education, higher household wealth and having been employed in the past year. Women in the 25–35 age group had higher odds (aOR1.27; 95% CI: 1.10,1.50) of seeking treatment compared to both younger (15–19 years) and older (35 years and above) women, along with women with more than eight years of schooling (aOR: 1.23; 95% CI: 1.05,1.44) and from richer wealth quintiles (aOR: 1.53; 95% CI: 1.35,1.83).ConclusionWomen’s use of services for reproductive tract infections remains a challenge in most parts of India. Our findings highlight the need to address barriers to seeking care and to improve measurement of gynaecological ailments in national surveys.

Unmet need for reproductive health in India

BackgroundDespite progress toward gender equity, enduring societal norms continue to shape women's roles, particularly impacting their sexual and reproductive health, including fertility, maternal health, and family planning, all of which are influenced by traditional gender expectations.AimThis review investigates how gender norms affect women's sexual and reproductive health outcomes.MethodsA systematic review was conducted on publications from 2013 to 2023, sourced from databases such as PubMed, Scopus, Web of Science, and Google Scholar, using keywords, MeSH terms, and Boolean operators. Of 1,500 articles identified, 38 peer-reviewed articles in English or French met the inclusion criteria. Data were extracted using a standardized form and evaluated with the mixed-methods appraisal tool. Findings from the selected studies were analyzed through a narrative synthesis approach.FindingsThe review identified key themes from the 38 included studies results underscoring the lack of comprehensive sexual education and the challenges posed by cultural norms and social stigma. It highlighted how cultural and gender dynamics restrict women's autonomy in family planning and maternal healthcare, with impacts varying by context. Finding also highlight the importance of culturally competent healthcare that respects diverse cultural beliefs and tackles educational and economic barriers to enhance women's sexual and reproductive health outcomes.ConclusionThis review identifies gender norms as one of major obstacles to accessing sexual and reproductive health (SRH) education and services among women. It emphasizes the need for comprehensive SRH education, women’s autonomy, and culturally competent healthcare services to address barriers and promote gender equity globally.

Testing the impact of gender equality on reproductive health: An analysis of developing countries

BackgroundIn many contexts, women with disability have less access to sexual and reproductive health information, screening, prevention, and care services than women without disability. Women with disability are also known to be more likely to experience physical and sexual violence than women without disability. In the Philippines, health service providers often have little awareness of the sexual and reproductive experiences of women with disability and limited capacity to provide services in response to their needs. Very limited data are available to inform development of disability-inclusive sexual and reproductive health, and violence prevention and response, services in the country. This paper presents the protocol for W-DARE (Women with Disability taking Action on REproductive and sexual health), a three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disability in the Philippines.DesignW-DARE is a disability-inclusive program that will use mixed methods to 1) increase understanding of factors influencing the sexual and reproductive health of women with disability, and 2) develop, implement and evaluate local interventions to increase supply of and demand for services. W-DARE will generate data on the prevalence of disability in two districts; the wellbeing and community participation of people with and without disability, and identify barriers to community; and describe the sexual and reproductive health needs and experiences, and service-related experiences of women with disability. These data will inform the development and evaluation of interventions aiming to improve access to sexual and reproductive health services, and violence prevention and response services, for women with disability. Local women with disabilities, their representative organisations, and SRH service providers will be involved as members of the research team across all stages of the research.DiscussionThis three-year study will provide evidence about factors undermining the sexual and reproductive health of women with disability in a lower-middle income country, and provide new insights about what may be effective in increasing access to services in settings of limited resources. Findings will be relevant across Asia and the Pacific. Analysis of the program will also provide evidence about disability-inclusion in participatory action research approaches.

Health is considered as a fundamental human right. It is a country where 68.80% of the population resides in a rural area and males significantly outnumber females. Health is considered as a fundamental human right. Health of women is not merely a state of physical well being but also an expression of many roles they play as wives, mothers, health care providers in the family and in the changed scenario even as wage earners. Reproductive health implies that people including men and women are able to have a satisfying safe sex life and they have the capability to reproduce and the freedom to decide if, when and how often to do so. It includes family planning services, access to contraception, counseling and information, antenatal, postnatal and delivery care, healthcare for infants, treatment for reproductive tract infections and sexually transmitted diseases, safe abortion services where legal and management of abortion related complications, prevention and appropriate treatment for infertility, information, education and counseling on human sexuality, reproductive health and responsible parenting and discouragement of harmful practices. Health plays important role in the generation of livelihoods of rural people in general and women in particular. Reproductive Health of women is neglected area and new reproductive health problems are increasing such as infection in uterus, breast cancer, and sexually transmitted disease. Well being of reproductive health of rural women enhances the chances of livelihood of rural women. The present study addresses all the issues concerning with livelihoods and reproductive health and this study was carried in Solapur and Kolhapur districts of Western Maharashtra. The objectives of study are to understand the socio-economic background of selected rural women for proposed project and to know the issues related rural women's reproductive health and availability of reproductive health care in rural areas. 200 married women respondents in age group of 18–25 were selected for study. Still fifty percentage of rural women are only unaware about the reproductive health and gender discrimination should be addressed and it is necessary to create the awareness about reproductive health among males

Putting sexual and reproductive health on the agenda