Birth In India Research Articles

Meta-analysis on prevalence of vaginal group B streptococcus colonization and preterm births in India

Objective Preterm birth is a major cause of neonatal morbidity and mortality. Vaginal colonization of Group B Streptococci (GBS) is associated with increased risk of preterm birth. However, the association of GBS colonization and preterm births in the Indian context remains an unrecognized problem. Data sources Data was collected using various online search tools from 36 (1981–2019) Indian studies comprising 9778 cases. Method of study selection Studies reporting the prevalence of GBS colonization in the Indian population were included. Tabulation, Integration, and Results The prevalence of GBS colonization in pregnant Indian women was estimated to be 7.8% (763/9778) with wide heterogeneity across studies. The prevalence of GBS was 7.4% when culture methods were used and 11.6% with use of immunological methods. The detection rate of GBS almost doubled when enrichment was used in the culture method (8.1 vs. 5%). The risk of preterm delivery was higher (OR 7.9) among women with GBS colonization as compared to those without GBS. Conclusions As compared to the western population, there is low prevalence of GBS colonization among Indian pregnant women; however, the risk of preterm births with GBS colonization is higher. There is a need to implement a universal GBS screening program prior to intrapartum antibiotic prophylaxis in women experiencing preterm births.

Caste, religion and regional differentials in life expectancy at birth in India: cross-sectional estimates from recent National Family Health Survey

ObjectiveThough estimates of longevity are available by states, age, sex and place of residence in India, disaggregated estimates by social and economic groups are limited. This study estimates the life...

DECLINING SEX RATIO AT BIRTH IN INDIA: IMPLICATION OF SEX DETERMINATION TECHNOLOGY MISUSE

The paper examined decline sex ratio at birth in India and its major states. Sex Ratio at Birth (SRB) refereed to male births per female births. As of 2014, the global sex ratio at birth was estimated at 107 boys to 100 girls. At present, declining sex ratio at birth deemed to be a silent emergency. But the crisis emerged as real, and its persistence has profound and frightening implications for society and the future of humankind. Keywords: Sex Ratio at Birth; Child Sex Ratio; Sex Determination Tests and Female Foetus Abortions

Rights-Politics and the Politics of Rights in Neoliberal India

In 1991, the Indian economy, was finally proclaimed liberalised from the control of the state; the market was now to be the sole engine of growth, development and poverty alleviation. But just over a decade later, a series of rights-based legislations––rights to food, work, information, education, and forests were seen as challenging the market’s dominance over an anti-poverty agenda and heralding the birth of India’s welfare state. These rights-based legislations have animated a growing field of social scientific inquiry which assesses the genesis and career of the different pro-poor laws that have passed since 2005. This paper reviews two recent contributions to that scholarship: Rob Jenkins and James Manor’s Politics and the Right to Work and Indrajit Roy’s Politics of the Poor, both of which are concerned with the National Rural Employment Guarantee Act (NREGA). After contextualising the two books within an emerging legal activism and providing an in-depth discussion of their key concepts, arguments and methods, attention is paid to each author's explanation of the contradictions between India’s neoliberal economy and welfare state. In conclusion, the strengths and limitations of prevailing approaches studying India’s poverty alleviation programmes are discussed and it is suggested that a theoretical cross-fertilisation with neoliberalism studies could further reinvigorate and give shape to this promising literature.

The levels and trends of contraceptive use before first birth in India (2015\u201316): a cross-sectional analysis

BackgroundIndian women are more prone to first birth at a relatively younger age after marriage. Also, we do not have sufficient literature available that focuses on contraceptive use before first birth. The analysis of the present study was done using data from the fourth round of National Family Health Survey (2015–16), India. The objectives of the present study were to measure the levels and trends of contraceptive use before first birth among Indian ever married women, aged 15–34 years.MethodsThe study includes 279,896 ever married women aged 15–34 years at the time of the NFHS-4 survey. To identify the socio-demographic determinants governing the pioneering study behavior, multivariable techniques have been used in the analysis. The statistical significance of the relationship between socio-demographic factors and contraceptive use prior to first birth was tested using a chi-squared test for association. Hosmer Lemeshow statistics and Nagelkerke R square have been used to check how well the logistic regression model fits the data. Map of India showing different zonal classification is made using the ArcGIS software version 10.3.ResultThe trends of contraceptive usage show a decline in use before first birth and the various socio-demographic factors affecting the use of contraceptive before first birth are religion, caste, education, wealth index, media exposure, age at marriage and the zonal classifications.ConclusionThe noticeable result in this study is the comparative decline in contraceptive use by women in India before first birth in NFHS-4 with respect to previous NFHS done in India. The likelihood of using contraception before first birth is significantly affected by factors like place of residence, religion, caste, current age of women, age at marriage, education level of women, wealth index, media exposure and zonal classification.

Maternal health of women: A comparative analysis of northern states of India

Health is a primary aspect of our lives, especially for women. Every country emphasizes on maternal health care. In 2005, maternal mortality rate was 296 per 100000 live births worldwide and 286 per 100000 live births in India (WHO, 2015). According to Millennium Development Declaration, maternal mortality rate should be reduced by three-quarter since 2015. Government of India launched Janani Suraksha Yojana on 12th April 2005 under the National Rural Health Mission. The aim of the JSY was to reduce maternal mortality and infant mortality rate by increasing institutional deliveries. The states of India divided into Low performing states and high performing states on the basis of maternal mortality rate. Low performing states are highly focussed under JSY than High Performing States. Even the cash incentives also vary in these two types of states. The aim of the analysis was to assess the impact of JSY on maternal health by comparing northern states; Punjab (HPS) and Uttar Pradesh (LPS). The data of National Family Health Survey-3 (2005-06) and National Family Health Survey -4 (2015-16) was compared for various aspects of maternal health in these two states. The aspects of maternal health included in this study were antenatal care, delivery care and postnatal care. The results have shown that Punjab retains its status of a high performing state, it had performed very well in areas of Antenatal care, Delivery care and postnatal care, whereas the performance of UP had not been too good in the above mentioned areas. Despite the bleak scenario in UP in term of performance, the cash incentives being handed out in UP (49%) were much greater as compared to those being given in Punjab (19%).

Does the preference for location of childbirth change for successive births? Evidence from the states and regions of India.

Universal health coverage is central to the development agenda to achieve maternal and neonatal health goals. Although there is evidence of a growing preference for institutional births in India, it is important to understand the pattern of switching location of childbirth and the factors associated with it. This study used data from the fourth round of the National Family and Health Survey (NFHS-4) conducted in India in 2015-16. The study sample comprised 59,629 women who had had at least two births in the five years preceding the survey. Bivariate and multivariate logistic regression analyses were applied to the data. About 16.4% of the women switched their location of childbirth between successive births; 9.1% switched to a health facility contributing to a net increment of 1.9% in institutional delivery, varying greatly across states and regions. There was at least a 4 percentage point net increment in institutional births in Chhattisgarh, Bihar, Punjab and Haryana, but the shift was more in favour of home births in Madhya Pradesh, Odisha and West Bengal. Women with high parity and a large birth interval had higher odds of switching their place of childbirth, and this was in favour of a health facility, while women with higher education, from lower social groups, living in urban areas, who had not received four antenatal care visits, and who belonged to a higher wealth quintile had higher odds of switching their place of childbirth to a health facility, despite having lower odds of switching their childbirth location. The study provides evidence of women in India switching their location of childbirth for successive births, and this was more prevalent in areas where the rate of institutional delivery was low. Only a few states showed a higher net increment in favour of a health facility. This suggests that there is a need for action in specific states and regions of India to achieve universal health coverage.

Integrated multisectoral strategy to improve girls’ and women’s nutrition before conception, during pregnancy and after birth in India (Swabhimaan): protocol for a prospective, non-randomised controlled evaluation

IntroductionSwabhimaan is a community-based programme to improve adolescent girls’ and women’s nutrition in the rural areas of three Indian states—Bihar, Chhattisgarh and Odisha with high prevalence of undernutrition.Methods and analysisSwabhimaan...

Determinants of contraceptive practices among married women in a tertiary care hospital in Rajahmundry, Andhra Pradesh

Background: India ranks the second most populous nation in the world. Currently, there are about 51 births in India in a minute. Most of the population, both men and women still lack access to adequate family planning method. Objectives: To estimate the extent of contraceptive practices among women in a tertiary care hospital and to determine the factors associated with contraceptive practices among the women. Material and methods: A cross-sectional study conducted in a tertiary care hospital, in the family planning unit of OBG department, for a period of three months (Jan 2019 to Mar 2019), among 432 married women. Results: About 70 (16.21%) women were not using any contraceptive, while 362 (83.79 %) women practiced any method of contraception (Prevalence). Female sterilization was the most common method practiced, 122 (33.70%), followed by IUD, 114 (31.5%). Emergency contraception and Male sterilization were the least, 7 (1.94%) and 10 (2.76%) respectively. The contraceptive use was significantly more in the age group of 40 – 49 years (X2 = 6.892, P = 0.031), among Hindus (X2 = 7.787, P = 0.0506), those living in nuclear family (X2 = 32.04, P = 0.000), among literate women (X2 = 128.9, P = 0.000), employed women (X2 = 13.17, P = 0.0002), literate spouse (X2 = 73.45, P = 0.000) and employed spouse (X2 = 70.57, P = 0.000). Marriage and fertility related factors showed that the contraceptive use was significantly more in those with 2 or more children (X2 = 79.45, P = 0.0000), preference for 2 or more male children (X2 = 16.34, P = 0.0002), those with no history of abortion (X2 = 9.748, P = 0.0017) and age of last child more than 5 years (X2 = 8.852, P = 0.0119). Conclusion: About 16.21% women were still not using any contraceptive, which is a considerable number. The factors responsible are many. Such factors should be focused and prevented.

Prevalence and determinants of voluntary caesarean deliveries and socioeconomic inequalities in India: Evidence from National Family Health Survey (2015-16)

IntroductionWith a substantial increase in Institutional births in India, the prevalence of C-section section deliveries witnessed a sharp rise, with a highly skewed prevalence among births in private health facilities. The study aims to investigate the dynamics of voluntary C-section across different socio-cultural strata in India, along its major drivers. MethodsThe study used data on 249,949 live births in the five years preceding 2015-16 NFHS-4 covering 699,686 women from 601,000 households across 640 districts in the country. Bivariate and binary logistic regression analysis have been used to analyses the data. The economic inequalities in voluntary C-section have been analyzed using the poor-rich ratio and the concentration index (CI) ResultsSeventeen percent of live births in five years preceding NFHS-4 were delivered by C-section, a sharp rise from 9% in 2005-06. C-section deliveries are common among first births (24%), in private sector health facilities (41% of deliveries), higher educated mothers and those residing in urban areas (28%). The likelihood of C-section deliveries is significantly higher among mother from high-income families. Values of the poor-rich ratio (0.092) and concentration index (0.031) has significantly revealed that voluntary C-section is more concentrated among the affluent class of households in India. ConclusionsThe study concludes that older women, higher educated mothers, residing in urban areas and, belonging to high socio-economic status are the ones who opt for voluntary C-section deliveries and seek private instructional delivery. The government of India should strengthen the regulatory protocol for private health facilities.

Heat, infant mortality, and adaptation: Evidence from India

We examine the impact of extreme heat during pregnancy on infant mortality and check if public interventions can serve as effective adaptation strategies. We show that 2 children die as infants out of 1000 births in India for high temperature during pregnancy, tentatively due to reduced agricultural yields, wages, and greater disease prevalence like diarrhea. The heat-infant mortality relationship holds in rural India only. Using phased introduction of an employment guarantee program and partial introduction of a community health care worker program for identification, we find that only the health program is effective in modifying the temperature-infant mortality relationship in rural India.

India’s Projected Aged Population (65+), Projected Life Expectancy at Birth and Insecurities Faced by Aged Population

India is the second largest country in the world having highest population after china. This study focuses on increasing aged population (65+) and Life expectancy at birth in India and especially of female population. Since, it is an evident fact that females are biologically stronger than males. Therefore, Life expectancy of females are always more than males. This study also focuses on the future outcome of increasing aged population. The data for this study comes from the Indian census-2011, SRS (Sample Registration System) based Life table and NSS (National Sample Survey) 60th Round. Census is conducted at every 10 years in India. To project aged population, data from C-14 table of Indian census has been extracted. This table includes information on population in five year age–group by residence and sex. The data from SRS based life Table (2012–16) has been used to project Life Expectancy at Birth (LEB). To study aspects of insecurities among aged population, morbidity and health care-based data from National Sample Survey (NSS, 60th round) has been extracted. The results from this study show that each year both aged males as well as females (65+) are increasing rapidly. Specially aged females (65+) will be more than aged males. Also, in future life expectancy at birth will also follow an increasing trend. It is concluded that dependency among aged population due to increasing ageing and life expectancy may increase. This may result in different types of insecurity (Economic, Health and Social insecurity) among elderly (65+).

Arriving at a Decision: A Semi-Parametric Approach to Institutional Birth Choice in India

We use nationally representative household survey data (N=157,804) to analyze the factors determining institutional births in India using the kernel multinomial logit model -- a state-of-the-art semi-parametric specification. In this study, we propose and implement a parallel computation algorithm to estimate the resource-intensive kernel MNL. Furthermore, we layout an empirical procedure to analyze the semi-parametric estimates and also to compare them with those of a conventional linear MNL model. Results from both models show that maternal education, asset level, distance to a formal health facility, and birth order play an essential role in determining birth location choice. However, we show significant differences in the marginal effect estimates derived from the two models. In fact, using a Monte Carlo study we show that the kernel MNL outperforms the linear MNL model. We argue that the flexibility offered by kernel MNL is insightful for policymakers.

Trends, Regional Variations, and Socioeconomic Disparities in Cesarean Births in India, 2010-2016

The World Health Organization recommends that rates of cesarean delivery range from 10% to 15%. India has the largest annual number of births in the world and needs updates of existing estimates. To provide a new set of estimates of the rates of cesarean delivery and to map regional and socioeconomic disparities within these rates in India. Cross-sectional study primarily based on cross-sectional figures drawn from the fourth round of the National Family and Health Survey conducted from January 20, 2015, through December 4, 2016, by the Indian Institute for Population Sciences in Mumbai. The survey interviewed 699 686 girls and women aged 15 to 49 years and collected information on their last 3 pregnancies since January 2010 (259 627 births). The study population was statistically representative of India's 36 states and Union territories and its 640 districts. The survey also included information on the socioeconomic status of households. The research is based on data tabulations and mapping and on spatial and regression analyses of microdata. Socioeconomic inequalities in access to cesarean deliveries were assessed using the Gini coefficient. Data were analyzed from August to October 2018. Rate of cesarean deliveries by regional and socioeconomic characteristics. The cesarean birth rate computed for 699 686 Indian girls and women aged 15 to 49 years (mean [SD] age, 26.8 [5.0] years) was 17.2% (95% CI, 17.1%-17.3%) in 2010 to 2016, which corresponds to an estimated 4.38 million cesarean deliveries per year during the period (95% CI, 4.34-4.41 million) in India. Cesarean birth rates vary widely within the country, with a range of 5.8% (95% CI, 5.1%-6.5%) to 40.1% (95% CI, 38.4%-41.8%) across states and 4.4% (95% CI, 4.3%-4.6%) to 35.9% (35.4%-36.4%) across socioeconomic quintiles. The rate significantly increased from 9.2% (95% CI, 9.1%-9.3%) in 2004 to 2008. According to the recommended 10% to 15% benchmark of cesarean birth rates by the WHO, the estimated deficit of cesarean births in India is 0.5 million per year, whereas the estimated excess of cesarean births is 1.8 million. The overall Gini coefficient of inequality in access to cesarean deliveries is 46.4. The rate of cesarean births is increasing in India and has already crossed the World Health Organization threshold of 15%. More research is needed to understand the factors behind the rapid rise of cesarean deliveries among affluent groups and in more developed regions.

Baby’s First Cry:A Prognostic Study by Varmam Therapy

This paper presents the efficacy and importance of Varmam application and treatment applied on new born to prevent Birth Asphyxia. In this study Varmam technique was tried to prevent birth asphyxia by bringing about the first cry in a baby. This is one of the main causes for Infant mortality. It is much more in developing countries. In India out of 25 million infants born every year, 3 - 5% experience birth asphyxia, which amounts to almost 7,50,000 infants. Infant mortality rate is 57 out of every 1000 live births in India, which is comparatively higher than developed countries. One of the main causes is birth asphyxia.

Identification of infants at risk of child undernutrition in India: building a predictive algorithm with data from a nationally representative survey

Abstract Background India is at the centre of global child undernutrition, with a burden of malnourished children nearly twice that of all sub-Saharan African countries. The Indian government has established many national-level initiatives to address this public health crisis. However, there is substantial variation between and within states in the prevalence of child undernutrition, and strategies to identify at-risk populations are needed in the context of limited resources. Here, we describe the development of an algorithm that can be deployed at the time of delivery to characterise newborns' risk of undernutrition in the first 5 years of life. Methods We extracted data on 232 440 children younger than 5 years from the 2015–16 National Family Health Survey. A child was considered undernourished if either height-for-age, weight-for-height, or weight-for-age was more than 2 SD below median WHO child growth standards. We used predictor variables identified in published studies if they could be measured at the time of delivery and used multilevel logistic regression to model the outcome. Model calibration was assessed using the Hosmer-Lemeshow test. We tested internal validity of the model using 200 bootstrapped samples to derive an optimism-adjusted c-statistic. All analyses were done with svy command in STATA to account for complex clustered sampling. Findings In 2016, 54·7% of Indian children younger than 5 years were either stunted (38·4%), underweight (35·8%), or wasted (21·0%). The predictive model for overall undernutrition included maternal factors (height, education, reproductive history, number of antenatal visits), child factors (sex and birthweight), and household characteristics (district of residence, caste, rural residence, toilet availability, presence of a separate kitchen). The model demonstrated good discrimination ability (c-statistic: 0·688, optimism-adjusted c: 0·686). The prevalence of child undernutrition in the lowest decile risk group was 24·0%, and in the highest decile risk group it was 77·9%. Interpretation We are developing a mobile-based app to collect the information and categorise children into a risk decile at the time of delivery. Since more than 80% of births in India are registered by community health workers, who are also responsible for implementing child nutrition programmes, this tool could help workers identify infants at risk of malnutrition and prioritise their interventions. Funding AS: NIH-NCATS (TL1-TR001454) and NIH-NICHD (1F30HD091975-01A1) [AS] and NIH-NIMH (P60-MD006912-05) [JA].

A Pregnancy Cohort to Study Multidimensional Correlates of Preterm Birth in India: Study Design, Implementation, and Baseline Characteristics of the Participants.

Globally, preterm birth is a major public health problem. In India, 3.6 million of the 27 million infants born annually are preterm. Risk stratification of women based on multidimensional risk factors assessed during pregnancy is critical for prevention of preterm birth. A cohort study of pregnant women was initiated in May 2015 at the civil hospital in Gurugram, Haryana, India. Women are enrolled within 20 weeks of gestation and are followed until delivery and once postpartum. The objectives are to identify clinical, epidemiologic, genomic, epigenomic, proteomic, and microbial correlates; discover molecular-risk markers by using an integrative -omics approach; and generate a risk-prediction algorithm for preterm birth. We describe here the longitudinal study design, methodology of data collection, and the repositories of data, biospecimens, and ultrasound images being created. A total of 4,326 pregnant women, with documented evidence of recruitment before 20 weeks of gestation, have been enrolled through March 2018. We report baseline characteristics and outcomes of the first 2,000 enrolled participants. A high frequency of preterm births (14.9% among 1,662 live births) is noteworthy. The cohort database and the repositories will become global resources to answer critical questions on preterm birth and other birth outcomes.

Out-of-pocket expenditure and correlates of caesarean births in public and private health centres in India

Increasing caesarean births is a global trend and of recent origin in India. Besides its utility and disutility, increasing caesarean births exert higher economic burden on households and the nation. Using 148,746 births from the National Family Health Survey, 2015–16, this paper examines the correlates and provides comparable estimates of out of pocket expenditure (OOPE) on caesarean births in public and private health centres in India. The monthly state specific rural-urban consumer price index and the OOPE on births over seven years are used to derive comparable OOPE estimate at 2016 prices. A composite variable combining type of birth and place of delivery is computed and classified as private and caesarean, public and caesarean, private and non-caesarean, public and non-caesarean. Descriptive statistics, logistic and tobit regression model were used to understand the differentials and determinants of OOPE on caesarean births.Caesarean births were significantly higher among mothers belonging to higher socioeconomic status, first order births, mothers with high BMI, pregnancy complications, repeat caesarean and in private health centres confirming that both maternal demand and institutional factors are leading to the increasing in caesarean rates in India. The mean OOPE of caesarean births in public health centres of poorer states was higher than that in the richer states of India (US$107 in low performing states compared to US$88 in high performing states) while such differentials across private health centres are small. The marginal effect of a caesarean birth in private health centres in low performing states was US$296 dollar higher than that of non-caesarean births.Improving the public health centres for conducting caesarean births, developing standard guideline for clinical practices in conducting caesarean births and creating awareness on comprehensive pregnancy care can reduce the caesarean rates and OOPE on caesarean birth in India.

Preterm Birth Facts: A Review

Preterm birth is the major complication in neonatal health care that cause death in newborns and also it is the second foremost cause of death in children. It is one of the important complications of neurological disability and impairment. Preterm babies are born before completion of 37 weeks of gestation, instead they born by 32 gestational week. This has several reasons; most preterm birth not only affects the newborns but also family members, to give care for preterm infants. This initiates how they spend several months in hospital and has increasing price for health services. It is estimated worldwide that 11.1% of all live births were born preterm in 2010 (14.9 million babies were born before 37 week of gestation), there is an increasing rate in almost countries with reasonable trend data with preterm. This review had discussed about the majority of factors behind the preterm birth in India. This review may help to prevent the preterm birth by early detection, appropriate intervention, screening for the risk, providing antenatal care, educating the teenage or adolescent pregnant women.

Levels and trends in the sex ratio at birth and missing female births for 29 states and union territories in India 1990–2016: A Bayesian modeling study

The sex ratio at birth (SRB) has risen in India and reaches well beyond the levels under normal circumstances since the 1970s. The lasting imbalanced SRB has resulted in much more males than females in India. A population with severely distorted sex ratio is more likely to have prolonged struggle for stability and sustainability. It is crucial to estimate SRB and its imbalance for India on state level and assess the uncertainty around estimates. We develop a Bayesian model to estimate SRB in India from 1990 to 2016 for 29 states and union territories. Our analyses are based on a comprehensive database on state-level SRB with data from the sample registration system, census and Demographic and Health Surveys. The SRB varies greatly across Indian states and union territories in 2016: ranging from 1.026 (95% uncertainty interval [0.971; 1.087]) in Mizoram to 1.181 [1.143; 1.128] in Haryana. We identify 18 states and union territories with imbalanced SRB during 1990–2016, resulting in 14.9 [13.2; 16.5] million of missing female births in India. Uttar Pradesh has the largest share of the missing female births among all states and union territories, taking up to 32.8% [29.5%; 36.3%] of the total number.