National Family Health Survey Research Articles

Food deprivation among adults in India: an analysis of specific food categories, 2016–2021

Adult undernourishment remains pervasive throughout India, and often results from food deprivation, which refers to the inadequate consumption of foods with caloric and nutrient significance. Therefore, understanding the extent to which food groups are missing from an individual's diet is essential to understanding the extent to which they are undernourished. We used data from two National Family Health Surveys conducted in 2016 and 2021 for this cross-sectional analysis. The study population consisted of women and pregnant women between the ages of 15-49, and men between the ages of 15-54. We examined shifts in the percentage of people not consuming dairy, pulses/beans/legumes, dark leafy green vegetables, fruits, eggs, and fish and meat among women, pregnant women, and men between the two time points. We also examined these patterns by household wealth and education, two important markers of socioeconomic status. Overall, we found that fewer women, pregnant women, and men were not eating each of the six food groups in 2021 than in 2016. Additionally, the gap in food group consumption between women, pregnant women, and men in the lowest and highest socioeconomic groups shrank between 2016 and 2021. Yet, food group deprivation remained most prevalent among those in the lowest socioeconomic groups. The two exceptions for this were for eggs and meat/fish. Nevertheless, the majority of India's poorest and least educated adults are not consuming high-quality protein sources, including dairy, the consumption of which is far more common among wealthier and more educated Indian adults. Our results show that fewer adults were not consuming important food groups in 2021 than in 2016. However, many of India's poorest and least educated adults are still not consuming high-quality sources of protein or fruits, two food groups that are essential for good health. While adults might be getting protein and nutrients from pulses, legumes, beans, and other vegetables, efforts are needed to improve affordability of, and access to, high-quality sources of protein and fruits. This work was supported by the Bill & Melinda Gates Foundation, INV-002992.

Revisiting the predisposing, enabling, and need factors of unsafe abortion in India using the Heckman Probit model.

Unsafe abortion refers to induced abortions performed without trained medical assistance. While previous studies have investigated predictors of unsafe abortion in India, none have addressed these factors with accounting sample selection bias. This study aims to evaluate the contributors to unsafe abortion in India by using the latest National Family Health Survey data conducted during 2019-2021, incorporating the adjustment of sample selection bias. The study included women aged 15 to 49 who had terminated their most recent pregnancy within five years prior to the survey (total weighted sample (N) = 4,810). Descriptive and bivariate statistics and the Heckman Probit model were employed. The prevalence of unsafe abortion in India was 31%. Key predictors of unsafe abortion included women's age, the gender composition of their living children, gestation stage, family planning status, and geographical region. Unsafe abortions were typically performed in the early stages of gestation, often involving self-administered medication. The primary reasons cited were unintended pregnancies and health complications. This study underscores the urgent need for targeted interventions that take into account regional, demographic, and social dynamics influencing abortion practices in India.

Assessing the link between hygienic material use during menstruation and self-reported reproductive tract infections among women in India: a propensity score matching approach.

Reproductive tract infections (RTIs) present a substantial health concern for women, especially in developing nations such as India, where inadequate access to proper sanitation and hygiene facilities frequently results in suboptimal menstrual health and hygiene (MHH), exacerbating the risk of RTIs. In this study, we analysed the self-reported prevalence of RTIs among young women in India and evaluated the impact of hygienic menstrual material usage on these RTIs. The study used information on 27,983 women aged 15-24 years, from the National Family Health Survey (NFHS-5) (2019-21). The prevalence of RTIs was calculated for all the states and UTs of India, and propensity score matching (PSM) technique was used to evaluate the impact of hygienic material use on RTIs among women in India. Every four out of 100 women reported RTIs in India in 2019-21. Notably, RTI prevalence displayed substantial state-level disparities. West Bengal exhibited the highest RTI prevalence at 9.3%, followed by Meghalaya, Arunachal Pradesh, and Himachal Pradesh, all surpassing 6%. In contrast, the lowest RTI rates were recorded in Puducherry at 0.9%, succeeded by Andaman and Nicobar Islands, Odisha, and Jammu & Kashmir, all registering rates below 2%. The PSM analysis revealed that women who utilized hygienic materials during menstruation exhibited a reduced prevalence of RTIs (referred to as the "treated group" with an Average Treatment Effect on the Treated (ATT) of 0.0315) compared to those who did not utilize such materials (referred to as the "control group" with an ATT of 0.0416). The study underscores the critical significance of using hygienic materials during menstruation as a preventive measure against RTIs among women in India. The findings suggest the need for targeted interventions focused at promoting hygienic menstrual materials to reduce the prevalence of RTIs among women in India.

Utilization and determinants of adequate quality antenatal care services in India: evidence from the National Family Health Survey (NFHS-5) (2019-21)

BackgroundPregnancy-related complications and insufficiencies in antenatal care services are leading causes of maternal and infant morbidity and mortality in low-resource settings. However, there has been an undue focus on achieving a minimum number of Antenatal Care (ANC) visits without adequate focus on the factors affecting ANC service utilization. This secondary data analysis from the fifth round of the National Family Health Survey (NFHS-5, 2019-21) was conducted to estimate the coverage of adequate quality ANC service and its determinants in India.MethodsThe study sample included 176,877 women aged 15–49 years who had experienced a pregnancy in the last 5 years. The primary outcome variable was the utilization of ANC services by women during their last pregnancy assessed by the frequency of ANC visits and the quality of ANC services. Quality of ANC service utilisation was categorised as adequate quality, inadequate quality and ≥ 4 ANC visits and, inadequate quality and < 4 ANC visits. We performed multinomial logistic regression and reported relative risk ratio (RRR) along with 95% confidence intervals. We adjusted for sampling weight, clustering, and stratification in the sampling design.ResultsThe median (IQR) number of ANC visits attended by a woman during her previous pregnancy was 4 (IQR 3–7). A majority (59.25%) of the women reported availing of ≥ 4 antenatal care (ANC) visits during their previous pregnancy while 6.12% of women reported availing no ANC visits in their last pregnancy. Women aged ≥ 30 years were significantly less likely (aRRR 0.73 95% CI 0.66, 0.80) to receive ANC services of inadequate quality, and < 4 ANC visits. Additionally, any exposure to mass media (aRRR 0.69 95% CI 0.66, 0.73), and having health insurance (aRRR 0.71 95% CI 0.68, 0.75) decreased their risk of receiving inadequate quality ANC services and < 4 ANC visits. Women belonging to the richest wealth quintile (aRRR 0.52 95% CI 0.47,0.58) and those with an intended pregnancy (aRRR 0.62 95% CI 0.58 ,0.66) were at significantly lower risk of utilizing inadequate quality ANC services and < 4 ANC visits.ConclusionAlthough nearly 3 in 5 women in India utilized a minimum mandated ≥ 4 ANC visits during their last pregnancy, only one in five of those received adequate quality of ANC services indicating suboptimal content. However, only one in five women utilized the WHO-mandated ≥ 8 ANC visits for a positive pregnancy experience. Furthermore, 14.3% of the women received ANC services of inadequate quality despite attending ≥ 4 ANC visits in their previous pregnancy. Our study emphasized the importance of the quality of ANC services utilised irrespective of number of ANC visits availed. Efforts should be undertaken to enhance the utilization of antenatal care (ANC) services by implementing media initiatives that aim to raise awareness, particularly among women belonging to disadvantaged population groups.

Prevalence and Predictors of Gestational Diabetes Mellitus and Overt Diabetes in Pregnancy: A Secondary Analysis of Nationwide Data from India

Abstract Background: This analysis was conducted to understand prevalence and determinants of gestational diabetes mellitus (GDM) and (overt) diabetes in pregnancy (DIP) in India, and also ascertain their health-seeking behaviour. Materials and Methods: The authors analysed data from the fifth National Family Health Survey of India. Binary logistic regression was used to assess the factors independently associated with GDM and (overt) DIP. Results: The weighted prevalence of GDM was 4.2% (95% confidence interval [CI]: 3.9–4.5), and the age-adjusted prevalence was 5.4% (95% CI: 4.5–6.4). The prevalence of GDM increased with age. The weighted prevalence of (overt) DIP was 0.38% (95% CI: 0.30–0.48), and the age-adjusted prevalence was 1.04% (95% CI: 0.64–1.68). On adjusted analysis, it was found that increasing age and obesity had significantly higher odds of having GDM. Higher odds of access to private facilities were found amongst women with higher education and those who were overweight. Significant regional variation in the prevalence of GDM was observed, with a very low burden observed in northeastern states and a comparatively higher burden in Central, Western and Southern Indian states. Conclusions: There is an increasing prevalence of GDM in India. Strengthening primary health systems to enhance GDM-related service availability, quality and delivery could be logical policy intervention.

Do Indian women know about and use the emergency contraceptive pill? An analysis of nationally representative data from 2005–06 and 2019–21

Abstract The emergency contraceptive pill (ECP) is a post-coital contraceptive method that prevents unintended pregnancy and is useful in specific circumstances. This study examined the awareness and use of the ECP in India, as there is scarce evidence in this area to guide policy development. This study used data from the 2005–06 (n = 124 385) and 2019–21 (n = 724 115) rounds of the National Family Health Survey of India. Bivariate analysis and multivariate logistic regression were applied to explore how demographic characteristics including age, education (none, primary, secondary, higher), wealth quintile, place of residence (urban, rural), marital status, parity, desire for children, whether current pregnancy was wanted, whether the women had had an abortion in the past 5 years, and whether current use of contraceptive methods affected the likelihood of knowledge and use of ECP. In the past 15 years, knowledge of ECP has increased by 37 percentage points but still remains relatively low at 48%. Less than 1% of the sample (0.55%) used ECP. Women aged 30–34 years, from wealthier and more educated backgrounds, living in urban areas, and currently using condoms had a higher likelihood of using ECP in comparison with women from age group 15–19 years, those from the poorest backgrounds, those with no education, those living in rural areas and those not using any contraceptive method, respectively. In comparison to married women, never-married women exhibited a higher awareness of ECP but lower use. More efforts must be made to improve awareness of the ECP, especially among adolescents, those with less education, poorer women and those in rural areas. The government is taking steps to improve access to ECP, and India’s female community health workers, the ASHAs, could be further supported to enhance awareness of ECP.

Comprehensive Knowledge about HIV/AIDS among Women of Reproductive Age in India.

HIV/AIDS has been a major threat to global public health, with India ranking third when it comes to the global burden of people living with HIV, especially women. It is imperative to assess the level of knowledge women have about transmission and prevention of this infection. This study sought to delineate the determinants of the comprehensive knowledge of HIV/AIDS among women in the reproductive age groups in India. Data from the fifth round of the National Family Health Survey conducted in India were analyzed. The sample included 95,541 women aged 15-49 years. Multilevel logistic regression was fitted with individual characteristics, household characteristics, and community characteristics to identify determinants of comprehensive knowledge on HIV/AIDS. Nearly a fourth (24.8%) of the women aged 15-49 in India who had ever heard of HIV had comprehensive knowledge of HIV/AIDS. Multilevel logistic regression showed that the likelihood of comprehensive knowledge of HIV/AIDS was higher among women aged 40-44 (AOR = 1.57) and 30-34 (AOR = 1.56). The likelihood of having comprehensive knowledge increased with the increase in the level of education. Women with secondary and higher levels of education were 1.9 times and 3.38 times more likely to have comprehensive knowledge, respectively, than those with no education. Household wealth, access to mass media, and having ever tested for HIV were also significant determinants of comprehensive knowledge of HIV/AIDS among women. The odds of having comprehensive knowledge about HIV/AIDS were higher for women with higher community wealth (AOR = 1.31), higher community education (AOR = 1.09), and higher community employment (AOR = 1.12). Factors at both the individual and community levels were shown to be indicators of comprehensive knowledge of HIV/AIDS. Policymakers and public health practitioners in India should come up with plans to close the information gaps about HIV/AIDS that exist among women and their demographic subgroups.

Families in Multi-Problem Situations in India: Exploration From the Fifth Round of the National Family Health Survey

Family is the cornerstone of many concepts in the social sciences, especially in demography and sociology. It is generally regarded as a major social institution and is positioned as the locus of much of an individual’s life-course decisions. This study’s aim was to investigate families in multi-problem situations and their determinants in India. National Family Health Survey round fifth was used. A total of 19,763 samples of families were analyzed using univariate, bivariate, and chi-square tests and multinomial logistic regression. More than half of Indian families are facing multiple problems. In India, 23.2% of families suffer from three and more problems. Those families with one problem have more domestic violence (25.6%) among women. The use of tobacco (36.4%) and alcohol (35.7%) among men is more in families having two problems. Families facing three problems have more women consuming tobacco (31.8%), more men consuming alcohol (31.4%), and more underweight and alcohol-consuming women (30.2% and 30.9%) in the family. The multinomial logistic regression analysis showed that more than two problems were associated with the men’s age groups, wealth index, status of shared toilet facilities, educational level of men and women, and caste. Findings suggest the importance of addressing multiple problems in Indian families. Inclusion of education, sanitation, violence, use of alcohol and tobacco, malnutrition among women, and children management strategies services needs to be taken into consideration by the program and policymakers.

Climate and Gender: Association Between Droughts and Intimate Partner Violence in India.

Extreme climate events are related to women's exposure to different forms of violence. We examined the relationship between droughts and physical, sexual, and emotional intimate partner violence (IPV) in India by using 2 different definitions of drought: precipitation-based drought and socioeconomic drought. We analyzed data from 2 rounds of a nationally representative survey, the National Family Health Survey, where married women were asked about their experiences of IPV in the previous year (2015-2016 and 2019-2021; n=122,696). Precipitation-based drought was estimated using remote sensing data and geographic information system (GIS) mapping, while socioeconomic drought status was collected from government records. Logistic regression models showed precipitation-based drought to increase the risk of experiencing physical IPV and emotional IPV. Similar findings were observed for socioeconomic drought; women residing in areas classified as drought-impacted by the government were more likely to report physical IPV, sexual IPV, and emotional IPV. These findings support the growing body of evidence regarding the relationship between climate change and women's vulnerability, and highlight the need for gender responsive strategies for disaster management and preparedness.

Prevalence and associated factors of undiagnosed hypertension among women aged 15-49 years in India: an analysis of National Family Health Survey-4 data.

Hypertension is a major risk factor for cardiovascular diseases globally. Fortunately, there is a vast armamentarium of effective therapeutic options at our disposal so undiagnosed hypertension represents a missed opportunity. In a previous analysis [1] of the NFHS-4 dataset for the prevalence and risk factors for undiagnosed hypertension and its associated risk factors among Indian women aged 15-49 years, we had overestimated prevalence by inclusion of self-reported cases. We have since retracted when this anomaly was highlighted [2]. We have now re-analyzed the same database and here present these data. The current analysis shows that the overall prevalence of undiagnosed hypertension was 8.05% among women aged 15-49 years in India. In rural areas, it was 7.89% compared with 8.38% for urban areas. Factors associated with undiagnosed hypertension in rural and urban areas were age, BMI, wealth quintiles, educational level, religion, caste and geographical zones. Nearly half the women aged 15-49 years in India with hypertension are unaware and this has implications for personal and reproductive health.

Fieldworker effects on quality of data collected on sensitive questions in National Family Health Surveys: An analysis based on intimate partner violence in India

National Family Health Survey (NFHS) has played a pivotal role in formulating policies and programs by providing nationally representative data on a wide range of monitoring and impact evaluation indicators in population, health and nutrition. However, due to measurement errors resulting in misreporting, the collection of accurate data on sensitive issues in sample surveys has always been a matter of concern. This study examines the fieldworker effect on the reporting of physical, sexual, and emotional Intimate Partner Violence (IPV) using fifth round of NFHS (2019-21) data in India. The cross-classified multi-level model was used to examine the fieldworker's effect on the reporting of IPV. The fieldworker effect accounted for around 32% of total variation in the reporting of intimate partner violence. The fieldworker's effect varied from 26% to 41 % for physical violence, 29% to 33% for emotional IPV and 30%–36% for sexual IPV. It was observed that variation due to fieldworker for non-sensitive outcomes was negligible.Of total variation, only 1.6% for information related to ever attending school, 4.8% for ever given birth, 5% for currently pregnant and 8.5% for information on ever terminated pregnancy was being explained by the fieldworker. Our results indicate a significant fieldworker influence on the likelihood of reporting intimate partner violence, underlining the need for an increased understanding of the impact of fieldworkers on data outputs, especially—but not exclusively—when queries contain delicate or stigmatized themes. This study highlights the importance of providing extra guidance and special training to the fieldworkers when collecting sensitive information related to IPV.

Assessing the prevalence and predictors of anemia among pregnant women in India: findings from the India National Family Health Survey 2019–2021

Background Anemia is more prevalent in low- and middle-income countries including India. Anemia in pregnancy is associated with increased risk of maternal health problems and adverse birth outcomes. This study estimates the prevalence and associated risk factors of anemia among pregnant women in India. Methods This cross-sectional study is based on secondary data from the India National Family Health Survey-V (NFHS-5) conducted during 2019–2021. We extracted data of 27,317 currently pregnant women to estimate the prevalence and contributory factors associated with anemia using descriptive statistics and logistic regression analysis. Results The prevalence of anemia among pregnant women in India was 52.2%. Anemia was higher among adolescent women (61.5%), those with no education (59.2%), those belonging to poorest wealth index (61.9%), scheduled tribes (59.3%), and those from the eastern region of India (62.1%). Further, it was more prevalent among women with a habit of smoking, tobacco, or alcohol (63.0%), and women with shorter birth intervals (59.7%). Among Indian states, anemia prevalence was higher in the state of Bihar (63.1%) and the union territory of Ladakh (71.4%). Logistic regression models show that women with no education (aOR = 1.41, 95% CI = 1.27–1.57), belonging to a poorest wealth quintile (aOR = 1.69, 95% CI = 1.51–1.90), and those with a habit of smoking, tobacco, or alcohol (aOR = 1.39, 95% CI = 1.18–1.63) were more anemic than their counterparts. Additionally, women with no education showed a four-times higher risk of severe anemia (aOR = 4.79, 95% CI = 2.75–8.36) than their highly educated counterparts. Conclusion Anemia affects half of all pregnant women in India. Anemia prevalence is higher among adolescents, illiterate, poor, and tribal communities. Social norm-based interventions and strengthening the community health facilitators should be implemented to reduce the high burden of anemia in India.

Association between mass media exposure and infant and young child feeding practices in India: a cross-sectional study

The first two years of life is a critical window for good nutrition. Promoting infant and young child feeding (IYCF) practices in the first two years can help improve child survival and promote healthy growth and development. Assessment of IYCF practices is important, especially in developing countries like India where optimal IYCF practices can potentially prevent 12% of all deaths under 5 years of age, to promote awareness and intervene appropriately. The objective of our study is to generate evidence for the association between different types of mass media and appropriate IYCF practices in India, including optimal breastfeeding and appropriate complementary feeding practices. A positive association between them can point to intervention at scale. We analyzed data from India’s National Family Health Survey 5 (NFHS-5), 2019–2021. Multivariable logistic regression was used to examine the association of appropriate IYCF practices with mass media exposure. After controlling for demographics and socioeconomic status, the analyses showed that, overall, women who had exposure to television followed by newspaper and movies, had higher odds of adopting the recommended IYCF practices. The results also showed that the association of media exposure varied for different IYCF practices by geography. For instance, in the rural areas, television exposure was positively associated with all the IYCF practices, but in the urban areas, television exposure was positively associated with only early initiation of breastfeeding [OR 1.25; (95% CI 1.1–1.42)]. The study strengthens our understanding that an appropriate selection of mass media channels for intervention programs can promote IYCF practices at scale. Appropriately selecting the type of mass media to create awareness about different IYCF practices, in specific urban–rural settings, could help customize intervention programs to successfully influence IYCF behaviors.

Does Empowering Women Influence Maternal Healthcare Service Utilization?: Evidence from National Family Health Survey-5, India.

Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. DATA ANDMETHODS: The study uses data from the fifth round of the National Family Health Survey conducted in 2019-2021 and analyzed 26,552 (15-49 aged)currently married women who had a live birth in the last 5years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality.

Dynamics of usage of menstrual hygiene and unhygienic methods among young women in India: a spatial analysis

BackgroundMenstruation, especially the menstrual cycle, is a vital sign for female adolescent health and maintaining menstrual hygiene is of utmost importance for menstruating girls and women. However, menstrual hygiene and management are issues that have not received adequate attention. Therefore, the present study aimed to explore spatial patterns of menstrual hygiene practices in India and to identify their socioeconomic and demographic determinants among women aged 15–24 years.MethodsThe study utilized data from the fifth round of the National Family Health Survey (NFHS-5) conducted during 2019–21 in India. The analysis was limited to 241,180 women aged 15–24 years. The statistical methods range from multinomial logistic regression, spatial autocorrelation in terms of Moran’s I statistics, to spatial regression in order to understand the spatial dependence and clustering in different methods of menstrual practices across the districts of India.ResultsAlmost half of the respondents (49.8 percent) reported using hygienic methods of bloodstain protection, while 22.7 percent still relied on unhygienic methods and 27.5 percent reported using both hygienic and unhygienic methods during their menstruation. Factors like age, place of residence, caste, religion, education, wealth index and toilet facility were found to be significantly associated with the use of unhygienic and both methods. It was also observed that the percentage of women practicing hygienic methods was predominantly higher in the Southern region. On the other hand, states like Madhya Pradesh and Bihar appeared to be hotspots for unhygienic menstrual practices. The univariate Moran’s I value for unhygienic and both methods were 0.722 and 0.596, respectively, depicting high spatial autocorrelation across districts in India. In spatial regression, rural residence, illiteracy, poverty, and no toilet facility were found to be statistically significant predictors of the use of unhygienic method and both methods.ConclusionYoung women should be educated about the importance of menstrual hygiene practices and the physiological consequences of unhygienic practices. Furthermore, interventions should target socio-economically disadvantaged women to increase the use of sanitary napkins.

Effect of exclusive breastfeeding practices on childhood morbidity among primiparous mothers in India: Analysis from National Family Health Survey-4, India during 2015-16

BackgroundExclusive breastfeeding (EBF) has many benefits for infants and mothers. ObjectivesThe study aimed to understand the prevalence of EBF practices among primiparous mothers and its associated clinical and socio-demographic characteristics among infants 0–6 months of age. Materials and methodsThis analysis was based on the 4th round of NFHS, a cross-sectional survey of India conducted between 2015 and 2016. Simple logistic regression was performed to examine the factors associated with EBF infants. ResultsOf the 5816 infants, the median age (IQR) was 4 months (2-5) with a female/male ratio of 1:1.10 respectively. The median (IQR) age of the mother was 22 (20-25) years. The prevalence of EBF was 60.57% (95% CI, 59.31-61.82). Households using clean fuel (OR 0.87, 95% CI 0.78-0.97) had lower odds of being EBF than polluting fuel. Infants with richer wealth (OR 0.84, 95% CI 0.74-0.94) had lower odds of being EBF than infants from poor wealth. Infants with fever (OR 0.65, 95% CI 0.56-0.75), cough (OR 0.78, 95% CI 0.66-0.92) and diarrhea (OR 0.60, 95% CI 0.51-0.71) had lower odds of being EBF, compared with infants without these morbidities. ConclusionEBF practices were very low in India, and the present result shows children born to lower socioeconomic status had a higher chance of being EBF. Further research is needed to understand the relationships between EBF up to six months versus less than six months of birth on various morbidity.

Spatiotemporal change in wealth-based inequalities in overweight/obesity among women of reproductive age in India, 2015–2021

BackgroundOverweight/obesity poses significant global health concerns, especially affecting women. This study aimed to measure changes in wealth-based inequality in overweight/obesity among women of reproductive age (WRA) across states of India from 2015 to 2021 and identify the contributing factors to this inequality. MethodsThe study used information on 582,851 and 587,435 women aged 15–49 from National Family Health Survey (NFHS)-4 (2015-16) and NFHS-5 (2019-21), respectively. Erreygers Concentration Index (ECI) was employed to measure the change in inequality over time. Further, ECI was decomposed to unravel the contributing factors to this inequality. ResultsOverweight/obesity among WRA in India increased from 20.3 % in NFHS-4 to 23.7 % in NFHS-5. A significant pro-rich inequality in overweight/obesity was observed at the national level and across all 28 states of India during both NFHS-4 and NFHS-5. The national wealth-based inequality reduced marginally over the study period (ECI: 0.25 in NFHS-4, ECI: 0.23 in NFHS-5), but at the state level, it rose in 8 states and declined in 16 states. Punjab witnessed the most significant increase (ECI: 0.10 in NFHS-4, ECI: 0.18 in NFHS-5) in inequality, while Maharashtra (ECI: 0.24 in NFHS-4, ECI: 0.16 in NFHS-5) saw the most significant decrease in inequality. The decomposition analysis results revealed that women's education, mass media exposure, and place of residence were major contributors, contributing more than 80 % to wealth-based inequality in overweight/obesity. ConclusionThe study highlights the growing prevalence of overweight/obesity among WRA in India, emphasizing that wealth-related inequalities in the prevalence of overweight/obesity represent a significant public health concern both at the national and state levels in India.

Extend of Multidimensional Poverty Index in Haryana: A Multidimensional Approach

To quantify poverty merely monetary approach does not provide a true representation of deprivations or wellbeingness of households. Multidimensional Poverty Index measures multiple dimensions of deprivation of poverty that gives a more complete picture of poverty. For the study MPI status of Haryana and India as a whole the secondary data on India National Multidimensional Poverty Index, Baseline Report, Based on National Family Health Survey-4 (NFHS) 2015-16 published in 2021 has been used. Main objective of the paper is to study the status of Multidimensional Poverty Index of India and the position of Haryana as it’s in top states with respect to per capita income from 2006 to 2021. The district wise deprivation and counting of different types of deprivations that individuals experience at the same time has been discussed. The study observed that Haryana stands in better position in Multidimensional poverty index (value 0.055) and less deprived in all the indicators of three dimensions of Multidimensional poverty index compare the average status of India as a whole (0.118). District level results revealed the district Mewat, Palwal, Sirsa and Rohtak, Mahendragarh have higher level of multidimensional poverty districts whereas Ambala stands at first rank in lowest head count ratio 1.99%, followed by Panchkula with 2.47%. Comparatively in third dimension of MPI status of Haryana is far better like in electricity. Its deprivation is 0.75 percent compare to 8.29 percent in India. Results show that there is inter district disparity among the indicators which has been reduced. Few districts are above in all indicators due to economic factors and few are deprived in all indicators like Mewat , which is just 58 km far from millennium city of India. Status of health, education and standard of living is worsening in Mewat. Causes are many Like Religion, political, socio orthodox and Illiteracy.

Gender-Gap in Internet Literacy in India: A State-Level Analysis

Internet literacy is the knowledge of using internet facility, deals with intellectual ability of men and women. Internet plays very important role in our daily life to live, learn, work in a society to access information, knowledge, entertainment and improve our skills and internet literacy is one of the basic literacy whereas the gender gap is difference between men and Women in social, political, intellectual, cultural, economic attainments’ or attitudes. The present study analyses gender gap in internet literacy in India using National Family Health Survey (NFHS) 5 data employing descriptive statistics, and t test. Study analyses gender gap in internet literacy in all the states of India shows clearly there is considerable level of gender gap among men and women. The finding indicates that just 63.06% of males and 40.65% of females have ever used the internet. Assam has one of the lowest rates of male Internet literacy in India, whereas Goa has one of the highest (82.90). Bihar has the lowest percentage of Internet-literate women, while Sikkim has the most. The gender disparity is most in the state of Telengana, with a score of 30.9, followed by Chhattisgarh (29.6), and it is at its smallest in the state of Sikkim, with a score of 1.5 and the gender difference seems to be more than 20 in the majority of the states.

Women's autonomy and completion of continuum of care in maternal healthcare

Abstract Background In low- and middle-income countries, interventions to improve maternal health services throughout pregnancy, during labor, and after delivery are often targeted independently. For health optimization, it is important to adopt a more comprehensive approach and identify factors that hinder women's continuum of care (CoC) in maternal health services. This study aimed to assess the association between women's autonomy and completion of CoC in maternal health services in India. Methods Using the fifth National Family Health Survey, 25,515 women aged 15-49 years who had births in the past five years were analyzed. Women's autonomy was determined based on their control over decision-making (either by themselves or jointly with husband/partner) about healthcare utilization, large purchases, visits to family/relatives, and spending of money. Women were considered as having completed CoC in maternal health services if they received at least eight antenatal care visits, gave birth in health facility with skilled birth attendants, and received postnatal care within 24 hours of birth. Multivariable-adjusted logistic regression analysis was performed. Results Overall, 64.55% of women were identified as having autonomy and 13.68% had completed CoC in maternal health services. Women's autonomy was associated with significantly increased odds of completing CoC in maternal health services (AORs: 1.19, 95% CI: 1.05-1.36), after adjusting for demographic and socioeconomic covariates. Conclusions Despite substantial progress made on maternal health services, completion of CoC remains low in India. Fostering a social climate to promote women's autonomy should be considered in comprehensive interventions to ensure completion of CoC for healthy pregnancy. Key messages • In India, the percentage of women who received full completion of care (CoC) in maternal healthcare services remained low. • Women's autonomy was significantly associated with higher CoC in maternal health services, highlighting the significance of women's participation in the household decision-making process.