National Family Health Survey Research Articles

Estimated effect of age of marriage on utilisation of India’s Integrated Child Development Service programme

BackgroundAge of marriage among women is considered an important indicator of their readiness for familial integration and parenting. This study estimated the effect of age of marriage of young mothers...

Factors Behind Women’s Decision Making Autonomy: An Analysis from Nationally Representative Survey

The socioeconomic variables have a strong impact on the decision-making and physical movement of women, worldwide studies suggest the same. In this study, we have tried to know the various determinants of women’s autonomy. We have taken the data from the fourth round National Family Health Survey (NFHS) (2015-16), published by the International Institution on Population Sciences (IIPS). For the statistical analysis, we used basic descriptive statistics and cross-tabulation between the socioeconomic variables and autonomy responses. Later to predict the occurrence of various autonomy aspects, binary logistic regression has been used with various socioeconomic variables. After getting the results, it has come to know that women’s decision-making and freedom of movement-related autonomy are largely influenced by socioeconomic variables. Major findings stated that with increasing age of women, autonomy increases. Women who belong to the rural setup have a low level of autonomy. From a religious perspective, women from the Muslim community have lower autonomy. Apart from these women have higher education, employed and in rich households have a higher likelihood of autonomy. Based on the outcomes, it is clear to us that women’s autonomy is largely influenced by their socioeconomic condition.

Prevalence and Predictors of Risky Sexual Behavior Among Young Men in India: Evidence From National Family Health Survey

Objective The study examines the prevalence and factors associated with high-risk sexual behavior among sexually active young Indian men. Methods This study used samples of 14,584 men aged 15 to 29 from the National Family Health Survey (NFHS-5), 2019–21. Results 14% of men engaged in early sexual debut (<18 years), 68% had unprotected sex, and 4% had multiple sexual partners in the past 12 months. Age, marital status, educational attainment, occupation, wealth quintile, alcohol consumption, internet use, media exposure, and region were significant predictors of risky sexual behavior. Conclusions We suggest a tailored approach for effective policy design considering risk factors of risky sexual behavior.

Gender-specific inequalities in coverage of Publicly Funded Health Insurance Schemes in Southern States of India: evidence from National Family Health Surveys

BackgroundPublicly Funded Health Insurance Schemes (PFHIS) are intended to play a role in achieving Universal Health Coverage (UHC). In countries like India, PFHISs have low penetrance and provide limited coverage of services and of family members within households, which can mean that women lose out. Gender inequities in relation to financial risk protection are understudied. Given the emphasis being placed on achieving UHC for all in India, this paper examined intersecting gender inequalities and changes in PFHIS coverage in southern India, where its penetrance is greater and of longer duration.Data and methodsThis study used the fourth (NFHS-4, 2015–16) and fifth (NFHS-5, 2019–21) rounds of India’s National Family Health Survey for five southern states: namely, Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, and Telangana. The World Health Organization’s Health Equity Assessment Toolkit (HEAT) Plus and Stata were used to analyse PFHIS coverage disaggregated by seven dimensions of inequality. Ratios and differences for binary dimensions; Between Group Variance and Theil Index for unordered dimensions; Absolute and Relative Concentration Index (RCI) for ordered dimensions were computed separately for women and men.ResultsOverall, PFHIS coverage increased significantly (p < 0.001) among women and men in Andhra Pradesh, and Kerala from NFHS-4 to NFHS-5. Overall, men had higher PFHIS coverage than women, especially in Andhra Pradesh, Tamil Nadu, and Telangana in both surveys. In both absolute and relative terms, PFHIS coverage was concentrated among older women and men across all states; age-related inequalities were higher among women than men in both surveys in Andhra Pradesh, Kerala, and Telengana. The magnitude of education-related inequalities was twice as high as among women in Telangana (RCINFHS-4: -12.23; RCINFHS-5: -9.98) and Andhra Pradesh (RCINFHS-4: -8.05; RCINFHS-5: -7.84) as compared to men in Telangana (RCINFHS-4: -5.58; RCINFHS-5: -2.30) and Andhra Pradesh (RCINFHS-4: -4.40; RCINFHS-5: -3.12) and these inequalities remained in NFHS-5, suggesting that lower education level women had greater coverage. In the latter survey, a high magnitude of wealth-related inequality was observed in women (RCINFHS-4: -15.78; RCINFHS-5: -14.36) and men (RCINFHS-4: -20.42; RCINFHS-5: -13.84) belonging to Kerala, whereas this inequality has decreased from NFHS-4 to NFHS-5., again suggestive of greater coverage among poorer populations. Caste-related inequalities were higher in women than men in both surveys, the magnitude of inequalities decreased between 2015–16 and 2019–20.ConclusionsWe found gender inequalities in self-reported enrolment in southern states with long-standing PFHIS. Inequalities favoured the poor, uneducated and elderly, which is to some extend desirable when rolling out a PFHIS intended for harder to reach populations. However, religion and caste-based inequalities, while reducing, were still prevalent among women. If PFHIS are to truly offer financial risk protection, they must address the intersecting marginalization faced by women and men, while meeting eventual goals of risk pooling, indicated by high coverage and low inequality across population sub-groups.

Impact of ambient air pollution and socio-environmental factors on the health of children younger than 5 years in India: a population-based analysis

Ambient air pollution and household environmental factors affect child health, particularly in low-income and middle-income countries. This study aimed to investigate the association between ambient air pollution (PM2·5) levels, socio-environmental factors (including household wealth, housing quality measures, smoking status), and the occurrence of respiratory illness in Indian children. In this retrospective and observational study, we analysed data from India's National Family Health Survey (NFHS-5, 2019-2021) combined with NASA's Global Annual PM2·5 Grids database. Bivariate and multivariable generalized additive models were employed to examine associations between key social-environmental factors and respiratory illness in children younger than 5 years. We analysed data from 224,214 children younger than 5 years, representing 165,561 families from 29,757 geographic clusters. Our results showed extremely high annual PM2·5 levels throughout India (median 63·4·g/m3, IQR 41·9-81·6), with higher exposure for rural and impoverished families. In bivariate analyses, PM2·5 was significantly associated with reported respiratory illness (p<0·001). Using generalized additive models and after accounting for key social and environmental factors, a monotonic increasing and non-linear relationship was observed between PM2·5 and respiratory illness (p<0·001), with increased likelihood of illness observed even at values near and below India's National Ambient Air Quality Standards of 40μg/m3. The study highlights the significant association of social-environmental conditions with health outcomes among young children in India. Efforts specifically targeting ambient air pollution and child health during monsoon season could have significant health benefits among this population and help achieve the goal of ending preventable deaths of children younger than 5 years. National Institutes of Health (NIH T-32-HL139443-3).

Influence of Maternal Height on Birth-Weight, Baby-Size and Gestational-Age in India: Evidence from National Family Health Survey, 2015-16

Influence of Maternal Height on Birth-Weight, Baby-Size and Gestational-Age in India: Evidence from National Family Health Survey, 2015-16

Analysis of age-specific fertility in India: Deterministic and non-deterministic modeling approaches

The main objective of this study is to investigate the pattern of age-specific fertility rates (ASFRs) in India using deterministic and non-deterministic approaches. Toward this end, we proposed statistical polynomial regression models to study the distributional pattern of ASFRs for total, rural, and urban women in India. Further, a comparative study considering selected skewed regression models was undertaken. For this study, secondary data on ASFR were collected from Sample Registration System, Statistical Report-2020, and from National Family Health Survey 5 (NFHS-5; 2019 &amp;ndash; 2021). It was found that all three subcategories of ASFRs, namely, the total, rural, and urban ASFRs, followed the reciprocal biquadratic polynomial model. On the other hand, all three subcategories of ASFR follow the skew-normal type 2 distribution. Similar findings were also obtained and validated based on NFHS-5 data. Further, the chosen statistical models&amp;rsquo; validity and stability were tested using various model validation techniques and model selection criteria.

Views of Men Regarding Not Availing Antenatal Care for Their Pregnant Partners in West Bengal

Antenatal care (ANC) is essential for the health of both the mother and the baby. Though females are the direct receivers of this care, yet the understanding of their husbands is crucial in determining the pregnant women’s access to ANC. NFHS–5 ( National Family Health Survey, 2019–2020 ) has reported that about 5.6% of women in West Bengal aged 15–49 who had a live birth in the five years preceding the survey had no ANC visit during their pregnancy. In this study, both qualitative and quantitative techniques have been used to understand the views of men whose female partners did not receive any ANC during their pregnancy in West Bengal. Data collection has been done from 130 respondents using a structured questionnaire, and then, statistical analysis has been performed using SPSS. Qualitative data have been collected from nine selected participants through telephonic interview. The result is that men’s views for their pregnant partners not availing ANC are influenced by the place of residence, educational qualification and number of children (statistically significant at p value &lt; .05). However, lack of awareness, financial constraint, poor spousal relationship and inaccessibility to the maternity clinics are a few important reasons that have been focused in this study.

Wealth inequalities in nutritional status among the tribal under-5 children in India: A temporal trend analysis using NFHS data of Jharkhand and Odisha states - 2006-21.

Undernutrition remains a major public health concern in India, especially among children belonging to the Scheduled Tribes (ST). In this study, we analyse wealth inequalities in nutritional outcomes within ST communities in two tribal-dominated states of India, namely, Odisha and Jharkhand. The study also compares the trends in nutrition outcomes between ST and Non-ST children in these states. We have conducted a trend analysis of the prevalence and inequalities in the nutritional indicators among ST children under age five using unit-level data of the National Family Health Survey (NFHS) [NFHS-3(2005-06),4 (2015-16) and 5(2019-2021)]. Wealth-related inequalities were analysed using the Slope Index of Inequality (SII), which measures absolute inequality, and the relative Concentration Index (CIX), which measures relative inequality. We have also analysed the correlation between Antenatal Care (ANC) visits and nutritional indicators using the Pearson Correlation test. The trend analysis shows that the prevalence of undernutrition remains higher among ST children in India as compared to Non-ST children between NFHS-3 (2005-06) and NFHS-5 (2019-2020) in Jharkhand and Odisha. The SII and CIX values show that statistically significant inequalities in stunting and underweight exist among children belonging to various wealth quintiles within the ST category in both states. Wasting is found to be significantly prevalent across all wealth quintiles. Also, we found a negative association between ANC visits and all three nutritional indicators. Our study highlights the importance of monitoring both the absolute and relative wealth inequalities in nutritional outcomes. This is due to the fact that while inequalities across groups may reduce, the prevalence of poor nutritional outcomes may increase among certain groups. Such observations, therefore, will enable policymakers to focus further on those groups and devise appropriate interventions.

Trends in the prevalence and social determinants of stunting in India, 2005–2021: findings from three rounds of the National Family Health Survey

ObjectivesTo assess social determinants of stunting and the shifts in contributions of socio-demographic factors to national prevalence trends in India between 2005 and 2021.MethodsWe leveraged data from three rounds of...

Prevalence and risk factor of diabetes and hypertension in northeastern and south Indian region in India: insights from large scale survey data

Background: Hypertension and diabetes, two of the major global risks for mortality are on a rapid rise in developing nations and leading risk factors for a hero sclerosis and its complications, including heart attacks and strokes. It is predicted that by 2030, India’s diabetes burden will be almost 87 million people. This study aimed to estimate the prevalence and risk factor of diabetes and hypertension in northeastern and south Indian region in India. Methods: This study utilised the fourth wave of the national family health survey (2015-16). Bivariate, multivariable logistic regression analyses were done to meet the aim of the paper. Results: Analysis shows that the highest prevalence of prehypertension is higher in Sikkim state whereas the prevalence of hypertension men is higher in also Sikkim state. Prevalence of women is prehypertension in Sikkim state and hypertensive women is higher prevalence in Nagaland and Assam state. Conclusions: Diabetes is developing with multi-morbidity like hypertension. Thus, there is need to provide the health education to diabetic people by public and private health care services and increase the health awareness in the society at grass root level. The main reason behind diabetes is heredity, less physical activity, higher body mass index, and increased cholesterol level in that group of south India and northeastern region. There is need that people should change their lifestyle and government should build the structure of city with health perspective.

Does women empowerment associate with reduced risks of intimate partner violence in India? evidence from National Family Health Survey-5.

Women empowerment is commonly believed to be an important factor affecting a woman's likelihood of facing violence from her intimate partner. Even as countries invest in policies that aim to strengthen women empowerment, studies show that increase in women empowerment does not necessarily decrease intimate partner violence (IPV) against them. Against this paradox, the present study seeks to understand the specific empowerment components that associate with IPV against women in India. It also studies the state-level distribution of the different types of IPV. The study analyses state-level data from the National Family Health Survey, India (2019-21). A total of 72,056 women responded to the domestic violence questionnaire. The Dimension Index (DI) was used to compute composite scores for Women Empowerment and for IPV to rank states and Union Territories. The correlation between Women Empowerment and IPV scores was determined using Spearman's rank correlation coefficient. The state of Karnataka had the highest composite score of IPV and also showed the highest burdens of physical, sexual and emotional IPV, while Lakshadweep had the lowest burden. Physical IPV was the most common form of IPV for most states across the country. The states in the western part of India had reduced burdens for all three types of IPV. Three specific components of empowerment, viz. household decision-making and mobile phone ownership significantly associated with reduction of all three types of IPV. Hygienic menstrual practices strongly associated with reduction of sexual and emotional IPV. However, property ownership of women increased risks of all three types of IPV, while employment had no significant association with any type of IPV. The study found no significant reduction in overall IPV with improvement in women empowerment. However, it identifies components of empowerment that associate with IPV. Household decision-making, ownership of mobile phones, and hygienic menstrual practices associated with a lowered risk. By contrast, owning property increased the risk. The findings of this study would inform future research and intervention that aim to strengthen specific components of women empowerment in India and other low-and-middle-income countries.

Infertility Burden Across Indian States: Insights from a Nationally Representative Survey Conducted During 2019-21.

Infertility is an escalating global concern, impacting approximately one-sixth of the reproductive age population worldwide. Employing data from the National Family Health Survey-5 (NFHS-5, 2019-21), this study assessed the prevalence of primary infertility at both national and state levels in India. The data of the study was extracted from the National Family Health Survey and Individual file (women file) of the fifth round of NFHS encompassing a sample of 491,484 currently married women in the age group of 15-49 years. The findings showed that the prevalence of infertility is 18.7 per 1,000 women among those married for at least five years and currently in union. This prevalence increases as the duration of marriage decreases. On a state-level analysis, regions such as Goa, Lakshadweep, and Chhattisgarh exhibit the highest burdens. These findings underscore the growing challenge posed by primary infertility in India, calling for targeted interventions and policy measures. The establishment of a national infertility surveillance system is of pivotal importance in addressing this pressing public health issue.

Changes in discourse on unmet need for family planning among married women in India: evidence from NFHS-5 (2019–2021)

Unmet needs for contraception in India have declined over time but the rate has not been uniform among women across geographies and socio-economic strata. Identifying the characteristics of women in communities where unmet need is still high is important to devise appropriate strategies to ensure access and uptake of modern contraceptive methods. The current study examined whether there was a national decline in unmet need over time and if regional disparities exist in unmet need. Demographic variations in unmet need based on factors such as maternal age, education, religion, caste, wealth index quintile, family size, and access to antenatal care (ANC) were also documented. Our approach was to document the prevalence of total unmet need for family planning and unmet need for spacing among married Indian women and quantify variability based on socio-economic and demographic drivers within a hierarchal framework, thus providing both macro and micro perspectives. We used data from the fourth and fifth rounds of the National Family Health Survey (NFHS) collected from all the States and Union Territories (UTs) in India. Quantile regression analysis and multilevel regression techniques were used to understand the predictors for the total unmet need for family planning and the unmet need for spacing. Results show a considerable decline in the prevalence of unmet need for family planning in India from NFHS-4 to 5 (from 12.9 to 9.3%) in the last six6 years. The north-eastern states show a significant reduction in unmet need for family planning in Manipur (17.8%), Nagaland (13.5%), and followed by Sikkim (9.1%). The predictors such as years of schooling, place of residence, caste, religion, wealth quintile, number of antenatal care (ANC) visits, and children ever born have a significant association with unmet needs for family planning and spacing among married women in India. There is a significant association between years of schooling with the total unmet needs for family planning at (q25) quantiles and the unmet need for spacing at (q25, q50) quantiles. Results reveal that the demand for unmet need for spacing and limiting was the highest among the women in the age categories 15–19 (17.8%) and 20–24 (17.3%). The demand for limiting was the highest (6.8%) among Muslim women. Across wealth quantile categories, the overall unmet demand (11.4%) for spacing and limiting was the highest among the women in the lowest socioeconomic groups. We conclude that greater access to frontline health workers among young wives, and significant investment in education in general, will continue to reduce the unmet needs for family planning in India.

Bio-Fortified Wheat and Soybean Varieties : A Sustainable Approach of Food and Nutritional Security at District Dewas in Madhya Pradesh

Food security of the country has been ensured due to green revolution through adopting of high yielding varieties and newly introduced agricultural technologies at ground realities, hence achieved the rational production (305.44 million tones) of cereal crops during 2020-21 (Ministry of Agriculture and farmers welfare third advance estimates). Now days country is facing with great problems of malnutrition (38.4%) of women, adolescent girls &amp; children resulted high rate of anemia (58.6%), underweight (35.7%) &amp; mortality (41%), whilein Madhya Pradesh malnutrition (42%), Anemia (68.9%), underweight (42.8%), mortality of children (51%) were higher comparatively to the country, may be due to imbalance, inappropriate nutrition, health &amp; hygiene, poor awareness of livelihood peoples etc.(National Family Health Survey 2015-16). A stealthier form of deficiency is known as hidden hunger which is caused due to the intake of inadequate nutritious cheap food and thosehaving the characteristic of fulfillness the stomach but actually lacked in essential vitamins and minerals nutrition ingredients. Keeping in mind to cope up the malnutrition problems the Indian council of Agriculture research has taken lead for the biofortification of cereal crops based on earlier national breeding research efforts including biotechnology transgenic techniques and agronomic practices promotion of encourage the utilization of micronutrient fertilizers, targeting the enhancement of nutrients like zinc, iron, protein, folic acid, riboflavin, KTI free, Lipoxygenase-2 etc. in staple major &amp; minor food and oilseed crops. The current study has planned to review the role and importance of bio-fortified cereal crops like wheat and oilseed associated with high rich protein i.e.soybean incorporated for balance and appropriate nutrition to overcome and reducing the risk of malnutrition i.e. anemia, underweight as well as to ensure the nutritional security on respondence of children less than 5 years. To achieve the goal the experiment has designed by incorporating the Porridge of biofortified durum wheat variety HI-8777 containing protein ˃14%, iron 48.7 ppm, zinc 43.6 ppm and soybean variety NRC-127 KTI free simultaneously on ten children at village Agera district Dewas (M.P.). The study comprises three treatments i.e.T1-Panjeeri, T2-HI-8777, T3-HI-8777 + NRC-127 (09:01) provided each treatment for 2 months respectively and total upto 6 months. The observations were recorded on various parameters like haemoglobin, total protein, iron, zinc, height and weight after two months intervals completing the each treatment. The base line data was recorded by adopting the standard analytical procedure for collecting the blood samples of respondents and their testing. The result data reveals that all studied parameters were found in increasing trend on treatment no.03 as compare to control. The maximum hemoglobin (13), total protein (7.9), iron (69), zinc (735) were recorded in treatment No. 03 in against of baseline data i.e. 09, 6.4, 13, 20 respectively after 6 months. Height and weightparameters were also higher in treatment no.03 as compare to treatment no.01. On the basis of data it concluded that recent bio-fortified wheat and soybean varieties were played vital role in contributing to the food and nutritional livelihood securities specially for the poor population of the rural areas in village Agera Distt Dewas to cope up the malnutrition problems in the state as well as the country.The result also confirmed by PriyaSingla and Kiran Grover during 2001

Trends and socioeconomic disparities in undernutrition among Muslim women in India: evidence from the last two decades (1998–2021)

PurposeA woman's nutritional status significantly determines her overall well-being. The authors critically examine the trends — including socioeconomic disparities — in undernutrition among Muslim women in India, a notably socio-economically disadvantaged group. The authors also investigate trends and variations across the dimensions of caste, place of residence (rural/urban), education, economic status and geographic regions.Design/methodology/approachThe analysis leverages the nationally representative National Family Health Surveys (NFHS) of India conducted between 1998 and 2021. The authors examined poor–rich ratios, concentration indices, disparity ratios and predicted probabilities of being underweight (captured using Body Mass Index).FindingsFrom 1998 to 2021, there has been a decline in undernutrition prevalence among Muslim women. However, stark socioeconomic variations persist. While the prevalence has decreased over time across all socioeconomic groups, disparities — both within and between groups — remain significant and, in many cases, have expanded. For certain socioeconomic subgroups (e.g. Muslim women with no formal education or those in the Central and Northeast regions), the disparity doubled between 1998 and 2021. In regions like the South, where undernutrition prevalence is low or has reduced, disparities remain significant and generally have increased.Originality/valueTo the authors’ knowledge, the study is the first to provide a comprehensive examination of the prevalence, trends and socioeconomic disparities in undernutrition among Muslim women in India over the past two decades.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-04-2023-0320

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.