National Family Health Survey Research Articles

Prevalence and risk factors associated with undiagnosed hypertension among adults aged 15–49 years in India: insights from the National Family Health Survey (NFHS-5)

ObjectivesTo estimate the prevalence and identify the factors associated with undiagnosed hypertension in India. Study designA secondary data analysis using the National Family Health Survey (NFHS-5) covering the period 2019–2021. MethodsInformation on hypertension among individuals aged 15–49 years was extracted from the survey dataset. We estimated the prevalence of undiagnosed hypertension using physical measurements along with self-reported data from the survey. A log-binomial model with survey-adjusted Poisson regression was used to estimate the prevalence ratio between undiagnosed and diagnosed hypertension. Multinomial logistic regression analysis examined the factors associated with diagnosed hypertension (vs healthy) and undiagnosed hypertension (vs healthy). All the analyses were survey-weight adjusted and stratified by gender. ResultsThe survey-adjusted prevalence of undiagnosed hypertension was 8.75% (8.62%–8.87%) and was higher among males [13.56% (13.03%–14.12%)] than in females [8.14% (8.03%–8.25%)]. The proportion of individuals with undiagnosed hypertension among total hypertension was 44.99% (44.44%–45.55%) and was higher in males [65.94% (64.25%–67.60%)] than in females [42.18% (41.66%–42.71%)]. ConclusionsOur findings revealed that age, higher body mass index, no access to health care, and having no comorbidities were risk factors for undiagnosed hypertension. One in twelve people had undiagnosed hypertension, and of those with hypertension, one in two were undiagnosed, with males being disproportionately affected. Targeted public health interventions are crucial to improve hypertension screening, particularly among middle-aged and obese individuals without comorbidities.

Learning from the Indian National Family Health Survey to assess population based oral, cervix and breast cancer screening in low-and-middle income countries

Learning from the Indian National Family Health Survey to assess population based oral, cervix and breast cancer screening in low-and-middle income countries

Rural-urban differentials in undernutrition among women in India: Evidence from a decomposition approach.

Background: Global healthcare and nutrition policies have not eliminated the pressing public health issue of undernutrition, which remains a paramount public health concern in countries like India, coinciding with overweight and obesity, in the form of dual burden of malnutrition. Aim: This study delves into the rural-urban differential in undernutrition among reproductive-aged women in India for targeted policy interventions and to achieve universal health coverage. Methods: Data from the recent iteration of the National Family Health Survey (NFHS-5; 2019-21) were utilized to examine the factors influencing rural-urban differentials in women's undernutrition. A set of logistic regression and Fairlie's decomposition analysis are employed to identify the associated covariates and understand the factors driving these differentials. Results: The analysis reveals that rural women are significantly more vulnerable to undernutrition compared to urban counterparts, with factors such as education, wealth status, age, and dietary diversity playing key roles. The decomposition analysis of the rural-urban gap revealed that the variables considered in the study accounted for approximately 75% of the disparity. The difference in household wealth between rural and urban areas contributed about 63% of the explained gap, followed by educational status (16%), age group (11%), dietary diversity (8%), religion (5%), and media exposure (4%). Conclusion: The findings underscore the importance of targeted interventions addressing socio-economic inequalities to mitigate undernutrition among women in India. Enhancing access to education, improving economic opportunities, promoting dietary diversity, and challenging cultural norms are crucial steps towards achieving equitable nutritional outcomes and reducing the existing rural-urban disparity.

Overcoming Educational Barriers: Analyzing Root Causes and Solutions for Gender Disparity in Adivasi Education

This paper examines the current state of the gender gap in literacy rates and school education among Adivasi populations in India. Despite significant progress in overall literacy rates in recent decades, Adivasi communities, particularly Adivasi girls, continue to lag behind. We analyze the latest data from the Census of India, National Family Health Surveys, and other government reports to quantify the extent of the gender gap in literacy and school enrollment, attendance, and dropout rates among major Adivasi groups across different states. Root causes including poverty, lack of access to schools, cultural norms, early marriage, and lack of female teachers are explored. The paper also reviews recent government initiatives and welfare schemes aimed at promoting education of Adivasi girls and reducing gender disparity. Based on the analysis, targeted policy recommendations are made to accelerate progress in closing the gender gap and ensuring basic school education for all Adivasi girls in India.

Joint effect of tobacco and meat on cardiovascular disease and treatment adherence in Indian Women

Abstract Background Cardiovascular disease (CVD) is a leading cause of death for both men and women in India. But it is often overlooked in women. Tobacco and meat consumption are common risk factors for CVD. While individual studies have explored the link between tobacco or meat consumption and CVD, their joint effect remained understudied. Methods The study analyzed data from the National Family Health Survey 2019-21, of 711431 women aged 15 to 49 in India. Univariate and multivariate logistic regression were used to assess the risk of individual and joint effects of tobacco and meat consumptions on self-reported CVD prevalence. Age, BMI, education, wealth index, residency, region, religion, and alcohol were used as covariates. Additionally, interactions model was assessed. Lastly, treatment adherence for CVD was studied, considering treatment behavior, insurance, and healthcare access barriers. Results Cardiovascular disease prevalence was 0.72%. The risk of CVD was higher among the smokers [aOR: 2.26(1.83-2.73)] than smokeless tobacco [aOR: 1.34(1.21-1.49)] consumers. In contrast daily meat consumers showed higher risk [aOR: 1.23(1.03-1.47)] than meat non-consumers. Women who were consumers of both tobacco and meat had risk of [aOR: 1.15 (1.02 - 1.30)] CVD compared to who did not consume both tobacco and meat. Interaction was not detected between tobacco and meat consumption. CVD treatment adherence was higher among the women who possess an insurance [OR: 1.11(1.04-1.19)]. The risk of treatment non-adherence was higher among women who were aged below 40 with no education and from the poorest section of the society. Barriers for accessing health care facilities were solo attendance, provider availability, and drug access. Conclusions Tobacco and meat both need to be addressed to control CVD among women. Empowering women and bringing them under government insurance with an improve health care system are crucial. Key messages • The joint effect of tobacco and meat consumption increased the risk of cardiovascular diseases among women. However, there was no interaction effects observed between tobacco and meat consumption. • Healthcare facilities needs to be improved and awareness among young adults are extremely crucial for better CVD treatment management among women in India.

Does drought increase intimate partner violence? Evidence from India

India has a high prevalence of intimate partner violence (IPV) against women. IPV has been observed to increase during natural disasters. Many studies have attempted to unravel the effect of drought on IPV; however, the evidence remains mixed. There is a gap in such studies in the Indian context, and this study seeks to fill this gap. We used data from the National Family Health Survey-4 (NFHS-4) (2015 – 2016) and NFHS-5 (2019 – 2021) to examine the effect of drought caused by the failure of the northeastern monsoon (NEM) in 2016 – 2018. Our analysis included data from 19 states and Union Territories of India (N = 34,590) in a difference-in-differences setup to evaluate the effect of the NEM drought on IPV. Exposure to the NEM drought was positively associated with physical violence (PV) and emotional violence, with results significant at the 95% and 99% confidence levels, respectively. A subsample analysis of rural and urban populations revealed that drought is significantly associated with an increase in sexual violence in urban areas, whereas it correlates with PV in rural areas. Additionally, exposure to drought is linked to a considerable rise in the controlling behavior of partners, for example, “He (is/was) jealous or angry if you (talk/talked) to other men,” “he (does/did) not permit you to meet your female friends).” These findings call for a two-fold policy action: providing support in the form of wage employment programs, subsidies, and other financial assistance during drought periods to help households cope with financial stress and implementing awareness programs aimed at changing partners’ mindsets, thereby reducing controlling behaviors in marriages.

An assessment of adequate quality antenatal care and its determinants in India

BackgroundAntenatal care (ANC) is an important component in the continuum of care. Providing adequate quality ANC is necessary to prevent maternal and newborn mortality. The coverage of ANC has increased significantly in the last decade in India, but a mere increase in coverage is insufficient if the issue of quality is not simultaneously addressed. This study examines the change in each component of quality ANC between 2015-16 and 2019-21, highlights the factors associated with adequate quality ANC, and observes the state- and district-level distribution of adequate quality ANC during 2019-21.MethodsThis study is based on data from the two most recent rounds of the National Family Health Survey (NFHS), the Indian equivalent of the Demographic and Health Surveys (DHS). These rounds were conducted in 2015-16 and 2019-21 in selected households of India with a total of 190,797 and 176,843 sampled births, respectively. The dependent variable was quality antenatal care, a composite variable consisting of skilled healthcare providers, timeliness, sufficiency, and appropriateness of content. The independent variables were mother’s age, education, wealth quintile, birth order, mass media exposure, health insurance coverage, relationship with the head of household, facility exposure, intended pregnancy, history of adverse pregnancy outcomes, and other socio-demographic variables. Change in each component and dimension of quality antenatal care was assessed using data from both rounds of the survey. A multivariate multinomial logistic regression analysis was employed to identify the determinants of adequate quality ANC using the NFHS-5 data.ResultsThe findings revealed that 32 per cent of mothers received adequate quality antenatal care in 2019–2021, an increase of only 9% points compared to the 2015-16 period. Two significant barriers to achieving adequate quality antenatal care, in terms of appropriateness of content, were the provision of Iron and Folic Acid (IFA) tablets and counselling. The highest utilisation of adequate quality antenatal care was observed in the southern states. The utilisation of quality ANC increased with an increase in women’s education and wealth status; and was more prevalent among those with health insurance coverage and exposure to mass media.ConclusionDespite some improvements in the coverage of antenatal care, the quality of antenatal care continues to be very low and needs urgent attention. Achieving quality antenatal care in both content and experience requires addressing service gaps and developing better measures to capture and improve women’s care experiences.

Trend and determinants of tobacco use among Indian males over a 22-year period (1998-2021) using nationally representative data.

Tobacco consumption is associated with an increased risk of morbidity and mortality. India is one of the largest consumers of tobacco worldwide. We assessed the trend of tobacco use among Indian males over a period of 20 years using data obtained from four rounds of the National Family Health Survey (NFHS). Data on tobacco usage and relevant socioeconomic variables obtained from NFHS rounds 2 to 5 over the period 1998-2021, was used for analysis. Specifically, data were available for 138,951 males from NFHS-2, 74,369 males from NFHS-3, 112,222 males from NFHS-4, and 101,839 males from NFHS-5. Significance of association between various socio-economic factors and tobacco usage was ascertained using a multicategory logistic regression model. Among all the forms of tobacco, smokeless tobacco was predominantly used by Indian males. The proportion of smokers and those using both smoke and smokeless forms peaked during NFHS-3, followed by a consistent dip; however, the use of smokeless tobacco plateaued from NFHS-4 to NFHS-5. NFHS-5 shows that 19.2% of Indian males smoked, 27.0% used smokeless tobacco, and 6.3% used both. Tobacco use has declined significantly over the last two decades. Tobacco usage is noticeably higher among the elderly, Muslims, and those from the backward classes, while it was considerably lower for individuals belonging to the educated and wealthier segment. There has been a steady decline in tobacco use in India over the past 22 years, specifically in the smoke-form category. However, smokeless tobacco use remains nearly unaffected. The outcome of this study might aid policymakers in devising targeted tobacco control policies and improving existing ones.

The nexus between maternal antenatal care attendance, newborn postnatal care and neonatal mortality in India: a matched case-control study

IntroductionOur study examines the relationship between newborn postnatal care and neonatal mortality stratified by maternal antenatal care attendance under a matched case-control framework.MethodsData from the fifth round of the National Family Health Survey was used. A total of 172,079 recent births to eligible women (15–49 years) in five years preceding the survey were included in the study. We used the conditional logistic regression model, a commonly used regression model to fit matched case-control data to examine the effects of newborn postnatal care on neonatal mortality. The mother’s age at birth of the newborn, previous birth intervals, birth order of the newborn, and birthsize of the newborn were included as the matching variables.ResultsNewborns receiving postnatal care within two days or more than two days of birth are less likely to die during the neonatal period. Preferences for newborn postnatal care were also observed to increase with more maternal antenatal care visits. Our study also found a lower risk of neonatal mortality among those newborns whose umbilical cord was examined within two days of birth, regardless of the number of maternal antenatal care visits. Similarly, the risk of newborn deaths was lower among babies whose body temperature was measured within two days of birth. The tendency to breastfeed their newborns within an hour after delivery was considerably higher among those births that occurred to mothers who had a higher number of maternal antenatal care visits. The risk of newborn deaths was also observed to be lower among those born in public or private healthcare facilities.ConclusionConsidering the cohesive nature of the relationship between neonatal mortality and maternal and child healthcare utilisation, strategic planning and management of the existing policies and programmes related to accessibility, availability, and affordability of maternal and child healthcare services is needed to achieve goal 3.2 of the Sustainable Development Goals. Promoting cost-effective measures such as continuous monitoring of the baby’s body temperature and umbilical cord care could also effectively help reduce neonatal mortality.

Self-reported prevalence of tuberculosis: unveiling spatial representation in the districts of Tamil Nadu.

The objective of the current study was to estimate the self-reported individual-level crude prevalence and cluster-level adjusted prevalence of TB for the districts of Tamil Nadu and to understand the spatial distribution of TB cases through spatial autocorrelation and hotspot analysis. National Family Health Survey (NFHS) data, gathered during 2014-2015 (NFHS-4) and 2019-2021 (NFHS-5), were used in the current study to estimate district-wise, individual-level crude and cluster-level adjusted TB prevalence per 100 000 population in Tamil Nadu. This was illustrated with the help of spatial geographic representation for various districts of Tamil Nadu using SPSS and QGIS software. The spatial autocorrelation and hotspot analysis were performed using Geoda software. The overall self-reported individual-level crude prevalence of TB was 337 (95% CI 302 to 375) and 169 (95% CI 144 to 197) per 100 000 population, whereas the cluster-level adjusted prevalence of TB was 356 (95% CI 311 to 405) and 184 (95% CI 154 to 219) per 100 000 population in NFHS-4 and NFHS-5, respectively. This study highlights those geographical areas with high rates of TB prevalence. This information would be useful for the state and district programme managers to identify areas of high TB prevalence where interventions can be focused.

Trends in the quality of antenatal care in India: Patterns of change across 36 states and union territories, 1999-2021.

Antenatal care (ANC) quality is important to maternal and neonatal mortality. However, trends in the quality of ANC received by pregnant women in India have been understudied. This paper seeks to fill this gap by examining the long-term patterns nationwide and the state-specific prevalence of inadequate ANC quality received by pregnant women in India. We utilised data from four National Family Health Surveys (NFHS) conducted in 1999 (NFHS-2), 2006 (NFHS-3), 2016 (NFHS-4), and 2021 (NFHS-5) across India's 36 states/union territories (UTs). The sample includes mothers who had given birth within three years (NFHS-2) and five years (NFHS-3, NHFS-4, and NFHS-5) before each survey. We define inadequate ANC quality as not completing seven essential ANC services (weight measurement, blood pressure measurement, urine sampling, blood sampling, provision of iron supplements, provision of tetanus vaccination, and ultrasound scans) during pregnancy. We calculated the standardised absolute change to quantify the change in the share of women receiving inadequate quality ANC nationally and by each state/UT. Additionally, we estimated the population headcount of mothers who received inadequate-quality ANC in 2021 and identified the socioeconomic correlates associated with inadequate ANC quality. The prevalence of inadequate ANC quality substantially declined between 1999-2021, from 84.8% (95% confidence interval (CI) = 84.1-85.5) to 28.8% (95% CI = 28.5-29.2). However, between-state inequality in ANC quality has increased over this time. We identified a weak correlation between prevalence and population headcounts in 2021. Socioeconomically disadvantaged groups exhibited a higher prevalence of inadequate quality of ANC than less disadvantaged groups. The proportion of pregnant women receiving inadequate ANC quality has decreased over time throughout India. However, multi-faceted efforts at national and state levels are necessary to enhance the effectiveness of existing policies. Additionally, innovative and targeted approaches are required to ensure the timely and equitable provision of high-quality ANC.

Distribution and determinants of early marriage and motherhood: a multilevel and geospatial analysis of 707 districts in India

BackgroundEarly marriage and motherhood have long been prevalent in India, with 44.5% of women aged 20–24 reporting marriage before 18 in NFHS 3 (2005–2006), dropping to 26.8% in NFHS 4 (2015–2016). Early motherhood has also seen a significant decline, with first births by age 18 decreasing from 34.3% in NFHS I to 8.2% in NFHS V. Despite these improvements, significant regional disparities persist due to social, normative, and legal factors. This study investigates the spatial heterogeneity of early marriage and motherhood across Indian districts, offering a multilevel analysis that reveals critical local variations often obscured at broader levels. Understanding these patterns is crucial for targeted policy interventions and addressing the root causes of early marriage and motherhood.MethodsUtilizing data from the fifth round of National Family Health Survey, this study employs multilevel logistic regression and geospatial analysis to assess the determinants and spatial distribution of early marriage and early motherhood among ever-married women in India. The analysis incorporates individual, household, and community-level variables, complemented by spatial analysis techniques, including Empirical Bayes Bivariate Moran’s I values and LISA cluster maps, to identify regional patterns and hotspots.ResultsThis study revealed that educational attainment emerged as a critical determinant, with uneducated women significantly more likely to marry early. Socioeconomic factors, such as poverty and limited mass media exposure, also heightened the risk of early marriage and motherhood. Caste and religion were significantly associated with these events, with marginalized groups facing higher prevalence. Spatial analysis revealed significant geographic disparities, with central and eastern regions showing higher concentrations of early marriage and motherhood. District-level characteristics and the influence of neighboring districts were also significant, highlighting the importance of localized interventions.ConclusionsThe findings underscore the critical role of education, economic empowerment, and media literacy in mitigating early marriage and motherhood risks. The study calls for multi-sectoral interventions in geographical hotspots to break the cycle of early family formation and promote reproductive health. Policies enhancing educational opportunities, addressing economic disadvantages, and considering district-specific factors are essential. Comprehensive strategies are necessary to empower women, foster reproductive health, and address the multifaceted nature of early marriage and motherhood in India.

Reproductive Health Status in India: Comparison of NFHS-IV and NFHS-V Findings

Background This study investigates the disparities in reproductive health and the underlying causes in various Indian states. Based on a large-scale population-based, nationally representative data set, this study aims to track the changes between National Family Health Survey (NFHS)-IV and NFHS-V in the status of reproductive health and examine the factors contributing to it in various regions of India for women aged 15–49 years in 29 states (NFHS-IV and V). Methods According to claims, in India’s states’ reproductive health status is gauged by the reproductive health index (RHI). The total fertility rate, infant mortality rate, childbirth order, mother-and-child delivery care and female educational attainment rate are the five variables that make up this composite index. Results In NFHS-IV, India’s RHI score was 61.5, and in NFHS-V, it was 67.8. Although there has been progress in RHI, it has not been at the level that was anticipated. Eleven NFHS-IV states and eight NFHS-V states have index values below India’s RHI threshold. Conclusion To move the situation forward, desires for using contraception should be given more weight. The level of educational achievement of women should also be raised, as should their passionate participation in economic activity.

Correction: Small area variations in four measures of poverty among Indian households: econometric analysis of National Family Health Survey 2019–2021

Correction: Small area variations in four measures of poverty among Indian households: econometric analysis of National Family Health Survey 2019–2021

Trends and predictors of severe and moderate anaemia among children aged 6–59 months in India: an analysis of three rounds of National Family Health Survey (NFHS) data

BackgroundChildhood anaemia remains a significant public health problem in India, as it adversely affects child development and overall health outcomes. This study aimed to analyse the prevalence of severe and moderate anaemia among children aged 6–59 months and identify consistent predictors of this condition over the past 15 years.MethodsData from the three most recent rounds of the NFHS were used for this analysis. The final weighted sample included 40,331 children from the NFHS-3 (2005–2006), 200,093 from the NFHS-4 (2015–2016), and 178,909 from the NFHS-5 (2019–2021). Descriptive and bivariate analyses were conducted, followed by binary logistic regression to identify factors associated with severe and moderate anaemia in children aged 6–59 months. All statistical analyses were performed using Stata version 14.ResultsOver the past 15 years, the prevalence of severe and moderate anaemia among children in India has shown a slight decline. However, the influence of various predictors has changed over time. Young children (aged 6–23 months), those from Scheduled Caste (SC) and Scheduled Tribe (ST) communities, and children born to mothers with high parity and low educational attainment remain particularly vulnerable to anaemia. Additionally, short-term illness significantly increases the risk of anaemia. Furthermore, women’s autonomy, indicated by higher education and lower fertility rates, along with maternal nutrition education, have emerged as key factors in reducing anaemia burden in the future. Notably, children whose mothers had no education were 1.4 times more likely to suffer from severe or moderate anaemia. Similarly, children born to mothers with four to five children (OR 1.1, p < 0.05) and those with six or more children (OR 1.2, p < 0.05) had an elevated risk of anaemia.ConclusionThe findings highlight three key areas for programmatic focus to accelerate anaemia reduction in India: [1] targeting young children (aged 6–23 months); [2] ensuring the inclusion of SC and ST communities in all relevant interventions; and [3] promoting women’s autonomy. These strategies are essential for reducing the burden of anaemia across the country.

Patterns of change in the association between socioeconomic status and body mass index distribution in India, 1999-2021.

Body mass index (BMI) is an important indicator of human health. However, trends in socioeconomic inequalities in BMI over time throughout India are understudied. Filling this gap will elucidate which socioeconomic groups are still at risk for adverse BMI values. This repeated cross-sectional study analysed four rounds of India's National Family Health Surveys (1998-1999, 2005-2006, 2015-2016, and 2019-2021). The outcome was BMI categories, measured in kilogram per metres squared (kg/m2), defined as severely/moderately thin (<17.0 kg/m2), mildly thin (17.0-18.4 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). We examined the prevalence, standardised absolute change, and odds ratios estimated by multivariable regression models by household wealth and levels of education, two important measures of socioeconomic status (SES). The study population consisted of 1 244 149 women and 227 585 men. We found that those in the lowest SES categories were more likely to be severely/moderately thin or mildly thin. Conversely, those in the highest SES groups were more likely to be overweight or obese. The gradients were steepest for wealth, and this was substantiated by the results of regression models for every wave. There has been a decline in the difference in the prevalence of severely/moderately thin or mildly thin between SES groups when comparing the years 1999 and 2021. SES-based inequalities in BMI were smaller in 2021 compared to 1999. However, those in low SES groups were most likely to be severely/moderately thin or mildly thin while those in high SES groups were more likely to be overweight or obese. Future research should explore the pathways that link SES with BMI.

Age at marriage and its determinants in Kerala and Bihar

BackgroundMarriage is a significant milestone in one’s life, and the age at which individuals choose to get married can have various implications. By examining the age at marriage and its determinants in different regions, such as Kerala and Bihar, we can gain insights into Socio-demographic factors that influence this decision.MethodsThe National Family Health Survey (2019–2021) data was used. A total of 41,392 ever married women from Kerala (8, 579) and Bihar (32,813) were analysed using bivariate and multiple binary logistic regression approaches to meet the study aim.ResultThe significant association was found between explanatory factors and age at first marriage in Karala and Bihar. In Bihar, educated women from the poorest families had a higher rate of early marriages. Conversely, in Kerala, uneducated women from non-majority religions and larger households (more than 6 members) were more likely to be married before18. After accounting major effects of background characteristics, the adjusted odds ratio showed that In Kerala Muslim religion women have significantly higher odds of getting married before 18 (OR: 3.09, CI 2.67–3.57) then the Hindu women whereas in Bihar Muslim religion women has the significantly lower chance of getting married before turning 18 (OR: 0.87, CI 0.81–0.93) compared to Hindu. In both the states Kerala and Bihar General social group women had the significantly lower odds of getting married below 18 (OR: 0.73, CI 0.57–0.93 and OR: 0.88, CI 0.81–0.96) with respect to SC/ST social group women’s.ConclusionWomen in Bihar usually marry in younger age due to socioeconomic and traditional reasons, whereas in Kerala reverse is true, because of a greater emphasis on education and a more progressive social outlook. These regional variations reflect different cultural norms and socioeconomic environments, shape different marriage age patterns between the two regions.

Hysterectomy across Different Occupational Groups of Women in India: A Cross-sectional Study

Abstract Aims and Objective: The paper aims to examine the prevalence of hysterectomy amongst 451,853 women aged 25–49 years by different occupation groups in India and seek to identify associated factors. It is a cross-sectional study using bivariate and multivariate analyses. Materials and Methods: Data available in the public domain from the fourth round of the National Family Health Survey, conducted pan-India including both rural and urban areas during 2015–2016 by the Ministry of Health and Family Welfare, Government of India, are used. Descriptive statistical analyses were performed to investigate hysterectomy prevalence across various states and union territories and other independent variables in India. Further, two binary logistic regression models were run to examine the determinants of hysterectomy where the dependent variable had undergone hysterectomy and not undergone hysterectomy. Results: The result revealed that about five in every 100 Indian women had undergone hysterectomy. Excessive menstrual bleeding was the most common underlying condition for undergoing hysterectomy amongst all occupation groups. The prevalence was found to be the highest amongst agricultural women workers who are 32% (odds ratio = 1.320; confidence interval: 1.209–1.440) significantly more likely to undergo hysterectomy compared to other occupation groups. Conclusion: These results raise questions about poor access to quality healthcare services particularly for sexual and reproductive health amongst women working in the agricultural sector.

COVID‐19 Pandemic and Women's Age at Marriage: New Evidence From India

AbstractA rich literature has documented the relationship between age at marriage and girls’ health and educational outcomes. The upheaval caused by the pandemic on household decision‐making has been hypothesized to have influenced the age of marriage, but the direction of impact is unclear. On the one hand, the pandemic may have increased the age at marriage if lockdown policies and negative income shocks to families placed a burden on household wealth and the ability to pay for weddings. On the other hand, the age of marriage could have decreased during the pandemic due to school closures that kept girls out of school, parental deaths that encouraged families to expedite weddings, and lower wedding costs because of government mandates to have smaller weddings. Using data from the National Family Health Survey of 2019–2021 of India, we explore how the pandemic impacted age at marriage for women using district and household fixed effects models. After accounting for secular trends in the age of marriage and contingent on the model and specification, we find a significant increase in age at marriage for women who got married during the pandemic by 1.1–1.2 years as compared with those married before the pandemic.

Early marriage and childbearing among Bengali women in India: Exploring the role of culture

One&amp;rsquo;s culture influences age at marriage, rules of mate selection, and fertility preferences. Language, as a component of culture, also influences culture itself. Therefore, language, as an indicator of cultural identity, is a significant, yet understudied social determinant of health in health-care settings. This study analyzes the role of cultural norms, measured through language, in early marriage and childbearing among Bengali speakers in India. Descriptive, bivariate, and multivariate analyses were conducted for 51,069 women aged 15 &amp;ndash; 49 years from three Indian states (Assam, Tripura, and West Bengal) using data from the fifth round of the National Family Health Survey (2019 &amp;ndash; 2021). Stata was used for the analyses, with p &lt; 5% considered significant. Among these women, 46% were married before the age of 18, 34% were married before 18 and began childbearing before 19, and 55% were native Bengali speakers. After controlling for predictors, Bengali-speaking women were significantly more likely to marry before the age of 18 (odds ratio [OR]: 1.72, 95% confidence interval [CI]: 1.66 &amp;ndash; 1.79) and marrying and having their first child before the age of 19 (OR: 1.55, CI: 1.49 &amp;ndash; 1.62) compared with their non-Bengali-speaking counterparts. Thus, Bengali culture appears to be associated with early marriage and motherhood. To address this, a multi-pronged strategy involving social and behavioral change communication, targeted programs delivered by grassroots health workers, and school-based campaigns that emphasize the adverse effects of early marriage and childbearing may help reduce these practices in states with significant Bengali-speaking populations.