National Family Health Survey Research Articles

Geographical health inequalities in India: the impact of the COVID-19 pandemic on healthcare access and healthcare inequality.

With an emphasis on spatial health disparities, this study examines how COVID-19 has affected healthcare access and inequality in India. The study developed the Healthcare Access Index (HAI) and Healthcare Inequality Index (HII) to assess the pandemic's effects on healthcare. The study addresses spatial health disparities in healthcare access and inequality, filling gaps in the literature. The final aim of the study is to offer policy suggestions to lessen healthcare inequities in India, particularly in the context of COVID-19. The study incorporates secondary data from publicly accessible databases such as the National Family Health Survey, Niti-Ayog and Indian Census databases and employs a quantitative research design. The impact of the COVID-19 pandemic on healthcare access and healthcare inequality in India is examined using the HAI and the HII. The five dimensions of healthcare access - availability, accessibility, accommodation, cost and acceptability - were used in developing the HAI. The study uses a panel data analysis methodology to examine the HAI and HII scores for 19 states over the pre-COVID-19 (2015) and post-COVID-19 (2020) periods. In order to investigate the connection between healthcare access, healthcare inequality and the COVID-19 pandemic, the analysis employs statistical tests such as descriptive statistics, correlation analysis, factor analysis and visualization analysis. According to the study, COVID-19 impacted healthcare access and inequality in India, with notable regional inequalities between states. The pandemic has increased healthcare disparities by widening the gap between states with high and low HII ratings. Healthcare access is closely tied to healthcare inequality, with lower levels of access being associated with more significant levels of inequality. The report advises governmental initiatives to lessen healthcare disparities in India, such as raising healthcare spending, strengthening healthcare services in underperforming states and enhancing healthcare infrastructure. For Indian healthcare authorities and practitioners, the study has significant ramifications. In light of the COVID-19 pandemic, there has been a main focus on addressing geographic gaps in healthcare access and inequality. The report suggests upgrading transportation infrastructure, lowering out-of-pocket costs, increasing health insurance coverage and enhancing healthcare infrastructure and services in underperforming states. The HAI and the HII are tools that policymakers can use to identify states needing immediate attention and appropriately spend resources. These doable recommendations provide a framework for lowering healthcare disparities in India and enhancing healthcare outcomes for all communities. The study's originality resides in establishing the HAI and HII indices, using panel data analysis and assessing healthcare inequality regarding geographic disparities. Policy choices targeted at lowering healthcare disparities and enhancing healthcare outcomes for all people in India can be informed by the study's practical consequences.

Spatial Clustering of Pregnancy Wastage and its Determinants in Manipur: Evidence from National Family Health Surveys

Spatial Clustering of Pregnancy Wastage and its Determinants in Manipur: Evidence from National Family Health Surveys

Nutritional Status and Anemia among Scheduled Caste Adolescent Girls of District Yamunanagar, Haryana, India

Background: During adolescence, nutrition is crucial for physical and cognitive development, yet socio-economic disparities and nutritional deficiencies, especially in girls, lead to health vulnerabilities, including high anemia rates. Despite recent data from the National Family Health Survey, there is limited information on adolescents aged 11-16 years, requiring targeted research. This cross-sectional study aims to assess the nutritional status, determine the prevalence of anemia, and explore associated factors among adolescent girls of the scheduled caste in District Yamunanagar, Haryana, India. Methods: The study sampled 450 scheduled caste girls aged 11-16 years from schools in District Yamunanagar, Haryana. Height and weight were measured to calculate Body Mass Index (BMI). Data on micro-environmental factors, socio-economic and demographic variables, and dietary habits were collected through interview-based schedule. Hemoglobin levels were measured using Sahli’s Acid Haematin technique, and nutritional status was assessed using the World Health Organization (WHO) standards (Z-score method). Results: The study found increases in height, weight, and BMI with age, with notable spurts at 12-13 years for height and 11-12 years for weight and BMI. Significant differences in height, weight, and BMI were observed between age groups. Moreover, 92.2% girls were found to be anemic, with most of them suffering from moderate anemia. Additionally, the prevalence of stunting was 67.33% and wasting was 64.90% among the girls. Household size, number of family members and menarcheal status of the girls showed a significant association with the nutritional status and anemic of the girls. Conclusion: The study emphasizes the need of regular screening and timely interventions to improve the nutritional and anemic status of adolescent girls.

Poverty induced inequality in nutrition among children born during 2010-2021 in India.

Almost two-fifth of the children in India is stunted and among various factors, poverty differential in child undernutrition is the largest. Using the latest population-based survey of National Family Health Survey, 2015-16 and 2019-21 this paper examined the poverty induced inequality in child stunting across the sub-populations of India. A sample of 213,136 children aged between 0-5 years from NFHS fourth round and 98,222 children in the same age group from the NFHS fifth round constitute the study sample. The wealth index is used as the proxy of household's economic wellbeing and height-for-age (HAZ) z-score of a child is used to identify the stunting status of the child. Box plots are drawn to understand the distributional characteristics of the HAZ score for both the study sample. We calculate the Erreygers corrected concentration index and decomposed the concentration indices using Gonzalo-Almorox and Urbanos-Garrido method. During 2015-16, more than half of the children from the poorest wealth quintile were stunted (52%), compared to 22% among the children from richest wealth quintile. In 2015-16, stunting was as high as 65% among the children of mothers with low stature (height less than 145 cm) and from the poorest wealth quintile whereas, the prevalence was observed 56% from the same sub-population during 2019-21. Among various factors, the concentration index of stunting was observed highest among the children of 36-47 months (-0.28) followed by children of age 48-59 months (-0.27) and among the fully immunized children (-0.25). Similar to NFHS-4, NFHS-5 also shows a predominantly higher socio-economic inequality among 24+ months children and among the fully immunised children. Factors like child age, birth order and sanitation showed positive elasticity. Decomposition analysis of NFHS-4 data shows that due to uneven distribution of wealth, mother's education as a determinant of child stunting solely explained 33% of the overall inequality followed by improved access to sanitation (24%), mother's height (8%) and place of residence (5%). Similar to NFHS-4, NFHS-5 data also shows that mother's education, sanitation, mother's height and place of residence predominantly contributes to the overall wealth inequality in child stunting. In India, poverty differential in child undernutrition is acute among the different sub-population of children. And the concentration of stunted children is higher among the different sub-population with higher wealth poverty. Mother's education, improved sanitation and mother's height explained larger variation in the overall inequalities in child nutrition across India.

Solid fuel combustion and adverse pregnancy outcomes: A nationwide study on stillbirth in India

ObjectivesStillbirth is a significant public health challenge in India, accounting for a substantial portion of the global burden. Exposure to household air pollution from solid fuel combustion during pregnancy has been associated with adverse pregnancy outcomes, including stillbirth. This study aimed to investigate the association between solid fuel use and stillbirth risk in India, utilizing data from the National Family Health Survey 5 (NFHS-5). Study designNationwide cross-sectional study. MethodsThe study employed data from the NFHS-5, a nationally representative cross-sectional survey conducted in India from 2019 to 2021. The study sample consisted of 204,723 women aged 15–49 years who had a pregnancy in the past 5 years preceding the survey. Stillbirth was calculated using calendar data, providing robust estimates. Logistic regression analysis was performed to assess the relationship between solid fuel use and stillbirth, adjusting for various sociodemographic and maternal factors. ResultsThe use of unclean cooking fuels was significantly associated with an increased risk of stillbirth (OR = 1.34, 95 % CI: 1.13–1.58, p < 0.001) compared to clean fuels. Other factors associated with higher stillbirth risk included rural residence, lower maternal education, belongingness to certain social categories, delivering at private healthcare facilities, limited antenatal visits, and undergoing caesarean delivery. ConclusionsThe findings highlight the detrimental impact of solid fuel use on stillbirth rates in India, underscoring the need for targeted interventions to promote cleaner cooking technologies and address socioeconomic disparities. Efforts to transition households towards cleaner energy sources and improve access to quality maternal healthcare services are crucial for reducing the burden of stillbirth in India.

Decomposing social groups differential in stunting among children under five in India using nationally representative sample data

Stunting among children is a reflection of the chronic malnutrition caused by a complex set of behavioural, demographic, and socioeconomic factors. This long-term detrimental exposure to chronic malnutrition is disproportionately higher among social and economically deprived groups, leading to significant differentials in the prevalence of stunting across various social strata. Therefore, this study investigates the inequality of social groups in terms of the prevalence of stunting across Schedule Caste (SC)-Scheduled Tribe (ST) and non-SC-ST. The study used 1,93,886 children’s data aged 0–59 months from the recent round of the National Family Health Survey. Descriptive statistics, multivariable logistic regression, F-test, t-test and chi-squared (χ²) test were applied to understand the prevalence, determinants, and associations, respectively. The Fairlie decomposition model was applied to quantify the factors contributing to the inequality of stunting across social groups. The results revealed that the prevalence of stunting was higher among SC-ST (39.60%) children compared to non-SC-ST (33.27%). In addition, children aged 15–30 months (AOR: 1.895, 95% CI: 1.843–1.949), and male (AOR: 1.074, 95% CI: 1.053–1.095), mothers had lower BMI (AOR: 1.543, 95% CI: 1.492–1.595), mothers who had no education (AOR: 1.595, 95% CI: 11.532–1.662), belongs to poorest wealth index (AOR: 1.857, 95% CI: 1.766–1.952), and the children belong to the household with unhygienic satiation practices (AOR: 1.097, 95% CI: 1.070–1.123) were more likely to be stunted. The decomposition results revealed that the variables included in the study could explain 68.9% of the stunting inequality between SC-ST and non-SC-ST groups. The household’s wealth index is found to be a leading factor, which contributed nearly 41.3% of total stunting inequality exists between these two groups, followed by mothers’ education (12.86%) and mothers’ BMI (11.02%), sanitation facilities (4.26%), children’s birth order (3.32%) and mother’s type of delivery (1.49%). These findings emphasize the importance of targeted interventions. Prioritizing policies that address household economic enhancement, women’s education and empowerment can be instrumental in reducing social group inequality and lowering the overall prevalence of stunting. Ensuring access to improved hygienic sanitation facilities in the household is equally important for achieving better health outcomes for the children.

Factors Associated with Acute Respiratory Infection among Children Under 5 Years in India: Results from 2019 to 2021 National Family Health Survey

Factors Associated with Acute Respiratory Infection among Children Under 5 Years in India: Results from 2019 to 2021 National Family Health Survey

Expert Opinion on the Role of Sacubitril/Valsartan in the Management of Hypertension in India.

Hypertension, a key modifiable risk factor for cardiovascular diseases (CVD), significantly contributes to premature death and morbidity worldwide. Despite stabilization in age-adjusted global prevalence, the absolute number of hypertensive individuals doubled from 2000 to 2010, largely due to increases in low- and middle-income countries. In 2021, only 21% of hypertensive individuals globally had effective blood pressure (BP) control. In India, hypertension is the leading risk factor for death and disability, with prevalence rates of 24% in men and 21% in women, as reported by the 2019-2020 National Family Health Survey (NFHS-5). Alarmingly, just 25% of rural and 38% of urban hypertensive Indians are undergoing treatment, with only 10% and 20% achieving BP control, respectively. This highlights the hypertension paradox, where clinical inertia and hesitancy in intensifying BP-lowering therapy persist despite the availability of antihypertensive drugs. This expert opinion paper aims to provide a comprehensive evaluation of sacubitril/valsartan in hypertension management, leveraging insights from its approved use in heart failure and examining its benefits and challenges across diverse hypertensive populations. The formulation of this expert opinion involved employing evidence-based methodologies and utilizing all available data. The document underwent scrutiny by expert cardiologists, whose clinical experiences and examination of the evidence and guidelines informed the formation of the expert opinion. This expert opinion paper provides a thorough and informed evaluation of sacubitril/valsartan, highlighting its potential to address unmet needs in BP control, particularly in challenging cases such as resistant hypertension and chronic kidney disease.

Trend of immunization &amp; gap in vaccine doses as observed in National Family Health Survey rounds in India

Background &amp; objectives Immunization is an efficient and cost-effective way of lowering the infectious disease related morbidity and mortality in the community. The current study reviewed the trend of immunization, gaps in doses of vaccine given at the same time and gaps between the doses of same vaccine from National Family Health Survey (NFHS 1-5) rounds. Methods The current study extracted data from all five NFHS rounds conducted from 1992-93 to 2019-21. The study analyzed the State-wise and demography-wise distribution of trends of immunization from NFHS-1 to NFHS-5. State wise distribution of change in vaccination coverage between NFHS-4 and 5 was analyzed. The study also assessed the State-wise trends of fully vaccinated and unvaccinated children from NFHS 1-5. Results The northeastern States had maximum gap between the vaccination given at birth i.e., 47.3 per cent between BCG and Hepatitis B, and 32.8 per cent between BCG and birth dose of OPV in Manipur in NFHS -5. A gradual rise in the percentage of male (40.2%) and female (41.9%) childrens’ vaccination was found across the NFHS rounds with reduction in gap between the male and female vaccination from NFHS-1 (2.6%) to NFHS-5 (0.9%). The percentage of vaccination decreased proportionately with birth order. The vaccination coverage has increased in both urban and rural population, but the rise was higher in rural (45.9%) areas than urban (24.8%). An increase in percentage of fully vaccinated children by 41.2 per cent and decrease in percentage of non-vaccinated children by 26.4 per cent was observed from NFHS-1 to NFHS-5. Interpretation &amp; conclusions Our analysis clearly suggests that immunization coverage has improved over a period of time but the variability in vaccine coverage across States and gap in vaccine doses needs attention of the policy makers to cover this for achieving our national immunization goals.

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.

Consumption of Milk a Probable Risk Factor of Hypertension in India: A Study Based on National Family Health Survey-5

Introduction: Chronic high blood pressure, often known as hypertension, can cause a number of cardiovascular issues due to its higher blood pressure levels. A growing body of research points to a possible link between the use of dairy products and a higher risk of hypertension. Objectives: The present study aims to provide information regarding a probable association between dairy consumption and hypertension among the population of India. Methodology: The current study uses data from the fifth series of the National Family Health Survey (NFHS-5) 2019–21 in order to examine this association. The sample size is 724115 in total. This study included eight factors in total: systolic and diastolic blood pressure, age, religion, ethnicity, education, wealth index, and frequency of milk/curd consumption. IMB-SPSS version 26.0 was used for all data analysis. Results: It was found that those consuming milk products daily and weekly have very strong chances of having stage 1(95.3% and 93.2%, respectively in 95% CI) and stage 2 hypertension (92.4% and 90.4%, respectively in 95% CI). daily consumption of milk products also significantly increases 80.3% the chance of having stage 3 hypertension as well (95% CI). Conclusion: It is abundantly obvious from the current study that consuming milk and curd on a daily and weekly basis considerably raises your risk of developing stage 1, stage 2, and stage 3 hypertension. Given that India consumes the most milk globally and that the bulk of it is unpasteurized, it is crucial to consider the connection between milk consumption and hypertension discovered in the current study.

Women’s Empowerment and Son Preference: The Case of India

The purpose of this article is to explore the changing patterns of women’s empowerment and son preference at the Indian sub-national level. We have measured the state-level degree of women’s empowerment and son preference for two different periods, that is, 2015–2016 and 2019–2020 using the fourth and fifth rounds state-level National Family Health Survey data. The sample of the study consists of women who can potentially have son preference. The study has examined whether the mean level of women’s empowerment and son preference has changed significantly between the two concerned time periods. The categorisation and cluster analysis of the states is done based on the degree of women’s empowerment and son preference. To explore the degree of association between son preference and women’s empowerment and its indicators, a correlation matrix is formed. No significant increase in the mean level of son preference is found whereas the average value of the degree of women’s empowerment increased significantly in 2019–2020 compared to 2015–2016. Further, the states categorised as having comparatively strong women’s empowerment do not necessarily have a comparatively low level of son preference. No significant association between women’s empowerment and son preference is explored through the correlation matrix as well. Thus, the study leads to the conclusion that son preference in India has no significant association with women’s empowerment.

Anaemia among lactating adolescents (15–19 years) in India: a repeated cross-sectional analysis of the NFHS data (2005–2021)

BackgroundAnaemia continues to be a pressing public health concern in India. Despite the high burden of anaemia among lactating adolescents in the country, research addressing this concern among this population remains scarce. Hence, this study attempted to examine the prevalence and determinants of anaemia among lactating adolescents in India.MethodsWe used data from three latest rounds of the National Family Health Survey (NFHS) carried out in 2005-06, 2015-16, and 2019-21 and analysed a pooled sample of 10,689 lactating adolescents aged 15–19 years from these three rounds. Bivariate statistics was used to analyse the prevalence of anaemia according to the background characteristics of lactating adolescents. Further, binary multivariate logistic regression was carried out to examine the factors associated with anaemia in the study population.ResultsThree in every five lactating adolescents from the pooled sample were found to have anaemia (66.98% in NFHS-3, 61.08% in NFHS-4 and 66.27% in NFHS-5). Lactating adolescents with a higher education had a 30% lower likelihood [adjusted odds ratio (AOR): 0.70, 95% CI: 0.49–1.01, p = 0.050] of being anaemic compared to those with no education. The likelihood of being anaemic among the poorest quintile was 41% (AOR: 1.41, 1.12-1.77; p = 0.003) higher than those from the richest quintile. Lactating adolescents from the Scheduled Tribe category had higher odds (AOR: 1.29, 95% CI: 1.01–1.46, p = 0.001) of anaemia than those categorised as ‘Others’. Those living in rural areas were 22% more likely to suffer from anaemia (AOR: 1.22, 95% CI: 1.00-1.26, p = 0.050) compared to their urban counterparts. Additionally, underweight lactating adolescents were 15% more likely (AOR: 1.15, 95% CI: 1.05–1.26, p = 0.002) to be anaemic than those with normal BMI. Odds of being anaemic were higher among the ones receiving supplementary nutrition during pregnancy (AOR: 1.18, 95% CI: 1.08–1.29, p < 0.001) in contrast to those not receiving.ConclusionThe consistently high prevalence of anemia among lactating adolescents, especially among those with lower education level, rural residence, underweight status, and belonging to ST category and poorest quintile, underscore the urgent need for targeted public health interventions to address and reduce anemia in this population.

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.

Association between child marriage and high blood glucose level in women: A birth cohort analysis

ObjectivesChild marriage prematurely forces girls (<18 years of age) to perform adult roles prior to physical and psychological maturity. Such precocious transitions to young adulthood can have consequences on their long-term health, however, limited work has examined such relationships to date. As such, this study examines whether child marriage is associated with the risk of having hyperglycemia, or high blood glucose, in adulthood. Study designObservational study using repeated cross-sectional data. MethodsUsing data from the 2015-16 and 2019-21 waves of the India National Family Health Survey, we matched 432,080 and 418,409 women, aged 20–49 years, by birth year and month to create birth cohorts. Fitting multivariable binomial and multinomial logistic models, we compared the odds of having hyperglycemia across groups by marriage age (i.e., before or after age 18 years) within respective birth cohorts. ResultsWe found that the adjusted odds of having high blood glucose among women married as children were 1.12 (95 % CI: 1.07–1.16) times that of their peers married as adults in the full-sample. The adjusted relative risks of having blood glucose levels higher than normal but lower than diabetic and diabetic ranges were 1.09 (95 % CI: 1.04–1.14) and 1.23 (95 % CI: 1.15–1.31), respectively, in comparison to blood glucose within normal range. These results were persistent across sub-groups of different birth cohorts. ConclusionOur findings suggest that child marriage was associated with higher risk of having high blood glucose in women, later in life.

Domestic Violence in India- Issues and Challenges

Domestic violence is violence or abusive behaviour which is used by one partner to control another partner in any relationship. Domestic violence can be physical, sexual, emotional, and psychological or any pattern. For example, it may take the form of sexual assault psychological abuse or verbal abuse to anyone. It affects people of all socioeconomic backgrounds and education levels. Domestic violence not only affects those who are abused, but also affects family members, friends, co-workers, other witnesses, and the community at large. According to the National Family Health Survey (NFHS), 2019-2021, 29.3% of married Indian women between the ages of 18 and 49 have experienced domestic or sexual violence in India. That is only the number of cases reported by women, there are frequently many more that never make it to the police. According to NFHS data, 87% of married women are victims of marital violence. The National Commission for Women said in 2020-21, it received 26,513 complaints from women, an increase of 25.09%, compared with the 20,309 complaints registered in 2019-20. The Indian legal system has formed Section 498A of the Indian Penal Code according to the Criminal Law (Second Amendment) Act, 1983 (46 of 1983), especially for dealing with domestic violence. 498A IPC states that “Husband or relative of husband of a woman subjecting her to cruelty. —Whoever, being the husband or the relative of the husband of a woman, subjects such woman to cruelty shall be punished with imprisonment for a term which may extend to three years and shall also be liable to a fine. Sec 498A IPC is cognizable, non-compoundable and non-bail able. Even though the law provides for the security of women, there is a big loophole; a lack of awareness among the victims, most of whom do not know that they have the option to approach the law. In this paper, the researchers have tried to explore the issue and challenges for stopping domestic violence 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 &amp;ndash; 2016) and NFHS-5 (2019 &amp;ndash; 2021) to examine the effect of drought caused by the failure of the northeastern monsoon (NEM) in 2016 &amp;ndash; 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, &amp;ldquo;He (is/was) jealous or angry if you (talk/talked) to other men,&amp;rdquo; &amp;ldquo;he (does/did) not permit you to meet your female friends).&amp;rdquo; 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&amp;rsquo; 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.