Abortion care-seeking and reproductive rights violation in health facilities: evidence from six states of India

Background: Unsafe abortion continues to draw the researcher's attention due to its close association with maternal morbidity and mortality. Empirical evidence on the role of health facilities in providing safe abortion care addressing the reproductive rights of Indian women is limited.Methods: Using data from the 2015 ‘unintended pregnancy and abortion in India’ study, the present paper aimed to understand the violation of the reproductive rights of abortion care seekers in health facilities (n=4001) in six states of India. The health facilities were sampled using a stratified random sampling strategy. Univariate and bivariate analysis was carried out using SPSS (V 25) on cleaned and weighted data.Results: A sizeable percentage of public and private health facilities across states found seeking the consent of the husband or family members before abortion provision, compel women to adopt contraception and turn away abortion seekers, commonly citing non-medical reasons. The provision of post-abortion complications services is usually not 24/7, even at the primary health centre level, hindering access to an urgent health care need.Conclusions: There is a need to improve access to facility-based abortion services, especially in underserved rural areas, by ensuring that all public-sector facilities have adequate equipment and supplies, including MMA drugs and trained providers. Sensitization of health care providers about the importance of ethical issues and women’s reproductive rights is urgently required to ensure safe, legal, and accessible abortion care

Does Education Leads to Contraceptive Use? A Study of Sexually Experienced Unmarried Men in India

The consequences of pre-marital sex have been the subject of common concern for the public health professionals and policy makers. In India, despite strict societal sanctions, the prevalence of pre-marital sex has been repeatedly documented across literatures. It is believed that existing education system could afford the responsibility to develop protective sexual behavior among unmarried youths. Using National Family Health Survey (2005-06) data, this study examines the effect of education on contraceptive and condom use among sexually experienced unmarried men. Results indicate that education has a positive effect on contraceptive as well as condom use. However the interaction effect of education and awareness on contraceptive and condom use provides the key explanations for safe sexual practices. The findings could help policy makers to focus on both education and awareness which might lead to improvement in safe sexual practices in India where introducing sex education is still a controversial issue. Keywords: Education, awareness, unmarried men, contraceptive and condom use, Indi

What Explains Child Malnutrition of Indigenous People of Northeast India?

Household risk factors affecting child health, particularly malnutrition, are mainly basic amenities like drinking water, toilet facility, housing and fuel used for cooking. This paper considered the collective impact of basic amenities measured by an index specially constructed as the contextual factor of child malnutrition. The contextual factor operates at both the macro and micro levels namely the state level and the household level. The importance of local contextual factors is especially important when studying the nutritional status of children of indigenous people living in remote and inaccessible regions. This study has shown the contextual factors as potential factors of malnutrition among children in northeast India, which is home to the largest number of tribes in the country. In terms of macro level contextual factor it has been found that 8.9 per cent, 3.7 per cent and 3.6 per cent of children in high, medium and low risk households respectively, are severely wasted. Lower micro level household health risks, literate household heads, and scheduled tribe households have a negating effect on child malnutrition. Children who received colostrum feeding at the time of birth and those who were vaccinated against measles are also less subject to wasting compared to other children, and these differences are statistically significant

Survival among children under-five in India: a parametric multilevel survival approach

Abstract Background Many studies have been conducted on under-five mortality in India and most of them focused on the associations between individual-level factors and under-five mortality risks. On the contrary, only a scarce number of literatures talked about contextual level effect on under-five mortality. Hence, it is very important to have thorough study of under-five mortality at various levels. This can be done by applying multilevel analysis, a method that assesses both fixed and random effects in a single model. The multilevel analysis allows extracting the influence of individual and community characteristics on under-five mortality. Hence, this study would contribute substantially in understanding the under-five mortality from a different perspective. Method The study used data from the Demographic and Health Survey (DHS) acquired in India, i.e., the fourth round of National Family and Health Survey (2015–16). It is a nationally representative repeated cross-sectional data. Multilevel Parametric Survival Model (MPSM) was employed to assess the influence of contextual correlates on the outcome. The assumption behind this study is that ‘individuals’ (i.e., level-1) are nested within ‘districts’ (i.e., level-2), and districts are enclosed within ‘states’ (i.e., level-3). This suggests that people have varying health conditions, residing in dissimilar communities with different characteristics. Results Highest under-five mortality i.e., 3.85% are happening among those women whose birth interval is less than two years. In case of parity, around 4% under-five mortality is among women with Third and above order parity. Further, findings from the full model is that ICC values of 1.17 and 0.65% are the correlation of the likelihood of having under-five mortality risk among people residing in the state and district communities, respectively. Besides, the risk of dying was increased alarmingly in the first year of life and slowly to aged 3 years and then it remains steady. Conclusion This study has revealed that both aspects viz. individual and contextual effect of the community are necessary to address the importance variations in under-five mortality in India. In order to ensure substantial reduction in under-five mortality, findings of the study support some policy initiatives that involves the need to think beyond individual level effects and considering contextual characteristics

Prevalence of severe wasting of children 0–59 months by Macro Amenities Index (MAI) in Northeast India.

<p>Source: Based on authors computation from Census 2001–2011 and NFHS-3 (2005–06)</p

Determinants of Maternity Care Services Utilization among Married Adolescents in Rural India

Background: Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed. Methodology/Principal Findings: Using the data from third wave of National Family Health Survey (2005–06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15–19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally

Profiles and demographic characteristics of states in northeast India.

<p><i>Sources</i>: 1- Census of India, 2011, 2- Sample Registration System, 2011</p><p>Profiles and demographic characteristics of states in northeast India.</p

Effect of maternal healthcare utilization on early neonatal, neonatal and post-neonatal mortality in India

This paper examines the effect of maternal healthcare utilization on early neonatal, neonatal and post-neonatal mortality in India using the recent round of National Family Health Survey (NFHS-4) data. At the national level, for the last live birth of women during the five year preceding the survey, the early neonatal mortality rate was about 16, neonatal mortality rate was 19 and post-neonatal mortality was 7 per thousand live births. Also, only one-fifth of women who had a birth in the past five years received full antenatal care (ANC), 83 percent women received safe delivery and 65 percent women received post-natal care. Findings of the study indicate that full ANC and postnatal care were significantly associated with early neonatal and neonatal mortality. However, no significant association between safe delivery and newborn mortality were found after adjusting the socio-economic and demographic characteristics. Therefore, for a policy point of view, there is a dire need to strengthen supply dependent factors regarding public awareness, accessibility, and affordability of maternal and child healthcare services. It is also necessary to focus on increasing utilization along with continuum of care of maternal and child healthcare services to sustain the reduction in mortality during infancy