Assessment of utilisation of government programmes and services by pregnant women in India.

BACKGROUND: Since the implementation of various maternal health programs, Maternal Mortality Ratio (MMR) has significantly declined in India through improvements in maternal health services. However, inequality persists at the regional and socio-economic levels. In light of this, the present study aims to assess the existing regional disparities in utilising various government initiatives for safe motherhood in India. METHODS: National-level datasets such as National Family and Health Surveys (NFHS-3 (2005-06); NFHS-4 (2015-16) and NFHS-5(2019-21); Health Management Information System (HMIS), 2019-20; Sample Registrar System (SRS), 2001-2018) were used in the study. In addition, composite Index and inequality measures (Range, Ratio, and Gini) were calculated to examine inequality. At the same time, the Pearson correlation was used to investigate the correlation between various components of maternal health services and Maternal Mortality Rate (MMR). RESULTS: The composite index score (0.65) reflects that India is still far behind the targets of the utilisation of maternal health care services. Within the utilisation of services, the Gini coefficient reveals that the least inequality was recorded in skilled birth assistance deliveries (0.03) and institutional deliveries (0.04). In contrast, the highest inequality was recorded in receiving Iron and Folic Acid (IFA) Tablets for 100 days (0.19) and four Antenatal Care (ANC) visits (0.13) among selected states. Based on the composite score for maternal health utilisation, Kerala, Tamil Nadu, Andhra Pradesh, Odisha, and Delhi were amongst the best performers, whereas Bihar, Jharkhand, Uttar Pradesh, and Assam were amongst the worst performers. CONCLUSION: This indicates that the government's single-minded focus on enhancing institutional deliveries and skilled health-assisted deliveries has detracted from other essential interventions related to maternal health. Therefore, the states with the utilisation of maternal services need to initiate immediate action to increase the ANC and Post-natal Care (PNC utilisation with more attention towards better implementation of existing ANC programmes by the government.

Coverage of iron and folic acid supplementation in India: progress under the Anemia Mukt Bharat strategy 2017-20.

High prevalence of anaemia is a severe public health problem in India. In 2018, India launched the Anemia Mukt Bharat (AMB) strategy that focuses on six beneficiary groups for coverage, six institutional mechanisms for health system strengthening and six programmatic interventions to accelerate reductions in anaemia prevalence. This paper uses the Health Management Information System data (2017-18 to 2019-20) to examine gains in IFA coverage across Indian states. A coverage-based AMB index is computed to review performance across states. After the launch of AMB strategy, the Iron and Folic Acid (IFA) supplementation coverage between 2017-18 and 2019-20 has increased for all beneficiary groups [pregnant women from 78% to 90%; lactating mothers from 34% to 49%; school going adolescent girls (boys) from 23% to 40% (21% to 42%); out-of-school adolescent girls from 6% to 23%; children 5-9 years from 8% to 3% and children 6-59 months from 7% to 15%]. Coverage was relatively low for target groups being served through a multi-departmental convergence mechanism (health and other departments such as education department for schools or women and child development department for Anganwadi centres) than compared to those served by health department alone. However, no major gender disparities are noted in the coverage of IFA supplementation among school-going girls and boys. Bulk of the variations in coverage is attributable to state-specific differences. Training and sensitization workshops for state and district officials are found to be associated with increased coverage across beneficiary groups. The paper argues that despite following international best practices in the field, it is important to harness synergy in programme implementation across line departments to eliminate coverage inefficiencies.

Can Anganwadi services strengthening improve the association between maternal and child dietary diversity? Evidence from Project Spotlight implemented in tribal dominated Gadchiroli and Chandrapur districts of Maharashtra, India.

Dietary intake is a fundamental determinant of maternal and child nutrition. This paper presents evidence on whether maternal and child dietary diversity can be improved with systemic improvements focused on strengthening training, capacity building, and behavior change communication among frontline workers to encourage improved nutritional practices among mothers and children in the intervention area. The evidence is derived from Project Spotlight intervention that was jointly implemented by Department of Women and Child Development, Government of Maharashtra and Tata Trusts in tribal dominated Gadchiroli and Chandrapur districts in Maharashtra. Based on a pre-post comparison of baseline (2019) and endline (2021) household survey data it is confirmed that there is a significant association between maternal and child dietary diversity in the study area. Notably, dietary diversity in mother-child dyads is marked with a higher consumption of fruits and vegetables as well as eggs and flesh foods. Econometric analysis further reveals that the association between maternal and child dietary diversity has improved after the systems strengthening interventions. The paper concludes that local interventions such as Project Spotlight for strengthening counselling services and coverage by frontline workers and enhancing knowledge and awareness on maternal and child dietary diversity among communities are important for improving maternal and child nutrition.

Maternal dietary diversity during lactation and associated factors in Palghar district, Maharashtra, India.

Dietary adequacy and diversity during the lactation period are necessary to ensure good health and nutrition among women and children. Behavioral interventions pertaining to health and nutrition counselling during pregnancy and lactation are critical for awareness about dietary diversity. The issue assumes salience for marginalized communities because of the Covid-19 pandemic and associated economic and societal disruptions. This paper assesses the dietary patterns among 400 lactating mothers in the tribal-dominated district of Palghar in Maharashtra, India in 2020. The study is based on primary data regarding consumption of 10 food groups among women across 10 food groups based on 24-hour recall period. The primary outcome variable was binary information regarding Minimum Dietary Diversity defined as consumption from at least 5 food groups. Econometric analysis based on multilevel models and item-response theory is applied to identify food groups that were most difficult to be received by mothers during the early and late lactation period. We find that the daily diet of lactating mothers in Palghar primarily consists of grains, white roots, tubers, and pulses. In contrast, the intake of dairy, eggs, and non-vegetarian food items is much lower. Only Half of the lactating women (56.5 percent; 95% CI: 37.4; 73.8) have a minimum diversified diet (MDD). The prevalence of lactating women with MDD was higher among households with higher income (73.1 percent; 95% CI: 45.2; 89.9) than those in lower income group (50.7 percent; 95% CI: 42.3; 58.9). Lactating Women (in early phase) who received health and nutrition counseling services are more likely (OR: 2.37; 95% CI: 0.90; 6.26) to consume a diversified diet. Food groups such as fruits, meat, poultry, fish, nuts, and seeds were among the rare food items in daily diet. The dietary pattern lacking in fruits, nuts, and heme (iron) sources indicates more significant risks of micronutrient deficiencies. The findings call for improving dietary diversity among lactating mothers, particularly from the marginalized communities, and are driven by low consumption of dairy products or various fruits and vegetables. Among the different food items, the consumption of micronutrient-rich seeds and nuts is most difficult to be accessed by lactating mothers. Also, diet-centric counseling and informing lactating mothers of its benefits are necessary to increase dietary diversity for improving maternal and child nutrition.

Population estimates and determinants of severe maternal thinness in India.

OBJECTIVE: To examine prevalence, risk factors, and consequences of maternal severe thinness in India. METHODS: This mixed methods study analyzed data from the Indian National Family Health Survey (NFHS)-4 (2015-2016) to estimate the prevalence of and risk factors for severe thinness, followed by a desk review of literature from India. RESULTS: Prevalence of severe thinness (defined by World Health Organization as body mass index [BMI] <16 in adult and BMI for age Z score < -2 SD in adolescents) was higher among pregnant adolescents (4.3%) compared with pregnant adult women (1.9%) and among postpartum adolescent women (6.3%) than postpartum adult women (2.4%) 2-6 months after delivery. Identified research studies showed prevalence of 4%-12% in pregnant women. Only 13/640 districts had at least three cases of severely thin pregnant women; others had lower numbers. Three or more postpartum women aged ≥20 years were severely thin in 32 districts. Among pregnant adolescents, earlier parity increased odds (OR 1.96; 95% CI, 1.18-3.27) of severe thinness. Access to household toilet facility reduced odds (OR 0.72; 95% CI, 0.52-0.99]. Among mothers aged ≥20 years, increasing education level was associated with decreasing odds of severe thinness (secondary: OR 0.74; 95% CI, 0.57-0.96 and Higher: OR 0.54; 95% CI, 0.32-0.91, compared with no education); household wealth and caste were also associated with severe thinness. CONCLUSION: This paper reveals the geographic pockets that need priority focus for managing severe thinness among pregnant women and mothers in India to limit the immediate and intergenerational adverse consequences emanating from these deprivations.