Revisiting the predisposing, enabling, and need factors of unsafe abortion in India using the Heckman Probit model.

Unsafe abortion refers to induced abortions performed without trained medical assistance. While previous studies have investigated predictors of unsafe abortion in India, none have addressed these factors with accounting sample selection bias. This study aims to evaluate the contributors to unsafe abortion in India by using the latest National Family Health Survey data conducted during 2019-2021, incorporating the adjustment of sample selection bias. The study included women aged 15 to 49 who had terminated their most recent pregnancy within five years prior to the survey (total weighted sample (N) = 4,810). Descriptive and bivariate statistics and the Heckman Probit model were employed. The prevalence of unsafe abortion in India was 31%. Key predictors of unsafe abortion included women's age, the gender composition of their living children, gestation stage, family planning status, and geographical region. Unsafe abortions were typically performed in the early stages of gestation, often involving self-administered medication. The primary reasons cited were unintended pregnancies and health complications. This study underscores the urgent need for targeted interventions that take into account regional, demographic, and social dynamics influencing abortion practices in India.

Factors associated with public and private healthcare utilization for outpatient care among older adults in India: A Wagstaff's decomposition of Anderson's behavioural model.

In India, an expanding ageing population will become a public health alarm, putting additional pressure on the healthcare system. Therefore, the current study aimed to examine the factors associated with outpatient healthcare choices among older Indian adults. We used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018). A total of 34,588 individuals (age 45 years and over) who accessed outpatient healthcare services in the last 12 months during the survey were included in this research. A bivariate chi-square test was used to present the percentage distribution of types of outpatient healthcare utilisation by background characteristics. Multinomial logistic regression and Wagstaff's decomposition analyses were employed to explore the interplay of outpatient healthcare utilisation and allied predisposing, enabling, and need factors and examine these factors' contributions to the wealth-based inequalities in public, private, and other healthcare utilisation. Outpatient healthcare utilisation varied significantly according to socioeconomic and demographic factors. The findings suggest that consumption quintiles, place of residence, education, and health insurance were significant determinants of private and public healthcare utilisation and contributed to wealth-based inequalities in healthcare choices. The current study emphasises the need to strengthen and promote public healthcare services.

Levels, patterns and determinants of using reversible contraceptives for limiting family planning in India: evidence from National Family Health Survey, 2015-16.

BACKGROUND: Demand for family planning is predominantly for birth limiting rather than birth spacing in India. Despite several family planning programmes in India, the use of reversible contraception for limiting family planning has been stagnant and largely depends on female sterilization. Though many researchers have examined patterns and determinants of using modern contraception for total family planning, studies on patterns and determinants of contraceptive use for birth limiting are limited in India. This paper examines the patterns of contraceptive use for liming demand and its determinants in India. METHODS: The National Family Health Survey-4, 2015-16 data was used. Bivariate chi-square significant test and multivariate binary logistic regression model used to accomplish the study objectives. RESULTS: Majority of women (86.5%) satisfied limiting demand (SLD) in India; the SLD was found significantly low among the women's age 15-19 years (53.1%) and parity 0 (42%). The satisfied limiting demand by modern reversible contraception (mrSLD) was found significantly high in age group 15-19 years (49.1%), Muslims (30.6%) and North-east region (45.4%). The satisfied limiting demand by traditional contraception (tSLD) was almost three times higher in North-east region (26.1%) than national average of India (8.7%). The women's years of schooling, wealth status, religion and presence of son child found to be significant determinants of mrSLD. The likelihood of tSLD was found significantly high among the women who had no son child (AOR = 1.41; 95% CI:1.34, 1.48), Muslim (AOR = 1.78; 95% CI:1.70, 1.87). A considerable regional variability in levels of SLD, mrSLD and tSLD was found in India. CONCLUSION: Public investment in family planning is required to promote and provide subsidized modern reversible contraception (MRC) services, especially to women from North-east region, Muslim, Scheduled tribe, poor household and who had no son child. Improving the quality and availability of MRC services in public health centre will be helpful to increase SLD among the above mentioned women. Besides, the promotion of MRC will be supportive to overcome the issues of sterilization regrets in India.

Examining the predictors of healthcare facility choice for outpatient care among older adults in India using Andersen's revised healthcare utilization framework model.

BACKGROUND: In India, the demand for outpatient care is substantially higher than inpatient care among older adults. Therefore, the current study examines the level, patterns, and factors associated with outpatient care use. METHODS: The present research used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18). A total of 34,588 older adults (45 years and above) who accessed outpatient healthcare services in one year prior to the survey were included in this study. A bivariate chi-square test was applied to present the percentage distribution of types of outpatient healthcare utilization by background characteristics and healthcare responsiveness. Multinomial logistic regression analyses were employed to explore the interplay of outpatient healthcare utilization and allied predisposing, enabling, and need factors. RESULTS: About 63.7% of total older adults used a private facility, followed by 22.8% used a public facility, and 13.5% used other facilities. Years of schooling, household wealth status, place of residence, self-rated health, and health insurance were all found to be significant determinants of public or private facility use. In contrast, respondents' sex was found to be a significant determinant of private healthcare use only. The study finds that there was inadequate healthcare reaction to public health facilities. CONCLUSION: The current study revealed that the use of private facility for outpatient care is noticeably high in India. Older adults' educational attainments, health insurance coverage, and household level economic background were found to be significant factors in healthcare choice. The current study emphasizes the need to strengthen public healthcare services for outpatient care.

Examining the rural-urban divide in predisposing, enabling, and need factors of unsafe abortion in India using Andersen's behavioral model.

BACKGROUND: The prevalence of unsafe abortions significantly varies with geography; therefore, more research is needed to understand the rural-urban differences in unsafe abortion practices in India. The present study aims to explore the rural-urban differences in predisposing, enabling, and need factors of unsafe abortion in India. METHODS: The present study used the fourth round of the National Family Health Survey (2015-16) and included the women aged 15-49 who terminated pregnancies by induced abortion during the 5 years prior to the survey (N = 9113) as the study sample. Descriptive statistics, bivariate chi-square significance test and multivariate logistic regression model were used to accomplish the study objectives. RESULTS: The findings revealed that almost one-third of pregnancies were terminated through unsafe measures with sharp rural-urban contrast. The likelihood of unsafe abortions increases with decreasing women's age and spousal level of education. Younger women in urban settings were more vulnerable to unsafe abortion practices. In rural settings, women with an uneducated spouse are more likely to have unsafe abortions (OR: 1.92). Poor households were more likely to undergo unsafe abortions, which were more common in rural settings (OR: 1.26). The unmet need for family planning was revealed to be a significant need factor for unsafe abortion, particularly in rural settings. CONCLUSION: Although abortion is legal, India's high estimated frequency of unsafe abortions reveals a serious public health issue. Due to socio-economic vulnerability, unmet family planning needs, and a lack of awareness, significant numbers of women still practice unsafe abortions in India.

Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu.

BACKGROUND: Caesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively. METHODS: This study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015-16. We utilized 190,898 women aged 15-49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson's Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data. RESULTS: Of participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35-49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31). CONCLUSION: Findings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.

Impact of maternal education on under-five mortality of children in India: Insights from the National Family Health Survey, 2005-2006 and 2015-2016.

Under-five (U-5) mortality is a major public health problem in lower-middle income countries. The aim of this study is to examine the associations between maternal education and mortality of children below 5 years age in Indian context. We have used bi-variate and multivariate logistic regressions to assess the associations. Our study reveals that increasing level of education among women and in association with socio-economic and demographic factors significantly reduces the incidence of U-5 mortality. The findings suggest that increasing opportunities for female education and addressing socio-economic and demographic vulnerabilities could be effective strategies to combat the incidence of U-5 mortality.

Prevalence and correlates of menstrual hygiene practices among young currently married women aged 15-24 years: an analysis from a nationally representative survey of India.

PURPOSE: This paper aims to investigate the prevalence by geographical locations and socio-demographic correlates of menstrual hygienic practices among young currently married Indian women. METHODS: The study is based on secondary data, collected from the latest round of the National Family Health Survey (NFHS-4), conducted in 2015-16. A total of 94,034 young currently married women aged 15-24 years were utilised in this study. The prevalence of menstrual hygienic practices was portrayed across regions, states, and districts of India. Bivariate and multivariate analyses were carried out to assess the factors associated with menstrual hygienic practices. RESULTS: Nearly half of the women (49.3%) practice hygienic methods to contain menstrual bloodstains. The prevalence of menstrual hygiene practices is lower in low-income states of central and eastern India. Multivariate analyses reveal that education of women and wealth status are found to be the most important positive factors of menstrual hygienic practices. Women's autonomy and exposure to mass media also have a positive impact on the use of menstrual hygiene practice. In contrast, women residing in rural areas, belonging in scheduled tribes and unemployed women are less likely to use hygienic methods during their menstruation. CONCLUSION: The findings of this study suggest increasing opportunities for female education, providing economic incentives, enhancing women's autonomy could help to increase hygienic practices of women during menstruation period. Furthermore, interventions should target socio-economically disadvantaged women to raise the use of sanitary napkins.

Do malnutrition, pre-existing morbidities, and poor household environmental conditions aggravate susceptibility to Coronavirus disease (COVID-19)? A study on under-five children in India.

BACKGROUND: The novel Coronavirus disease 2019 (2019-nCoV) outbreak, caused by severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), has become the worst serious global risk to humanity in the last century and linked with various risk factors. OBJECTIVE: To find out the risk zone associated with Coronavirus disease among children under-five age using malnourished status, pre-existing morbidity conditions, poor household environmental conditions, and also with case fatality rate (CFR) and active case rate (ACR) of COVID-19 in India. DATA SOURCES & METHODS: Data was collected from the 4th round of the National Family Health Survey (NFHS)-4, 2015-16, and CFR and ACR of COVID-19 related data collected from the Ministry of Health and Family Welfare (MoHFW) on 18th May 2020. Mean, standard deviation, and Z-score statistical methods have been employed to identify the risk factors zone and Hot Spot analysis (Getis-Ord Gi) has been done. RESULTS: The states and union territories (UTs) which have a high composite vulnerability score (CVS) of COVID-19 among under-five children are in Meghalaya (CVS = 1), Uttar Pradesh (CVS = 0.93), Jharkhand (CVS = 0.86), Bihar (CVS = 0.74), Madhya Pradesh (CVS = 0.74), and Odisha (CVS = 0.55). The states and UTs which have low composite vulnerability score of COVID-19 among under-five children are in Sikkim (CVS = -0.90), Daman & Diu (CVS = -0.76) Lakshadweep (CVS = -0.74), Kerala (CVS = -0.72), Chandigarh (CVS = -0.71). The COVID-19 high-risk zones (hot spot: 99% Confidence interval [CI]) were observed in Madhya Pradesh, Uttar Pradesh, Jharkhand, Bihar, and Meghalaya states of India, which are spatially high clustered and the low-risk zones (cold spot: 95% CI) were observed in Kerala, Mizoram states of India. CONCLUSIONS: Well-built public health measures, including rapidly searching in high focus areas and testing of COVID-19, should be performed in vulnerable regions of COVID-19.

Maternal Education and Child Mortality Differentials: An Upshot From the National Family Health Survey 2015-2016, India.

Child mortality is a sociodemographical problem in India. Although nationally representative survey (National Family Health Survey) showed child mortality was gradually declining, that was not satisfactory, and child mortality differentials prevailed all over India. The study intended to identify the effect of maternal educational level along with some sociodemographical determinants on the mortality of their children. The study was run through bivariate association and logistic regression using the data from National Family Health Survey-4 (2015-2016). Findings declared that maternal education had significantly high influence (odds ratio: no education 3.9, primary 2.9, secondary 1.8; adjusted odds ratio: no education 2.9, primary 2.3, secondary 1.6) on child mortality in the Indian context.

Are child and youth population at lower risk of COVID-19 fatalities? Evidences from South-East Asian and European countries.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has revealed many lacunas of public health preparedness, especially in lower and middle-income countries and fatality differentials between European and South-East Asian countries. The case fatality rate (CFR) in most of the South-East Asian countries is much lower than the European countries. The percentages of child and youth population are more in South-East countries. OBJECTIVE: The study aims to show the impacts of age composition on fatality differentials in European and South-East Asian countries by age-structure, especially the percentage share of child and youth population. DATA AND METHODS: This study has been done based on data provided by UNDP, WHO and worldometers. The case fatality rate (CFR) has been calculated to find out the mortality differentials of countries, and the higher fatality risk countries have been identified by the composite Z score technique. RESULTS: It is revealed that the COVID-19 case fatality rates are substantially high in highly developed countries of the European countries compared to the South-East Asian countries. Our study shows that there is an issue of child and youth population which affects the lower CFR in SE Asian countries. In France, the CFR was 16.72% which was nearly 7 times more than India (2.31%). The COVID-19 fatality risk ratio was highest in Germany (0.77) while the lowest risk ratio was observed in Bangladesh (-0.71). CONCLUSION: Despite of having a very high level of human development and preparedness, the current pandemic COVID-19 has revealed that there exist significant differentials among fatality status of European and South-East Asian countries. The CFR is lower in the SE Asian countries where the child and youth population are more than the older population.

Lockdown for COVID-19 and its impact on community mobility in India: An analysis of the COVID-19 Community Mobility Reports, 2020.

BACKGROUND: Coronavirus disease (COVID-19) is a novel public health problem threatening the whole world. As an upshot, countrywide lockdown due to COVID-19 pandemic has been supportive of changing community mobility trends of various place categories including retail and recreation, groceries and pharmacies, parks, transit stations, workplaces, and residential in India. OBJECTIVE: To analyze the impact of lockdown for COVID-19 on community mobility using spatial time-series change over different states and union territories (UTs) of India. DATA & METHODS: This study has been organized based on states & UTs wise time-series data of the daily percentage of change of community mobility from baseline in India, collected from 15th February to 30th April 2020. Conditional formatting techniques, time-series trends plotting method, spatial inverse distance weighted (IDW) interpolation mapping techniques have been employed to show pre and post lockdown mobility trends due to COVID-19 i.e. to fulfill the objective. RESULTS: Across India, retail and recreation, grocery and pharmacy, visits to parks, transit stations, and workplaces mobility dropped by -73.4%, -51.2%, -46.3%, -66% and -56.7% respectively. Visits to residential places mobility increased by 23.8% as people mostly stayed home during the lockdown. The COVID-19 lockdown started on 24 March 2020 and just gone one day (March 25, 2020) of the beginning of lockdown, there have a decreased in percentage (-70.51% in retail and recreation mobility), (-64.26% in grocery and pharmacy mobility), (-46.17% in parks mobility), (-65.6% in transit stations mobility), (-60.03% in workplaces mobility) from baseline in compared to the pre-lockdown period and residential mobility has been increased in percentage (26.32%) from baseline due to people stayed home during the lockdown for COVID-19 pandemic in India. CONCLUSION: Study figures out mobility trends over time during pre-lockdown and after lockdown period across different categories of places such as retail and recreation, groceries and pharmacies, parks, transit stations, workplaces, and residential, which can be used in public health strategies to drop the spread of COVID-19.

Impact of lockdown on learning status of undergraduate and postgraduate students during COVID-19 pandemic in West Bengal, India.

To assess the impact of lockdown amidst COVID-19 on undergraduate and postgraduate learners of various colleges and universities of West Bengal. An online survey was conducted from 1 May to 8 May 2020 to collect the information. A structural questionnaire link using 'Google form' was sent to students' through WhatsApp and E-mail. A total of 232 students provided complete information regarding the survey. The simple percentage distribution was used to assess the learning status of the study participants. During the lockdown period, around 70% of learners were involved in e-learning. Most of the learners were used android mobile for attending e-learning. Students have been facing various problems related to depression anxiety, poor internet connectivity, and unfavorable study environment at home. Students from remote areas and marginalized sections mainly face enormous challenges for the study during this pandemic. This study suggests targeted interventions to create a positive space for study among students from the vulnerable section of society. Strategies are urgently needed to build a resilient education system in the state that will ensure to develop the skill for employability and the productivity of the young minds.

Decomposing rural-urban gap in unsafe disposal practice of child stool in India using nationwide sample survey data.

A significant rural-urban disparity in unsafe child stool disposal practices exists in India, yet existing research falls short in identifying the contributing factors to this gap. This study addresses the research gap by contextualizing the rural-urban divide in unsafe child stool disposal using data from the fifth round of the National Family Health Survey (NFHS-5, 2019-21). In particular, the study examines the prevalence and predictors of unsafe disposal practices, exploring associated contributing factors to this gap. The study involves a sample of 78,074 women aged 15-49 with a living child under 2 years, without any missing data related to the study interest. Employing descriptive statistics, the Pearson chi-square test, multilevel logistic regression, and the Fairlie decomposition model, the research aims to fulfill its objectives. The rural-urban gap in unsafe child stool disposal practices among the study participants was 22.3 percentage points (pp), with a more pronounced gap among the Scheduled Tribes (ST). Notably, the gap was particularly wide in Madhya Pradesh (33.9 pp), Telangana (27.5 pp), Gujarat (26.1 pp), and Rajasthan (25.8 pp). Predictors such as mother's education, mass media exposure, household wealth quintile, and sanitation facilities proved significant irrespective of residence. However, religion, social group, and water facility on household premises emerged as significant factors in rural areas only. The study identified that 67% of the explained gap in unsafe child stool disposal practices was attributed to the rural-urban difference in household wealth. Other noteworthy contributors were 'household sanitation facility' (21.3%), 'mother's education level' (3.9%), and 'water facility on household premises' (3.9%). These findings underscore the need for population and area-specific policy interventions, especially for individuals from socio-economically disadvantaged backgrounds, those with lower education levels, and limited exposure to mass media, particularly in states with a high prevalence of unsafe disposal practices. Such interventions are crucial to mitigating the existing rural-urban gap in unsafe child stool disposal practices.

Exploring drivers of unsafe disposal of child stool in India using hierarchical regression model.

BACKGROUND: Disposal of children's stools is often neglected in Indian sanitation programs, putting them at higher risk of diseases transmitted through the fecal-oral route. Therefore, the current study aims to identify the socioeconomic and demographic factors associated with the unsafe disposal of child stool in India and to estimate the geographical variation in unsafe disposal. METHODS: The study used 78,074 births under two years from the fifth round of the National Family Health Survey (2019-21). Descriptive statistics, bivariate analysis with the chi-square test, and a four-level hierarchical logistic regression model were applied to accomplish the study objectives. RESULTS: Findings revealed a 61.3% prevalence of unsafe stool disposal nationwide, significantly varying between rural (45%) and urban (67%) areas. Multilevel logistic regression highlighted that mother's education, wealth quintile, and sanitation facility were significant predictors of unsafe disposal of child stools. Random intercept statistics revealed a substantial geographical unit-level variance in unsafe stool practice in India. CONCLUSION: The study emphasizes the widespread unsafe disposal of child stool among Indian mothers with young children below two years, and the study underscores a range of contributing factors, including education, media exposure, prosperity, water availability, and sanitation. It also accentuates the significance of the geographical variance in the unsafe disposal of child stool in India, particularly at the household level, followed by the community level. Hence, the findings underscore the importance of focused interventions, including targeted household-level poverty alleviation programs, initiatives to enhance sanitation and water facilities, and community-level public health awareness programs.

Re-examining the Nexus Between Maternal Smoking Behavior and Under-Five Children's ARI in India: A Comprehensive Study.

Background: The burden of acute respiratory infections (ARIs) among children under-five is a serious concern in lower and middle-income countries (LMICs), including India, where it is positively associated with indoor smoking exposures. This study re-examines the impact of maternal smoking on ARIs among children under 5 in India, considering other indoor air pollutant factors and covariates. The aim is to establish existing findings and capture any differentials in results using comprehensive analytical approaches. Methods: Data from the National Family Health Survey (NFHS-5), 2019 - 21, was used. Descriptive statistics, bivariate analysis, multivariable logistic regression models, and interaction analysis were applied to accomplish the study objective. Results: The adjusted likelihood of ARI was 1.24 (95% CI: 1.04-1.48) times higher in under-five children with smoking mothers than those with non-smoking mothers. The result was also observed to be almost similar across all seasons. Moreover, the combined effect of maternal smoking with other household members smoking and using unclean cooking fuel without a separate ventilated kitchen escalated the risk (AOR: 2.01; 95% CI: 1.98-2.67). Breastfeeding was found to be a preventive measure for reducing the risk of indoor smoking exposure. The children who were never breastfed and were born large or small were more susceptible to maternal smoking. Conclusion: The study highlights the association between maternal smoking and ARIs in Indian under-five children. Interventions include reducing maternal smoking, promoting breastfeeding, and improving respiratory health in fuel-exposed households.

Unveiling the spatial divide in open defecation practices across India: an application of spatial regression and Fairlie decomposition model.

OBJECTIVE: The study contextualises the spatial heterogeneity and associated drivers of open defecation (OD) in India. DESIGN: The present study involved a secondary cross-sectional survey data from the fifth round of the National Family Health Survey conducted during 2019-2021 in India. We mapped the spatial heterogeneity of OD practices using LISA clustering techniques and assessed the critical drivers of OD using multivariate regression models. Fairlie decomposition model was used to identify the factors responsible for developing OD hot spots and cold spots. SETTING AND PARTICIPANTS: The study was conducted in India and included 636 699 sampled households within 36 states and union territories covering 707 districts of India. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measure was the prevalence of OD. RESULTS: The prevalence of OD was almost 20%, with hot spots primarily located in the north-central belts of the country. The rural-urban (26% vs 6%), illiterate-higher educated (32% vs 4%) and poor-rich (52% vs 2%) gaps in OD were very high. The odds of OD were 2.7 and 1.9 times higher in rural areas and households without water supply service on premises compared with their counterparts. The spatial error model identified households with an illiterate head (coefficient=0.50, p=0.001) as the leading spatially linked predictor of OD, followed by the poorest (coefficient=0.31, p=0.001) and the Hindu (coefficient=0.10, p=0.001). The high-high and low-low cluster inequality in OD was 38%, with household wealth quintile (67%) found to be the most significant contributing factor, followed by religion (22.8%) and level of education (6%). CONCLUSION: The practice of OD is concentrated in the north-central belt of India and is particularly among the poor, illiterate and socially backward groups. Policy measures should be taken to improve sanitation practices, particularly in high-focus districts and among vulnerable groups, by adopting multispectral and multisectoral approaches.

Contextualizing the standard maternal continuum of care in Pakistan: an application of revised recommendation of the World Health Organization.

Objective: This study utilizes recent nationally representative data to contextualize the standard maternal continuum of care (SMCoC) in Pakistan. The revised SMCoC framework encompasses at least eight antenatal care visits, skilled birth attendants during delivery, and postnatal care within 48 h of childbirth. Methods: The study used a sample of 3,887 ever-married women aged 15-49 from the latest Pakistan Demographic and Health Survey (PDHS) conducted in 2017-18. Several statistical methods were employed: descriptive statistics, bivariate, multilevel logistic regression models, and Fairlie decomposition analysis. Results: Only 12% of women had accessed full SMCoC services in Pakistan. Education and the wealth quintile emerged as pivotal factors influencing the utilization of SMCoC. The likelihood of full SMCC utilization was more likely among higher educated women (OR: 3.37; 95% CI: 2.16-5.25) and those belonging to the wealthiest household wealth quintile (OR: 4.95; 95% CI: 2.33-5.51). Media exposure, autonomy, healthcare accessibility, residence, and region were also identified as significant predictors of SMCoC utilization among women. Conclusion: In conclusion, while most women did not utilize full SMCoC services in Pakistan, the pattern is substantially varied by background characteristics. Education, wealth quintile, mass media exposure, and autonomy were significant factors, along with geographical aspects such as healthcare accessibility and region. The study underscores the need for a multifaceted approach to ensure equitable access to full SMCoC services for women in Pakistan, addressing individual, socioeconomic, and geographical factors.

Exploring the Socioeconomic Factors Associated with Girl Child Marriage and its Impact on Pregnancy Outcomes: A Study from Malda District of West Bengal.

Background: Child marriage is not a new phenomenon in India. The prevalence of child marriage remains high in many districts of West Bengal. Objectives: The present study aims to address socioeconomic factors associated with girl child marriage and its effect on selected pregnancy outcomes among women in the Malda district of West Bengal. Methods: The study is based on primary data, collected from the Manikchak CD block by adopting a random sample survey technique. The participants in the study consisted of 357 ever married women aged 15-49 years. Results: Multivariate analysis revealed that the prevalence of child marriage was substantially higher among women who had no formal education resided in the marginalized family. Similarly, educated parents were less likely to marry their daughter at an early age. Besides, the likelihood of miscarried or stillbirth, complications during pregnancy and delivery were significantly higher among those married <18 years than those married at 18 years or later. Conclusions: The findings of this study suggest preventing child marriage by increasing opportunities for girls' education and employment. The targeted approach should be made among rural and poor girls to reduce the vulnerability of child marriage.

Perceived academic satisfaction level, psychological stress and academic risk among Indian students amidst COVID-19 pandemic.

Background: The Covid-19 pandemic has a significant impact on education and mental health outcomes. This study attempts to analyze the factors associated with academic satisfaction level, psychological stress/anxiety, and future academic risk among Indian students of higher education in the wake of the Covid-19 pandemic. Methods: An online survey was conducted through a structured questionnaire among students of higher education. Multivariate ordered logistic regression models were performed to find out the predictors of perceived academic satisfaction level, psychological stress, and academic risk among the participants. Results: Among the 630 participants, the majority of the students (73%) had low to moderate levels of academic satisfaction. Over two-thirds of participants (68%) had a high level of stress and nearly two-fifths (38%) of the participants felt very high risk in their academic career. The multivariate logistic regression models show that the likelihood of psychological stress and academic risk was significantly higher among students aged above 25 years, researchers, and those who belong to broken families. Besides, the higher probability of satisfaction level is associated with female students, undergraduates, belonging to economically well-off families, and rural residents. Conclusion: Our study suggests that the Covid-19 pandemic leads to a range of psychological health problems. Therefore, increase students' satisfaction with online classes and it is essential to preserve the mental health of individuals and to develop psychological interventions that can improve the mental health of students during the Covid-19 pandemic.