Dynamics of caste and early childbearing in India: a perspective of three decades.

BACKGROUND: Early childbearing disrupts girls' otherwise healthy growth into adulthood and adversely affects their education, livelihood, and health. Individual, sociocultural, economic, environmental, and health service-related factors contribute to childbearing among young females. In India, caste affects health outcomes despite several affirmative policies aimed at improving the health and welfare of the backward castes/tribes. However, there is a dearth of empirical evidence about the impact of caste on early childbearing, more specifically, regarding the trajectory of inter-caste disparities in early childbearing. METHOD: This study used data from all five rounds of the National Family Health Survey (NFHS) in India to assess the association between caste and early childbearing over the last three decades. All women aged 20-24 [NFHS-1 (n = 17,218), NFHS-2 (n = 15,973), NFHS-3 (n = 22,807), NFHS-4 (n = 122,955) and NFHS-5 (n = 118,700)] were considered to create a pooled data set (n = 297,653) for analysis. Bivariate analysis and binary logistic regression were conducted using Stata (v17). ArcMap (v10.8) presented the caste-wise prevalence of early childbearing among the states and Union Territories (UTs). RESULTS: Many women continue to have early childbearing despite a considerable reduction over the last three decades from 47% in 1992-93 to 15% in 2019-21. Compared to NFHS-1, the odds of early childbearing increased by 15% in NFHS-2 and, after that, declined by 42% in NFHS-3 and 64% in NFHS-4 and NFHS-5. The inter-caste disparity in early childbearing persists, albeit with a narrowing gap, with the Scheduled castes (SC) remaining the most vulnerable group. Adjusting the effects of socio-demographic and economic characteristics, SC women had significantly higher odds of early childbearing (OR = 1.07, CI = 1.04-1.11) than those from the General caste. CONCLUSION: To decrease early childbirth, a focus on adolescent marriage prevention and increasing contraceptive use among young SC women is necessary. Strengthening ongoing programs and policies targeting educational and economic empowerment of the socially weaker castes/tribes will help in reducing early childbearing. Efforts to prevent early childbearing will accelerate the achievement of the Sustainable Development Goals (SDGs)-especially those related to health, poverty, nutrition, education, and general wellbeing, in addition to protecting women's reproductive rights.

Men's attitude towards wife-beating: understanding the pattern and trend in India.

BACKGROUND: Intimate partner violence (IPV) is a severe human rights violation and a global burden on public health. Wife-beating is a form of IPV and an extension of the patriarchal philosophy that legitimizes men's control over their spouses. This study investigates (a) the trends and patterns of men's attitudes towards justification of wife-beating and (b) the socio-demographic factors associated with changes in men's attitudes towards wife-beating between 2005-06 and 2019-21 in India. METHODS: The present study utilized data from the last three rounds of the National Family Health Survey (NFHS): NFHS-3 (2005-06), NFHS-4 (2015-16), and NFHS-5 (2019-21) with a total sample of 2,76,672 men aged 15-54. The primary outcome variable was men's attitudes toward wife-beating. Attitude towards the household and the sexual autonomy of the wife were the two key predictors, in addition to other structural factors. Descriptive, bivariate, and multivariate logistic regression analyses were performed on weighted data using Stata. Hosmer-Lemeshow test, Classification table, and ROC curve were carried out to enhance the robustness of the analysis and validity of the model. RESULTS: In 2005-06, 50% of men justified wife-beating in at least one of the seven contexts, which reduced to 42% in 2015-16 and then marginally increased to 44% in 2019-21. Men with an authoritarian attitude toward household autonomy (AOR: 2.34; CI: 2.30,2.38) and sexual autonomy of the wife (AOR: 1.68; CI: 1.65,1.71) were more likely to justify wife-beating than their egalitarian counterparts. Inadequate education, younger age, family history of IPV, alcohol consumption, poverty, and rural settings are associated with an elevated risk of abusive attitudes towards wife-beating. CONCLUSION: A sizable percentage of men, more so those socio-economically marginalized, continue to justify wife-beating, albeit with considerable decline over the years. The findings suggest customized policies and programs enhancing gender egalitarian norms among young men, more opportunities to pursue higher education, alleviating poverty through employment opportunities, and raising awareness about domestic violence in rural settings would help develop more egalitarian gender norms and attitudes towards wife-beating.

Factors affecting pregnancy registration in India: does the pregnancy intention matter?

BACKGROUND: Pregnancy registration is one of the most critical components of women's reproductive health because it is the gateway to entering the continuum of care services such as antenatal care, institutional delivery, and postnatal care. There is a lack of studies exploring the relationship between pregnancy intention and pregnancy registration, especially in the Indian context. METHOD: This study used the National Family Health Survey-5 (2019-21) data to explore the relationship between birth intention and failure of pregnancy registration. The bivariate and multivariate (binary logistic regression) analysis was carried out. RESULTS: Adjusting the effects of socio-demographic and economic characteristics, compared with women with an intended pregnancy, the odds of failure of pregnancy registration were significantly high among women with a mistimed pregnancy (OR = 1.60, 95% CI = 1.47-1.73) and unwanted pregnancy (OR = 1.38, 95% CI = 1.26-1.52). The study found pregnancy intention as a significant predictor of pregnancy registration. CONCLUSIONS: Results suggest strengthening the interaction of grassroots-level health workers with women, especially those with possibly lower healthcare autonomy and unintended pregnancy. Higher and earlier pregnancy registration will enhance maternal healthcare utilization and reduce adverse health consequences to mothers and children, thus ensuring better maternal and child health.

Examining the influence of Mother-in-law on family planning use in South Asia: insights from Bangladesh, India, Nepal, and Pakistan.

BACKGROUND: Contraceptive use contributes to improved maternal and child health, education, empowerment of women, slow population growth, and economic development. The role of the family in influencing women's health and health-seeking behavior is undergoing significant changes, owing to higher education, media exposure, and numerous government initiatives, in addition to women's enhanced agency across South Asia. Against this backdrop, this study assesses the relationship between women's living arrangements and contraceptive methods used in selected south Asian countries (India, Pakistan, Nepal, and Bangladesh). METHODS: Data of currently married women aged 15-49 from the recent round of Demographic and Health Survey (DHS) of four South Asian countries, i.e., Nepal (2016), Pakistan (2017-18), Bangladesh (2017-18), and India (2019-21) had been used. Bivariate and multinomial logistic regression was performed using Stata with a 5% significance level. RESULTS: Living arrangement of women had a significant association with contraceptive use in South Asia. The Mother-in-law (MIL) influenced the contraceptive method used by the Daughter-in-law (DIL), albeit a country-specific method choice. Modern limiting methods were significantly higher among women living with MIL in India. The use of the modern spacing method was considerably high among women co-residing with husband and/or unmarried child(ren) and MIL in Nepal and India. In Bangladesh, women living with husband and other family member including MIL were more likely to use modern spacing methods.. Women co-residing with the MIL had a higher likelihood of using any traditional contraceptive method in India. CONCLUSIONS: The study suggests family planning program to cover MIL for enhancing their understanding on the benefits of contraceptive use and modifying norms around fertility. Strengthening the interaction between the grassroots level health workers and the MIL, enhancing social network of DIL may help informed choice and enhance the use of modern spacing methods. Women's family planning demands met with modern contraception, and informed contraceptive choices, must also be achieved to reach the 2030 Agenda for Sustainable Development.

Patterns and correlates of post-abortion complications in India.

BACKGROUND: Abortion complications can range from minor and treatable to severe but rare complications that can result in morbidity or even death. There is limited evidence on the socioeconomic and demographic correlates of post-abortion complications, though abortion is associated with pregnancy and birth-related complications and contributes to maternal mortality in India. This study thus assesses the patterns and correlates of post-abortion complications in India. METHODS: This study gathered data from the cross-sectional National Family Health Survey(2019-21) on women aged 15-49 who had their last pregnancy terminated by induced abortion in the five years preceding the survey (n = 5,835). Multivariate logistic regression was used to check the adjusted association of socioeconomic and demographic characteristics with abortion complications. The data were analysed using Stata with a 5% significance threshold. RESULTS: Post-abortion complications affected 16% of the women. Women who had an abortion with a gestational age of 9-20 weeks (AOR:1.48, CI: 1.24-1.75) and those who had an abortion due to life risk/medical reasons (AOR:1.37, CI:1.13-1.65) had higher odds of abortion complications than their respective counterparts. Women in the North-Eastern (AOR:0.67, CI:0.51-0.88) and the Southern (AOR:0.60, CI:0.44, 0.81) regions were less likely to have abortion complications than those in the Northern region. CONCLUSION: Many Indian women suffer from post-abortion complications, with the primary causes being increased gestational age and abortions performed due to life-threatening or medical conditions. Efforts to educate women about early abortion decision-making and improve abortion care will reduce post-abortion complications.

Effectiveness of mobile technology and utilization of maternal and neonatal healthcare in low and middle-income countries (LMICs): a systematic review.

BACKGROUND: Maternal and neonatal mortality are important indicators of the development of a nation and pose a severe health concern, especially in developing and Low and Middle-Income Countries (LMICs). Healthcare providers use various mobile technologies as tools to provide antenatal, delivery, and postnatal care and thereby promote maternal and child health. We conducted a systematic review to critically assess the existing literature on the effectiveness of mobile phone technology in maternal and neonatal healthcare (MNH) utilization, especially in LMICs in Asia and Africa. METHODS: A systematic search strategy was developed, and Boolean combinations of relevant keywords were utilized to search relevant literature on three electronic databases (PubMed/Medline, Scopus, and Google Scholar) from 2012 to 2022. After assessing the inclusion and exclusion criteria, 25 articles were selected for systematic review. A narrative synthesis strategy was applied to summarise the information from the included literature. RESULTS: This review reveals that research and evaluation studies on mobile phone or Mobile Health (mHealth) and MNH service utilization substantially varied by research designs and methodology. Most studies found that mobile phone technology is highly appreciable in improving several MNH indicators, especially in LMICs. Despite the identified benefits of mobile technology in MNH utilization, some studies also mentioned challenges related to technology use and misuse, rich-poor discrimination, and disparity in phone ownership need to be addressed. CONCLUSION: There is constantly increasing evidence of mobile counseling and the use of digital technology in the MNH care system. Public health practitioners and policymakers need to make efforts to smooth the functioning of technology-based healthcare services, considering all the issues related to the confidentiality and safety of health-related data on the Internet.

Socioeconomic inequality in cognitive impairment among India's older adults and its determinants: a decomposition analysis.

BACKGROUND: Cognitive impairment (CoI) is a significant risk factor for ill-health status among the older adults and a major burden on public health. This study unearths the degree of socioeconomic inequalities and assesses the determinants of CoI among the older adults in India. METHODS: Data on cognitive impairment of older adults aged 60 + years (n = 31,646) gathered in a nationally representative Longitudinal Ageing Study in India (2017-18) was analyzed through STATA with a significance level of 5%. Binary logistic regression, the concentration index, concentration curve, and Shapley decomposition analysis were performed to assess the socioeconomic inequalities and the determinants of CoI. RESULTS: Sixteen percent of the older adults had CoI. Females (OR = 1.88, 95% CI = 1.70-2.09), those aged 80 plus years (OR = 3.98, 95%CI = 3.56-4.44), from ST (OR = 2.65, 95%CI = 2.32-3.02), with perceived poor health (OR = 1.61,95%CI = 1.45-1.79), with depression (OR = 1.32, 95%CI = 1.21-1.43), with no schooling (OR = 16.46, 95%CI = 11.31-23.97) with 1 + ADL (OR = 1.43, 95%CI = 1.31-1.57) and 1 + IADL (OR = 1.30, 95%CI = 1.19-1.41) had higher odds of CoI than their respective counterparts. Older adults from urban areas (OR = 0.63, 95%CI = 0.57-0.70), higher income groups (OR = 0.61, 95%CI = 0.53- 0.70) and higher education level with sources of financial support (OR = 0.68, 95%CI = 0.61- 0.76) less likely to experience CoI. Economic inequalities exist in the distribution of CoI-the poorest being the most disadvantaged (concentration index value = -0.118). CONCLUSIONS: There are socioeconomic-related inequalities in CoI among the older adults. The socioeconomically vulnerable older adults, including those illiterates, with poor economic status, women, not-in-union, the older, and those without social support, are more likely to develop CoI. The results suggest awareness generation and more customized policies and programs to reduce the socioeconomic inequalities in CoI among the older adults in India. The improved mental health of the older adults will contribute to achieving Sustainable Development Goals, including Goal 3 on guaranteeing good health and well-being for all.

Gynecological morbidity and treatment-seeking among older adult (aged 45-59) women in India.

BACKGROUND: Women's gynecological health needs are not limited to the reproductive years of their life. Women are at risk of hormonal changes, gynecological malignancies, and various genitourinary conditions as they move toward menopause and beyond. Concerns about older women's sexual and reproductive health and rights (SRHR) continue to be taboo in many countries, of little interest to researchers and professionals in the field of healthcare, and a "blind spot" in discussions about policy as a whole. Despite the widespread agreement, the life course approach to addressing SRHR concerns has received minimal attention. The study estimates the prevalence, assesses the correlates, and treatment-seeking of gynecological morbidity (GM) among older adult women aged 45-59 years (N = 18,547) in India. METHOD: The analysis was based on the nationally representative Longitudinal Ageing Study (2016-2017) data that adopted a multistage stratified area probability cluster sampling to select respondents. The outcome variables used in this analysis were 'had any GM' and 'sought treatment for any GM.' Women with any morbidity such as per vaginal bleeding, foul-smelling vaginal discharge, uterus prolapses, mood swings/irritability, fibroid/cyst, and dry vagina causing painful intercourse were considered to have any GM. Of the respondents with GM, who sought a doctor's consultation or treatment were considered 'sought treatment for any GM.' Binary logistic regression was conducted to examine the adjusted effect of socioeconomic and demographic predictors of GM and treatment-seeking. Stata (V 16) was used for statistical analyses with a 5% significance level. RESULTS: Fifteen percent of the women had any GM, and only 41% of them sought treatment. Age, marital status, education, number of pregnancies, hysterectomy, involvement in household decision-making, social group, religion, wealth status, and region were significantly associated with GM. The odds of treatment-seeking were higher among women with 10+ years of schooling (OR 1.66, CI 1.23, 2.23), with hysterectomy (OR 7.36, CI 5.92, 9.14), with five-plus pregnancies (OR 1.25, CI 0.96, 1.64), and those from the richest (OR 1.91, CI 1.40, 2.60) households than their respective counterparts. CONCLUSION: Many older adult women experience GM, and treatment-seeking is inadequate. The GM prevalence and treatment-seeking vary considerably by socioeconomic and demographic characteristics. Results suggest community-level awareness generation and the inclusion of this otherwise ignored group in programs targeting better health and wellbeing of women.

Menstrual health and hygiene among Juang women: a particularly vulnerable tribal group in Odisha, India.

BACKGROUND: Menstruation is a normal biological process that all women go through, yet it is shrouded in secrecy, taboos, and even stigma in many societies. Studies have shown that women from socially disadvantaged groups are more likely to have preventable reproductive health issues and have less understanding of hygienic menstrual practices. Therefore, this study aimed to provide an insight into the most sensitive issue of menstruation and menstrual hygiene practices among the women of the Juang tribe, recognized as one of the particularly vulnerable tribal groups (PVTG) in India. METHODS: A cross-sectional study using a mixed-method approach was carried out among Juang women in Keonjhar district of Odisha, India. Quantitative data was gathered from 360 currently married women to assess practices associated with menstruation and its management. In addition, 15 focus group discussions and 15 in-depth interviews were conducted to explore the views of Juang women on menstrual hygiene practices, cultural beliefs, menstrual problems, and treatment-seeking behaviour. Inductive content analysis was used to analyse the qualitative data, while descriptive statistics and chi-squared tests were used to analyse quantitative data. RESULTS: Most Juang women (85%) used old clothes as absorbents during menstruation. Distance from the market (36%), lack of awareness (31%), and high cost (15%) were cited as the contributing factors to the low level of sanitary napkin usage. Around 85% of women were restricted from participating in religious activities, and 94% avoided social gatherings. Seventy-one percent of the Juang women experienced menstrual problems, while only one-third of them sought treatment for their problems. CONCLUSION: Hygienic practices during menstruation are far from satisfactory among Juang women in Odisha, India. Menstrual problems are common, and the treatment sought is insufficient. There is a need for awareness generation on menstrual hygiene, the adverse effects of menstrual problems, and the provision of low-cost sanitary napkins among this disadvantaged, vulnerable tribal group.

Exploring the Relationship between Household Structure and Utilisation of Maternal Health Care Services in India.

The role of household structure, especially the mother-in-law (MIL) influencing daughter-in-law's maternal health care (MHC) seeking behaviour, has been a continuing debate due to the former's advantageous position in the household. This study assesses the association of household structure and particularly the presence of MIL with MHC utilisation in India using the National Family Health Survey-4 data (2015-16). The sample of women aged 15-49 years who have given birth during the last five years preceding the survey (n=184,641) was considered for analysis. The outcome variables were full-antenatal care, institutional delivery, and postnatal care. Binary logistic regression was used to check the adjusted effects of the household structure on MHC utilisation. The analyses were done with STATA (version 13) with a significance level of 5%. Adjusting the effects of socio-demographic and economic characteristics, women from non-nuclear households with MIL had higher odds of full-antenatal care (OR= 1.04, CI= 0.99-1.08) and institutional delivery (OR=1.05, CI=1.01- 1.10) than their counterparts from nuclear households. Women from non-nuclear households without MIL had lower chances of postnatal care (OR=0.98, CI=0.96-1.00) than those from nuclear households. The study unearths a very weak association between the presence of MIL in the household and MHC services utilisation of the daughter-in-law, a notable change from the earlier literature often portraying MIL as a barrier.

Why do women abort their pregnancies? Evidence from the National Family Health Survey (2019-21) of India.

Induced abortion is closely associated with maternal morbidity, mortality, and reproductive rights of women and thus continues to draw research interest. This study assesses the reasons for abortion and their predictors using India's National Family Health Survey-5 (2019-21) data. The sample of women aged 15-49 who had terminated their last pregnancy by induced abortion in the five years preceding the survey (n=5835) was considered for analysis. Multinomial logistic regression was used to check the adjusted effects of the socioeconomic predictors on the reasons for abortion. Stata (v16.0) was used for the data analysis. Women were more likely to abort their pregnancy at home/other than in the public health sector if unintended pregnancies (RR: 2.79; CI: 2.15-3.61) and sex-selective abortions (RR: 2.43; CI: 1.67-3.55) rather than life risk. The study found unintended pregnancy as the primary contributor to induced abortion. However, some women undergo the procedure due to medical reasons and the undesired gender of the unborn child. Unintended pregnancies that end in abortion are strongly correlated with gestational age, method of abortion, place of abortion, number of surviving children, religion, place of residence, and region. Again, there is a strong association between the sex-selective reason for abortion and the gestational age, method of abortion, place of abortion, number of surviving children, proper knowledge of the ovulatory cycle, religion, wealth quintile, and region. Women had abortions mainly due to unintended pregnancies, and there was socioeconomic, demographic, and geographic variation in the reasons for abortion in India. Sex-selective abortions continue to exist, especially among women of higher parity, poorest households and from the central, eastern, and north-eastern regions. The key to reducing unintended pregnancies and abortions is raising the understanding of contraception and empowering women in reproductive decisions. Reducing unintended pregnancies will contribute to lower induced abortion and thus improve women's health.

Determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India.

Background: Undernutrition is a significant public health problem and the leading risk factor for India's disease burden. Aim: To understand the determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Methods: The study used the National Family Health Survey-4 (2015-16) data. The analysis was carried out for under-five children who have availed of any ICDS services in the 12 months preceding the survey (n = 1,27,813). Stunting, wasting, and underweight were estimated following the World Health Organization guideline and used as the outcome variables. The binary logistic regression was conducted to examine the association of ICDS utilization and socioeconomic-demographic predictors with under-five children's nutritional status. STATA (V 13) was used for statistical analyses. Results: A sizable proportion of under-five children receiving any ICDS services suffer from undernutrition. The undernutrition prevalence varied considerably by socioeconomic and demographic characteristics. Logistic regression found an insignificant association of ICDS utilization with the nutritional status of under-five children. Children not immunized in ICDS centers were less likely to be stunted (OR: 0.93; P < 0.01), wasted (OR: 0.93; P < 0.01), and underweight (OR: 0.90; P < 0.01) than their counterparts. The child's age and gender, maternal education and nutrition status, wealth index, social group, region, residence, and region were significant determinants of undernutrition among ICDS beneficiaries. Conclusion: The study suggests the need to ensure all available services to children enrolled in the Anganwadi Center (AWC). The program should also emphasize feeding practices and educate parents about improving child health and nutrition.

Determinants of minimum acceptable diet feeding among children aged 6-23 months in Odisha, India.

OBJECTIVE: To assess the level, pattern and determinants of minimum acceptable diet (MAD) feeding in Odisha, India. DESIGN: Utilising cross-sectional data, the MAD was estimated through a dietary assessment method wherein the child's mother was asked to recall all the food intake of the youngest child the previous day and night of the surveyed date. SETTING: National Family Health Survey 2015-2016. PARTICIPANTS: Children aged 6-23 months, living with mother and for whom complete information on MAD was available (n 3073). RESULTS: Only 8·4 % of the children aged 6-23 months were fed MAD, and the MAD feeding varies considerably by socio-demographic characteristics. Children aged 12-17 months had two times (OR: 2·51, 95 % CI (1·48, 4·26)) and those aged 18-23 months had three times (OR: 3·77, 95 % CI (2·25, 6·30)) higher odds of having a MAD than their counterparts aged 6-8 months. Children whose mother was exposed to any mass media had a higher chance of MAD feeding (OR: 1·46, 95 % CI (1·01, 2·11)). CONCLUSIONS: The children of higher age, second or higher-order births, with mother exposed to mass media are significantly more likely to be fed with a MAD. At the same time, children from scheduled caste (SC) households have a lower probability of MAD feeding. The lower MAD feeding among the SC households suggests strengthening the ongoing programmes with a higher emphasis on the inclusion of this disadvantaged and marginalised group. Findings from the current study would assist policymakers, and public health managers improve MAD feeding practices in Odisha, India, in a targeted manner.

Abortion care seeking in India: patterns and predictors.

Unsafe abortions remain a considerable public health problem and continue to be a leading cause of maternal morbidity and mortality throughout the world. This study assessed whether women's choice of type of health care facility for abortion in India varied by their socio-demographic and economic characteristics, and aimed to determine the significant predictors of choice of health care facility. Data were taken from the 2015-16 Indian National Family and Health Survey (NFHS-4). The study sample included women aged 15-49 years, irrespective of their marital status, who had terminated their last pregnancy by induced abortion in the five years before the survey (N = 6876). A bivariate analysis was carried out to assess the pattern in the choice of health care facility type for an abortion, and a multinomial logistic regression model was fitted to assess the predictors affecting the choice of health care facility type for an abortion. The results showed that, at the time of the 2015-16 survey, women in India went to private facilities more than public facilities for abortion care, irrespective of their age, distance to facility and financial constraints. The probability of visiting a private facility increased with women's age, gestational age and the wealth quintile. A wide variation in choice of health facility for abortion care by socioeconomic characteristics was observed.

Informed choice in modern contraceptive method use: pattern and predictors among young women in India.

Research on informed choice in modern contraceptive method acceptance by young married women is pertinent in the broader context of individual freedom and reproductive rights, especially in countries where women continue to have limited control over their reproductive and contraceptive choices. This study in India asked: (1) is young married women's acceptance of specific modern contraceptive methods an informed choice? and (2) what are the enablers and barriers to informed choice? The study used data for currently married women aged 15-24 (N = 20,752) from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015-16. A Method Information Index (MII) was calculated as a measure of informed choice from the percentage of users who responded 'yes' to all three questions on: whether they were informed about methods other than the one they received, told about the method-specific side-effects, and advised what to do if they experienced side-effects. Binary logistic regression analysis was carried out to examine the adjusted effect of factors associated with the MII separately for female sterilization, the intrauterine device and the oral contraceptive pill, and a combined MII including all three methods plus injectables. One-fifth of the study women used any modern contraceptive method at the time of survey, of which only 36% had fully informed choice. The likelihood of being informed about the methods was significantly higher among those using the oral contraceptive pill (OR: 1.75, CI 1.58-1.94), IUD (OR: 2.23, CI 1.97-2.52) and injectables (OR: 1.37, CI 0.97-1.94) compared with those who were sterilized. Informed choice varied by region and the socioeconomic profile of the users. Inadequately informed choice violates the reproductive rights of young women and might result in higher post-use health problems, discontinuation of and unmet need for contraceptives, unintended pregnancies, induced abortions and regret, adversely affecting women's health. Training of health/family planning workers in India about the importance of reproductive rights is urgently required to enhance informed contraceptive choice and improve the health of young married women.

Enhanced catalytic reductive hydrogenation of an organic dye by Ag decorated graphitic carbon nitride modified MCM-41.

Utilization of efficient, stable and reusable catalysts for wastewater treatment and catalytic elimination of toxic pollutants is a challenge among researchers. This present work shows the synthesis of high-surface-activity Ag nanoparticle decorated gC3N4 modified MCM-41 and its efficiency towards catalytic hydrogenation of organic dye in the presence of reducing agent NaBH4. The proposed mechanism is based on the transfer of H+ and 2e- between the dye and the catalyst. Adsorption of dye stuff on the catalyst is a rate-determining step and is accelerated by the MCM-41 support which enhances the surface area. The catalytic efficiency and optimum time requirement were examined through the adsorption-desorption equilibrium, pseudo-first-order reaction kinetic model for the dye. The result obtained was 98% catalytic efficiency followed by the catalytic hydrogenation reaction.

Prevalence and predictors of minimum acceptable diet (MAD) feeding among tribal children aged 6-23 months in India.

Minimum acceptable diet (MAD) that combines minimum dietary diversity (MDD) and minimum meal frequency (MMF) is one of the eight core indicators for assessing infant and young child feeding (IYCF) practices for children aged 6-23 months. With low MAD, young children and infants are more susceptible to undernutrition. The study assesses the prevalence and predictors of MAD among tribal children aged 6-23 months in India. Descriptive, bivariate, and multivariate analyzes were performed on data from 6326 tribal children of the National Family Health Survey (2019-21). Stata was used for the analyzes, with a 5% significance level. Only 12% of tribal children were fed with a MAD, while 24% had MDD and 34% MMF. Children aged 18-23 months had a three times higher chance of MAD than their 6-8 months counterparts. Children receiving Integrated Child Development Services (ICDS), children of mothers with ten or more years of schooling, children whose mothers were exposed to mass media, and whose mothers had 4+ antenatal care visits in their last pregnancy had a higher likelihood of MAD. The study concludes that MAD among tribal children aged 6-23 months is unsatisfactory and varies significantly by socio-demographic characteristics, suggesting targeted intervention.

Identifying factors associated with maternal deaths in Jharkhand, India: a verbal autopsy study.

Maternal mortality has been identified as a priority issue in health policy and research in India. The country, with an annual decrease of maternal mortality rate by 4.9% since 1990, now records 63,000 maternal deaths a year. India tops the list of countries with high maternal mortality. Based on a verbal autopsy study of 403 maternal deaths, conducted in 2008, this paper explores the missed opportunities to save maternal lives, besides probing into the socioeconomic factors contributing to maternal deaths in Jharkhand, India. This cross-sectional study was carried out in two phases, and a multistage sampling design was used in selecting deaths for verbal autopsy. Informed consent was taken into consideration before verbal autopsy. The analytical approach includes bivariate analysis using SPSS 15, besides triangulation of qualitative and quantitative findings. Most of the deceased were poor (89%), non-literates (85%), and housewives (74%). Again, 80% died in the community/at home, 28% died during pregnancy while another 26% died during delivery. Any antenatal care was received by merely 28% women, and only 20% of the deliveries were conducted by skilled birth attendants (doctors and midwives). Delays in decision-making, travel, and treatment compounded by ignorance of obstetric complications, inadequate use of maternal healthcare services, poor healthcare infrastructure, and harmful rituals are the major contributing factors of maternal deaths in India.

Determinants of the First Birth Interval Among Women in India.

Objective: The first-birth interval after a marriage indicates the reproduction behavior of women and influences the population's birth rates and size. The present study assesses predictors of the interval between marriage and first childbirth in India. Materials and methods: The study employed the Cox proportional hazard model and Kaplan Meier Survival plot based on the data collected from 79,787 ever-married women in the 15-49 age group from the National Family Health Survey 2019-2021. Results: The median age of marriage to the first birth interval was 23 months in India. The older marriage cohort had longer birth intervals than the younger. The hazard ratios (HR) showed that the risk of first birth after marriage was much higher among women with higher education (HR= 2.05, 95% confidence interval (CI) = 1.98-2.11) than women without education. Women in urban areas (HR=1.22, 95% CI = 1.20-1.25) had a higher risk of first birth after marriage earlier than women from rural areas. Women from North-east (HR=1.14, 95% CI=1.10-1.18) and South (HR=1.15, 95% CI=1.12-1.19) had a higher risk of having their first birth earlier after marriage than women in the North region. The women who married within 18-24 years of age had a 69 percent higher likelihood of first birth interval than those women who were married below the age of 18. The risk of first birth after marriage increased as women delayed marriage up to age 25 years and more (HR=3.18, 95% CI=3.02-3.35) than others. Conclusion: The timing of first birth was associated with the age at the first marital union, women's educational attainment, place of residence, region, economic status, exposure to mass media, contraception use, and history of pregnancy termination.