Carolina Digital Repository (University of North Carolina at Chapel Hill), Sep 29, 2014
Background: Almost one in five contraceptive users in India uses a temporary method. It is import... more Background: Almost one in five contraceptive users in India uses a temporary method. It is important to understand user profiles and method use patterns for optimal program targeting. This analysis examines differences in demographic characteristics, discontinuation and use patterns of temporary method users among a representative sample of urban women from four cities in Uttar Pradesh, India. Methods: Individual data from a panel of women aged 15-49 were collected in 2010 in Agra, Aligarh, Allahabad, and Gorakhpur and follow-up data from the same women were collected in 2012. A contraceptive calendar was used to collect month-by-month data on contraceptive use, non-use, discontinuation, reason for discontinuation, and pregnancy and birth, covering the approximately two-year period between the baseline and midterm surveys. The analysis sample is 4,023 non-sterilized women in union at baseline. A descriptive comparison is made of socio-demographic characteristics, fertility desires, discontinuation, method switching, and pregnancy outcomes. Reasons for discontinuation are assessed by the order of discontinuation. Results: There were a number of socio-demographic differences between users of temporary methods during the calendar period; by education, wealth, and caste. Notably, women who used only condoms during this time had the most education, were the least likely to be poor, and the least likely to be from a scheduled caste or tribe as compared to users of other temporary methods. Compared to the full sample of women, users of temporary methods during this period were less likely to reside in slum areas. The group of multiple method users was small in comparison to the groups of women using a single method throughout the calendar period. This indicates that there was little method switching between condoms, traditional methods, and other forms of modern methods reported in the calendar. Conclusions: The calendar may not be well-suited to measure coital-dependent contraceptive use (e.g., condoms and traditional methods), as "continuous" monthly use may be overstated. A coital episode-specific data collection tool may produce more accurate records of contraceptive use in such contexts. Research findings also lead to useful programmatic recommendations for addressing unmet need and unintended pregnancies in urban Uttar Pradesh and beyond.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2016
Context-Postpartum family planning is a compelling concern of global significance due to its sali... more Context-Postpartum family planning is a compelling concern of global significance due to its salience to unplanned pregnancies, and to maternal and infant health in developing countries. Yet, women face the highest level of unmet need for contraception in the year following a birth. A costeffective way to inform women about their risk of becoming pregnant after the birth of a child is to integrate family planning counseling and services with maternal and infant health services. Methods-We use recently collected survey data from 2733 women from six cities in Uttar Pradesh, India who had a recent birth (since 2011) to examine the role of exposure to family planning information at maternal and infant health visits on (1) any contraceptive use in the postpartum period, and (2) choice of modern method in the postpartum period. We use discretetime event history multinomial logit models to examine the duration to contraceptive use, and choice of modern method, in the 12 months following the last birth since 2011. Results-We find that receiving counseling in an institution at the time of delivery has the strongest influence on women's subsequent uptake of modern contraception (female sterilization and IUD). Being visited by a CHW in the extended postpartum period was also strongly associated with subsequent uptake of modern contraception (IUD, condom and hormonal contraception). health visits has the potential to increase uptake of modern contraceptive method in urban Uttar Pradesh.
A study to evaluate the effectiveness of WHO tools -- Orientation Programme on Adolescent Health for Health Care Providers and Adolescent Job Aid -- in improving the quality of health services provided by health workers to their female adolescent clients in India
Given the strong association between girls' education and delayed marriage, several CCTs aimed at... more Given the strong association between girls' education and delayed marriage, several CCTs aimed at increased educational attainment in school have been evaluated to assess their impact on the age of marriage. However, only a few CCTs designed to delay marriage have been assessed to gauge their impact on girls' educational attainment. This study, undertaken by the International Center for Research on Women (ICRW) is one of the few that falls in the latter category. It assesses the educational impact of Apni Beti Apna Dhan (ABAD), a CCT implemented in Haryana, India to delay girls' marriage. In a large quasi-experimental study of beneficiary and eligible non-beneficiary girls, we found that this CCT impacts girls' education only until the 8th grade and not for higher education beyond this level. We also found that the program had no effect on marriage before age of 18. The majority of beneficiaries and non beneficiaries were unmarried after they had turned 18 and at the time of the second survey. Making Change with Cash?
The findings from this study support the importance of birth planning in improving maternal, chil... more The findings from this study support the importance of birth planning in improving maternal, child health, and nutritional outcomes. The proper planning of births could help to achieve the Sustainable Development Goal-3 of good health and well-being for all by 2030 in India, where a significant proportion of women still participate in early marriages, early childbearing, and a large number of births with close spacing.
Universal access for women and girls. Accelerating access to HIV prevention treatment care and support for female sex workers and wives of migrant men
As part of the global initiative Universal Access for Women and Girls (UA Now!) to improve and ac... more As part of the global initiative Universal Access for Women and Girls (UA Now!) to improve and achieve universal access to HIV prevention and treatment services for women the International Center for Research on Women (ICRW) implemented a research study to expand the evidence base on access to services for two key populations -- female sex workers and wives of migrant men. The main objectives of the research study were to explore barriers to HIV services experienced by the study populations and based on the findings to identify entry points for improving HIV services among women in India more broadly. The key findings from the survey with female sex workers suggest that there is indeed a high level of awareness of HIV condom use as a prevention method and a high uptake of HIV testing among both sex worker populations. It was also found that while peer outreach workers are the most important source of condoms for non-brothel based sex workers more must be done to reach this population since nearly half of these women surveyed didn’t identify the outreach workers as a source for condoms. NGO clinics play an important role in STI management and HIV testing for female sex workers. But increased attention needs to be paid by these and other health facilities to educating and counseling women about STIs and also ART when they are tested for HIV. It is evident that female sex workers face structural barriers to accessing services including restricted mobility (particularly for young brothel-based sex workers) violence stigma and discrimination and a lack of social support (mainly non-brothel-based women). In case of wives of migrant men it was found that HIV information and testing is yet to be universally accessed by the wives of migrant men. There is low awareness of STIs and consequently treatment seeking is minimal among those who have experienced an STI symptom. Due to their low decision making ability limited household income and restricted mobility women are constrained in accessing health care for STIs and ART. Inequitable gender norms impact on women’s access to information health-seeking behavior and experiences of stigma. The fact that link workers prefer talking to women in the absence of their husbands points to deeply entrenched gender norms prevalent in the community. These findings point to the need for interventions at the individual health service delivery and structural levels. (Excerpts)
Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition progra... more Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens Background Despite increasing focus on health inequities in low-and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India. Methods Utilising survey-weighted logistic regression, we estimated programmatic impact using difference-in-difference estimators from Mathematica data collected at the beginning (2012, n = 10 174) and after two years of program implementation (2014, n = 9611). We also examined changes in disparities over time using eight rounds of Community-based Household Surveys (CHS) (2012-2017, n = 48 349) collected by CARE India. At baseline for the Mathematica data, least marginalised women generally performed desired health-related behaviours more frequently than the most marginalised. After two years, most disparities persisted. Disparities increased for skilled birth attendant identification [+16.2% (most marginalised) vs +32.6% (least marginalized), P < 0.01) and skinto-skin care (+14.8% vs +20.4%, P < 0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9, P < 0.01). For the CHS data, odds ratios compared the most to the least marginalised women as referent. Results demonstrated that disparities were most significant for indicators reliant on access to care such as delivery in a facility (OR range: 0.15 to 0.48) or by a qualified doctor (OR range: 0.08 to 0.25), and seeking care for complications (OR range: 0.26 to 0.64). Conclusions Disparities observed at baseline generally persisted throughout program implementation. The most significant disparities were observed amongst behaviours dependent upon access to care. Changes in disparities largely were due to improvements for the least marginalised women without improvements for the most marginalised. Equity-based assessments of programmatic impacts, including those of universal health approaches, must be undertaken to monitor disparities and to ensure equitable and sustainable benefits for all. The online version of this article contains supplementary material.
Carolina Digital Repository (University of North Carolina at Chapel Hill), Feb 27, 2018
Background: The sex composition of existing children has been shown to influence childbearing dec... more Background: The sex composition of existing children has been shown to influence childbearing decision-making and behaviors of women and couples. One aspect of this influence is the preference for sons. In India, where son preference is deeply entrenched, research has normally focused on rural areas using cross-sectional data. However, urban areas in India are rapidly changing, with profound implications for childbearing patterns. Yet, evidence on the effect of the sex composition of current children on subsequent childbearing intentions and behavior in urban areas is scant. In this study, we analyze the impact of sex composition of children on subsequent (1) parity progression, (2) contraceptive use, and (3) desire for another child. Methods: We analyze prospective data from women over a four year period in urban Uttar Pradesh using discretetime event history logistic regression models to analyze parity progression from the first to second parity, second to third parity, and third to fourth parity. We also use logistic regression models to analyze contraceptive use and desire for another child. Results: Relative to women with no daughters, women with no sons had significantly higher odds of progressing to the next birth (parity 1
Objective A large proportion of neonatal deaths in India are attributable to low birth weight (LB... more Objective A large proportion of neonatal deaths in India are attributable to low birth weight (LBW). We report population-based distribution and determinants of birth weight in Bihar state, and on the perceptions about birth weight among carers. Design A cross-sectional household survey in a state representative sample of 6007 live births born in 2018-2019. Mothers provided detailed interviews on sociodemographic characteristics and birth weight, and their perceptions on LBW (birth weight <2500 g). We report on birth weight availability, LBW prevalence, neonatal mortality rate (NMR) by birth weight and perceptions of mothers on LBW implications. Setting Bihar state, India. Participants Women with live birth between October 2018 and September 2019. Results A total of 5021 (83.5%) live births participated, and 3939 (78.4%) were weighed at birth. LBW prevalence among those with available birth weight was 18.4% (95% CI 17.1 to 19.7). Majority (87.5%) of the live births born at home were not weighed at birth. LBW prevalence decreased and birth weight ≥2500 g increased significantly with increasing wealth index quartile. NMR was significantly higher in live births weighing <1500 g (11.3%; 95% CI 5.1 to 23.1) and 1500-1999 g (8.0%; 95% CI 4.6 to 13.6) than those weighing ≥2500 g (1.3%, 95% CI 0.9 to 1.7). Assuming proportional correspondence of LBW and NMR in live births with and without birth weight, the estimated LBW among those without birth weight was 35.5% (95% CI 33.0 to 38.0) and among all live births irrespective of birth weight availability was 23.0% (95% CI 21.9 to 24.2). 70% of mothers considered LBW to be a sign of sickness, 59.5% perceived it as a risk of developing other illnesses and 8.6% as having an increased probability of death. Conclusions Missing birth weight is substantially compromising the planning of interventions to address LBW at the population-level. Variations of LBW by place of delivery and sociodemographic indicators, and the perceptions of carers about LBW can facilitate appropriate actions to address LBW and the associated neonatal mortality.
IN INDIA, as well as in several other countries of Asia, son preference has been pervasive for ce... more IN INDIA, as well as in several other countries of Asia, son preference has been pervasive for centuries. Son preference is deeply rooted in patriarchal cultural and religious beliefs that uphold the essential value of having a son in a family. Th e kinship and inheritance systems in a family also powerfully drive son preference. Th e belief that sons are essential for social survival for a family by carrying on its lineage sustains the ideology of son preference. Sons are also seen to ensure a family's economic security over time as providers of income and resources to parents in their old age. Women experience intense societal and familial pressure to produce a son and failure to do so, oft en carries the threat and consequences of violence or abandonment in their marriage (Das Gupta M, 2006). Women may have many pregnancies until a boy is born-putting their own health at risk. Th e desire to have a son also contributes to the neglect or postnatal death of innumerable girls who are born but not desired (WHO, 2011). Previous research clearly shows that during early childhood, girls in India suff er health and nutritional discrimination (Pande and Malhotra, 2006).
Objectives Responding to pandemics is challenging in pluralistic health systems. This study asses... more Objectives Responding to pandemics is challenging in pluralistic health systems. This study assesses COVID-19 knowledge and case management of informal providers (IPs), trained practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) and Bachelor of Medicine, Bachelor of Surgery (MBBS) medical doctors providing primary care services in rural Bihar, India. Design This was a cross-sectional study of primary care providers conducted via telephone between 1 and 15 July 2020. Setting Primary care providers from 224 villages in 34 districts across Bihar, India. Participants 452 IPs, 57 AYUSH practitioners and 38 doctors (including 23 government doctors) were interviewed from a census of 1138 primary care providers used by community members that could be reached by telephone. Primary outcome measure(s) Providers were interviewed using a structured questionnaire with choicebased answers to gather information on (1) change in patient care seeking, (2) source of COVID-19 information, (3) knowledge on COVID-19 spread, symptoms and methods for prevention and (4) clinical management of COVID-19. Results During the early days of the COVID-19 pandemic, 72% of providers reported a decrease in patient visits. Most IPs and other private primary care providers reported receiving no COVID-19 related engagement with government or civil society agencies. For them, the principal source of COVID-19 information was television and newspapers. IPs had reasonably good knowledge of typical COVID-19 symptoms and prevention, and at levels similar to doctors. However, there was low stated compliance among IPs (16%) and qualified primary care providers (15% of MBBS doctors and 12% of AYUSH practitioners) with all WHO recommended management practices for suspect COVID-19 cases. Nearly half of IPs and other providers intended to treat COVID-19 suspects without referral. Conclusions Poor management practices of COVID-19 suspects by rural primary care providers weakens government pandemic control efforts. Government action of providing information to IPs, as well as engaging them in contact tracing or public health messaging can strengthen pandemic control efforts.
ObjectivesResponding to pandemics is challenging in pluralistic health systems. This study assess... more ObjectivesResponding to pandemics is challenging in pluralistic health systems. This study assesses COVID-19 knowledge and case management of informal providers (IPs), trained practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) and Bachelor of Medicine, Bachelor of Surgery (MBBS) medical doctors providing primary care services in rural Bihar, India.DesignThis was a cross-sectional study of primary care providers conducted via telephone between 1 and 15 July 2020.SettingPrimary care providers from 224 villages in 34 districts across Bihar, India.Participants452 IPs, 57 AYUSH practitioners and 38 doctors (including 23 government doctors) were interviewed from a census of 1138 primary care providers used by community members that could be reached by telephone.Primary outcome measure(s)Providers were interviewed using a structured questionnaire with choice-based answers to gather information on (1) change in patient care seeking, (2) source of COVID-19 ...
Additional file 3: of Distinct mortality patterns at 0â 2â days versus the remaining neonatal period: results from population-based assessment in the Indian state of Bihar
Figure S1. Distribution of illness symptoms (not mutually exclusive) and treatment sought for tha... more Figure S1. Distribution of illness symptoms (not mutually exclusive) and treatment sought for that symptom among newborns who survived 3â days or more in the Indian state of Bihar. (DOCX 23 kb)
Additional file 2: of Distinct mortality patterns at 0â 2â days versus the remaining neonatal period: results from population-based assessment in the Indian state of Bihar
Table S2. Survival status at discharge post-birth and mean days of facility stay for neonates bor... more Table S2. Survival status at discharge post-birth and mean days of facility stay for neonates born at a facility in the Indian state of Bihar. (DOCX 22 kb)
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