Browsing by Author "Sourav Chowdhury"

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Assessing the coverage of full antenatal care among adolescent mothers from scheduled tribe and scheduled caste communities in India
(BioMed Central Ltd, 2023) Aditya Singh; Vineet Kumar; Harpreet Singh; Sourav Chowdhury; Sanjana Sharma
Background: The persistently high rates of maternal mortality and morbidity among historically marginalised social groups, such as adolescent Scheduled Castes (SCs) and Scheduled Tribes (STs) in India, can be attributed, in part, to the low utilisation of full antenatal healthcare services. Despite efforts by the Indian government, full antenatal care (ANC) usage remains low among this population. To address this issue, it is crucial to determine the factors that influence the utilisation of ANC services among adolescent SC/ST mothers. However, to date, no national-level comprehensive study in India has specifically examined this issue for this population. Our study aims to address this research gap and contribute to the understanding of how to improve the utilisation of ANC services among adolescent SC/ST mothers in India. Data and methods: Data from the fourth round of the National Family Health Survey 2015–16 (NFHS-4) was used. The outcome variable was full antenatal care (ANC). A pregnant mother was considered to have ‘full ANC’ only when she had at least four ANC visits, at least two tetanus toxoid (TT) injections, and consumed 100 or more iron-folic acid (IFA) tablets/syrup during her pregnancy. Bivariate analysis was used to examine the disparity in the coverage of full ANC. In addition, binary logistic regression was used to understand the net effect of predictor variables on the coverage of full ANC. Results: The utilisation of full antenatal care (ANC) among adolescent SC/ST mothers was inadequate, with only 18% receiving full ANC. Although 83% of Indian adolescent SC/ST mothers received two or more TT injections, the utilisation of the other two vital components of full ANC was low, with only 46% making four or more ANC visits and 28% consuming the recommended number of IFA tablets or equivalent amount of IFA syrup. There were statistically significant differences in the utilisation of full ANC based on the background characteristics of the participants. The statistical analysis showed that there was a significant association between the receipt of full ANC and factors such as religion (OR = 0.143, CI = 0.044–0.459), household wealth (OR = 5.505, CI = 1.804–16.800), interaction with frontline health workers (OR = 1.821, CI = 1.241–2.670), and region of residence in the Southern region (OR = 3.575, CI = 1.917–6.664). Conclusion: In conclusion, the study highlights the low utilisation of full antenatal care services among Indian adolescent SC/ST mothers, with only a minority receiving the recommended number of ANC visits and consuming the required amount of IFA tablets/syrup. Addressing social determinants of health and recognising the role of frontline workers can be crucial in improving full ANC coverage among this vulnerable population. Furthermore, targeted interventions tailored to the unique needs of different subgroups of adolescent SC/ST mothers are necessary to achieve optimal maternal and child health outcomes. © 2023, The Author(s).
Decomposing the gap in intimate partner violence between Scheduled Caste and General category women in India: An analysis of NFHS-5 data
(Elsevier Ltd, 2022) Sourav Chowdhury; Aditya Singh; Nuruzzaman Kasemi; Mahashweta Chakrabarty
Scheduled Caste (SC) women, one of India's most oppressed and neglected population groups, are the most vulnerable to intimate partner violence (IPV). IPV, on the other hand, is less common among women in the General category. No study has been conducted to measure the gap in IPV between these two groups. This study is an attempt to fill this gap. This study aims to comprehensively explore the factors that underlie and explain the gap in IPV between SC and General women. Information on 10,168 ever-married SC and 9695 ever-married General women aged 15–49 from the fifth round of the National Family Health Survey was analyzed. The Fairlie decomposition (Blinder–Oaxaca decomposition modified for binary outcomes) was used in this study to explain the gap in ever experience of IPV prevalence between SC and General women. About 37.3% and 24.4% of ever-married SC and General women in India suffered either physical or mental or sexual violence from their husbands. The large part of the gap in IPV between SC and General women was due to differences in husbands' alcohol consumption (26.33% gap), wealth index (24.48% gap), controlling behavior by husband (24%) and parental IPV (15.87% gap). With the introduction of appropriate interventions and programs, these gaps can be reduced. Interventions aimed at reducing alcoholism should be emphasized. © 2022 The Author(s)
Decomposing the gap in undernutrition among under-five children between EAG and non-EAG states of India
(Elsevier Ltd, 2023) Sourav Chowdhury; Nuruzzaman Kasemi; Aditya Singh; Mahashweta Chakrabarty; Shivani Singh
In India, the Empowered Action Group (EAG) states (Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, Uttarakhand, Odisha, Jharkhand, and Chhattisgarh, including Assam) have a higher prevalence of undernutrition among children under the age of five (U5) than non-EAG states. However, no research has attempted to explain the difference in U5 child undernutrition between EAG and non-EAG states. To fill this gap, this study used data from the fourth round of the National Family Health Survey (NFHS-4) and applied modified Blinder–Oaxaca decomposition (also known as Fairlie decomposition). This decomposition helps quantify the relative contribution of various factors explaining the gap between EAG and non-EAG states in U5 child undernutrition. In EAG states, nearly four out of ten U5 children suffered from being underweight and stunted, and one out of five suffered from wasting. The prevalence of undernutrition was relatively higher in the EAG states than in the non-EAG states. The decomposition results revealed that almost two-thirds of the gap in U5 undernutrition between EAG and Non-EAG states was explained by the variables used in the analysis. Household wealth explained about half the difference in stunting and wasting, while religion accounted for a quarter of the difference in underweight and wasting. Maternal education explained a fourth of the difference in stunting between EAG and Non-EAG states. The disparity in undernutrition between EAG and non-EAG states could be reduced by introducing suitable long- and short-term interventions and programs. Increasing access to the public distribution system (PDS), raising awareness among low-income mothers regarding optimal inter-birth intervals, proper health and hygiene, appropriate family planning, and the importance of maternal and child health care services by frontline workers (ASHAs, Anganwadi workers, etc.) could be some of the ways to bridge the gap in undernutrition between EAG and non-EAG states in the near future. © 2022 Elsevier Ltd
Economic Inequality in Intimate Partner Violence among Forward and Backward Class Women in India: A Decomposition Analysis
(Routledge, 2024) Sourav Chowdhury; Aditya Singh; Nuruzzaman Kasemi; Mahashweta Chakrabarty
Intimate partner violence (IPV) is a highly sensitive issue in India, where society is patriarchal and primarily segmented into castes/tribes. This study aims to measure and explain the economic inequality in IPV against women in two social groups: backward classes (Scheduled Castes, Scheduled Tribes, and Others Backward Classes) and forward classes (Others), using cross-sectional data from the National Family Health Survey-4 conducted in 2015–16. Economic inequality has been measured using the rate ratio, the concentration index (CI), and the concentration curve. In addition, concentration index has been decomposed to explain the economic inequality in IPV. Economic inequality was relatively higher among the women from the forward classes (CI: −0.30) than those from the backward classes (CI: −0.20). Woman’s education (25%), alcohol consumption by husbands (19.6%), and region of residence (18.7%) were the major contributors to economic inequality in IPV among backward class women. However, for forward class women, woman’s education (23.2%), region of residence (15.6%), parental IPV (14.6%), husband’s education (9.7%), and exposure to mass media were significant contributors to economic inequality in IPV (7%). In conclusion, there is a need for appropriate interventions and programs focused on reducing economic inequality in IPV against women from both backward and forward classes. © 2022 Taylor & Francis Group, LLC.
Exclusive use of hygienic menstrual absorbents among rural adolescent women in India: A geospatial analysis
(Elsevier B.V., 2022) Aditya Singh; Mahashweta Chakrabarty; Sourav Chowdhury; Shivani Singh
Objectives: Poor menstrual hygiene can contribute significantly to female morbidity, yet the use of hygienic absorbents during menstruation is considerably low among rural adolescent women. This study examines the spatial patterns of hygienic absorbent use during menstruation among rural adolescent women to identify the districts of India where it is significantly clustered. Further, it examines the factors responsible for the spatial disparity in the exclusive use of hygienic absorbents. Methods: We applied Global Moran's I to estimate the degree of spatial heterogeneity. In addition, we ran Cluster and Outlier Analysis (Anselin Local Moran's I) to locate clusters and outliers in the exclusive use of hygienic absorbents across the districts. Ordinary least squares, spatial lag, and spatial error models were used to identify the determinants of exclusive use of hygienic absorbents. Results: The Global Moran's I value for the outcome variable was 0.51, indicating a positive spatial autocorrelation in the exclusive use of hygienic absorbents. Central Indian districts had statistically significant cold spots, whereas statistically significant hot spots were discovered in south Indian districts. Our study identified that women's education, religion, social group, household wealth, mass media exposure, and women's employment status were significant determinants of the exclusive use of hygienic absorbents across Indian districts. Conclusion: There is a substantial spatial disparity in the exclusive use of hygienic absorbents among rural adolescent women in India. The use of hygienic absorbents by rural adolescent women could be encouraged through mass media campaigns, rural healthcare personnel, and free or subsidized delivery of hygienic absorbents in the identified cold spots. © 2022 The Authors
Full Antenatal Care Service Utilization Among Tribal Mothers in India: A Multilevel Analysis
(Springer Nature, 2025) Aditya P. Singh; Mahashweta Chakrabarty; Sourav Chowdhury; Vineet Kumar; Rakesh Chandra; Shivani Paratap Singh
Scheduled Tribes (ST) are one of the most disadvantaged socioeconomic groups in India, with a significant maternal mortality and morbidity burden. The coverage of full antenatal care (ANC) is low among ST mothers, leading to poor maternal and child health outcomes. We analyzed the data from the fourth round of the National Family Health Surveys (NFHS-4), conducted in 2015–2016. A multilevel binary logistic regression model was used to examine the factors associated with full ANC among ST mothers in India. Only one in every six tribal mothers in India received full ANC. Although 46% of ST mothers had four or more ANC visits and about 88% received one or more tetanus toxoid (TT) injections, only 27% consumed 100 or more iron–folic acid (IFA) tablets/equivalent amount of IFA in syrup during their pregnancy. Household wealth, maternal education, pregnancy registration, and spouse’s presence at the last ANC visit were associated with higher odds of receiving full ANC. High parity and undergoing the first ANC visit in the second or third trimester were associated with lower odds of receiving full ANC. India’s northern and central regions reveal a deplorable condition compared to southern and western regions in terms of the utilization of full ANC. To improve the coverage of full ANC, the government should prioritize reaching out to poor, illiterate, and high-parity ST women and encourage early registration of preganacy and a timely first ANC visit. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024.
Inadequate Iron–Folic Acid Consumption Among Pregnant Mothers in India: A Spatial Analysis
(Springer Nature, 2025) Aditya P. Singh; Mahashweta Chakrabarty; Sourav Chowdhury; Shivani Paratap Singh; Rakesh Chandra
Despite guidelines recommending that every expectant mother take 100 iron–folic acid (IFA) tablets or an equivalent amount of syrup for 100 days, over 70% of Indian mothers do not adhere to this recommendation. Understanding the geographical distribution of insufficient IFA intake and the factors influencing it is crucial for developing targeted prevention and intervention strategies. However, prior to this chapter, research exploring the geographic disparities in IFA consumption and its determinants in India has been limited. Therefore, this chapter aims to address this research gap by examining the spatial patterns of inadequate IFA consumption at the district level and identifying the factors explaining these district-level spatial patterns. This chapter analyzed data from 141,875 married women aged 15–49, using the fourth round of the NFHSs (2019–2021). The dependent variable, inadequate IFA, was defined as consuming fewer than the recommended 100 IFA tablets or equivalent syrup. A district-level prevalence map was prepared to assess the spatial pattern of inadequate IFA consumption. Further, spatial clustering in IFA consumption was evaluated by using Moran’s I statistic and bivariate local indicators for spatial association (BiLISA) maps. Finally, the correlates of inadequate IFA consumption were examined by using ordinary least squares, spatial lag, and spatial error models. The overall prevalence of inadequate IFA consumption in India was 70%, with substantial spatial heterogeneity across different regions, districts, and even socioeconomic groups. The statistically significant spatial autocorrelation value for inadequate IFA consumption indicated the existence of clustering in the distribution of inadequate IFA consumption across the districts of India. Further analysis revealed that several clusters of high values of inadequate IFA were concentrated primarily in the districts of empowered action group (EAG) states—i.e., Bihar, Uttar Pradesh, Madhya Pradesh, Jharkhand, and Rajasthan. BiLISA analysis revealed that the districts with high rates of inadequate IFA consumption also had high rates of poverty and illiteracy, a higher number of Scheduled Caste (SC) and Scheduled Tribe (ST) mothers, high rates of early marriage, the inadequate coverage of antenatal care (ANC), and low levels of mass-media exposure. Among the three regression models applied, the spatial error model was the best. The results of the model suggested that inadequate IFA consumption at the district level was positively associated with ANC visits and negatively associated with a respondent’s education. Considerable spatial heterogeneity exists at the district level in the consumption of inadequate IFA among expectant mothers in India. Redirecting resources to vulnerable subgroups and geographical areas that were identified as lagging in this study would be critical to ensuring equitable progress in reducing IFA deficiency-related anemia among expectant mothers across the country. In addition, appropriate interventions need to be introduced to increase the average number of ANC visits in districts where IFA consumption is substantially low. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024.
Intimate Partner Violence among Scheduled Caste Women in India: A Cross-sectional Study
(Routledge, 2024) Sourav Chowdhury; Aditya Singh; Nuruzzaman Kasemi; Mahashweta Chakrabarty; Tribarna Roy Pakhadhara
Scheduled Caste (SC) women, one of the most oppressed and neglected groups in India, have the highest prevalence of intimate partner violence (IPV), yet no study has analyzed correlates of IPV within this group, or analyzed them using nationally representative data. This study is an attempt to fill this gap. Information on 11,076 married SC women from the National Family Health Survey-4 was analyzed. Cross-sectional study design was followed. Binary logistic regression was applied to examine the factors associated with IPV. About 40% of married SC women in India suffered physical, mental, or sexual violence from their husbands. Alcohol consumption by husband (OR = 2.99, 95% CI = 2.62–3.41), employment status (OR = 1.26, 95% CI = 1.07–1.48), parity especially having 4 or more children (OR = 2.36, 95% CI = 1.82–3.06; OR = 2.10, 95% CI = 1.61–2.73) were associated with higher odds of IPV. Women from southern, eastern, and central regions of India were more likely to experience IPV. We conclude that there is a need to recognize the diverse experiences of vulnerable subgroups within SC women and undertake suitably designed targeted interventions to lower the high levels of IPV prevalent among these women. © 2022 Taylor & Francis Group, LLC.
Intra-urban differentials in the exclusive use of hygienic methods during menstruation among young women in India
(Public Library of Science, 2023) Aditya Singh; Mahashweta Chakrabarty; Rakesh Chandra; Sourav Chowdhury; Shivani Singh
Menstrual hygiene among women is a critical public health issue in urban India, but it remains understudied and under-researched. However, to our knowledge, no national level study in India has yet examined the differentials in the exclusive use of hygienic methods among young women (aged 15–24) in urban India. This study attempts to fill this gap by analysing biodemographic, socioeconomic, and geographic differentials in the exclusive use of hygienic methods among these women. We analysed data on 54561 urban women aged 15–24 from National Family Health Survey-5, 2019–21. We used binary logistic regression to examine differentials in the exclusive use of hygienic methods. To examine spatial variation, we mapped exclusive use of hygienic methods across Indian states and districts. The study found that two-thirds of young women in urban India reported exclusive use of hygienic methods. However, there was significant geographic heterogeneity observed at both state and district levels. In states such as Mizoram and Tamil Nadu, the use of hygienic methods was over 90%, while in Uttar Pradesh, Bihar, Chhattisgarh, and Manipur, it was less than 50%. The district-level variation in exclusive use of hygienic methods was even more striking. In many states, districts with extremely low exclusive use (less than 30%) were located in close proximity to districts with high exclusive use. Being poor, uneducated, Muslim, having no mass media exposure, living in the north and central regions, not having a mobile phone, getting married before 18, and having an early experience of menarche were associated with lower exclusive use of hygienic methods. In conclusion, substantial biodemographic, socioeconomic, and geographic differentials in the exclusive use of hygienic methods suggest the need for context-specific behavioural interventions. Mass media campaigns and targeted distribution of subsidized hygienic methods could help reduce the existing inequities in the exclusive use of hygienic methods. © 2023 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Is the burden of anaemia among Indian adolescent women increasing? Evidence from Indian Demographic and Health Surveys (2015-21)
(Public Library of Science, 2023) Mahashweta Chakrabarty; Aditya Singh; Shivani Singh; Sourav Chowdhury
Anaemia is a significant public health issue, particularly affecting women in India. However, little is known about the burden of anaemia among adolescent women in India over time. This study aimed to analyse the change in the prevalence of anaemia among adolescent women in India from 2015 to 2021 and identify the factors associated with anaemia in this population. This study used information on 116,117 and 109,400 adolescent women (aged 15-19) from the fourth and fifth round of National Family Health Survey, respectively. Bivariate statistics and multivariable logistic regression were employed to identify the statistically significant predictors of anaemia. The prevalence of anaemia among adolescent women in India increased from 54.2% (99% CI: 53.6-54.8) to 58.9% (99% CI: 58.3-59.5) over the study period (2015-16 to 2019-21). Among the 28 Indian states, 21 reported an increase in the prevalence of anaemia. However, the levels of increase varied across the states. While Assam, Chhattisgarh, and Tripura showed a substantial rise of 15 percentage points, the states of Punjab, Karnataka, Telangana, Bihar, and Madhya Pradesh recorded a marginal increase of less than 5 percentage points. Notably, Uttarakhand and Kerala exhibited a decline in anaemia prevalence during the study period. Additionally, the number of states with anaemia prevalence exceeding 60%, doubled from 5 in 2015-16 to 11 in 2019-21. Several factors were found associated with anaemia, including having more than one child (AOR: 1.33, 99% CI: 1.16-1.51), having no education (AOR: 1.25, 99% CI: 1.16-1.34), belonging to Scheduled Tribes (AOR: 1.47, 99% CI: 1.40-1.53), being in the lowest wealth quintile (AOR: 1.17, 99% CI: 1.12-1.23), year of survey (AOR: 1.26, 99% CI: 1.23-1.29), and being underweight (AOR: 1.10, 99% CI: 1.07-1.12). In conclusion, the rise in anaemia prevalence among adolescent women in India suggests the need for targeted interventions to mitigate the burden of anaemia and enhance the overall health of this population. © 2023 Chakrabarty et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study
(BioMed Central Ltd, 2022) Aditya Singh; Mahashweta Chakrabarty; Shivani Singh; Rakesh Chandra; Sourav Chowdhury; Anshika Singh
Background: Exclusive use of hygienic methods (sanitary napkins, locally prepared napkins, tampons, and menstrual cups) to prevent the visibility of bloodstains during menstruation is still considerably low among adolescent women in rural India. However, no prior research has explored the prevalence and determinants of exclusive hygienic methods among rural Indian adolescent women. To address this gap, this study examines the factors affecting adolescent women’s exclusive use of hygienic methods in rural India. Additionally, this study explores state- and district-level geographical disparities in the exclusive use of hygienic methods among adolescent women in rural India. Methods: Information on 95,551 adolescent women from rural India from the latest round of National Family Health Survey (NFHS-5) was analyzed. Bivariate statistics and multilevel logistic regression analysis were used to assess the Individual- and community-level factors associated with exclusive use of hygienic methods among adolescent women in rural India. Choropleth maps were used to discern the geographical disparities in the exclusive use of hygienic methods. Results: In rural India, only 42% of adolescent women exclusively used hygienic methods, with substantial geographic disparities at the state and district levels. At the state level, the exclusive use of hygienic methods varied from 23% in Uttar Pradesh to 85% in Tamil Nadu. Even greater variation was observed at the district level. There was a clear north-south divide in the exclusive use of hygienic methods among adolescent women in rural India. The results of multilevel logistic regression indicated a considerable amount of variation in the exclusive use of hygienic methods at community level which further reduced when controlled for individual and community-level factors. Rural Indian adolescent women with higher education (AOR:3.20, 95% CI: 2.81–3.64), from general category (AOR: 1.14, 95% CI: 1.07–1.21), with medium mass media exposure (AOR: 1.43, 95% CI: 1.35–1.51), and from richest wealth quintile (AOR: 3.98, 95% CI: 3.69–4.30) were more likely to use hygienic methods exclusively. Conclusion: Wide differential across biodemographic and socioeconomic groups, and substantial geographic disparities at state- and district-level in the exclusive use of hygienic methods suggests a need to adopt context-specific interventions for adolescent women in rural India. Distribution of subsidized or free menstrual hygiene methods to disadvantaged adolescent women, and in the low-prevalence districts may increase the level of exclusive use of hygienic methods remarkably. © 2022, The Author(s).
Menstrual Irregularities Among Women: A Literature Review
(Springer Nature, 2025) Mahashweta Chakrabarty; Subhojit Let; Sourav Chowdhury; Vineet Kumar
Menstrual cycles are considered irregular when their duration is less than 21 days or more than 35 days, and they are characterized by unusually light or heavy bleeding. These irregularities are typically caused by hormonal imbalances, which alter the menstrual pattern and are associated with various health conditions. Given these implications, irregular menstruation is a significant indicator of women’s overall health. This review aims to clarify the definitions and types of menstrual irregularities, discuss their prevalence, identify risk factors, and explore their broader impact on women’s health. A thorough search of the PubMed, Medline, and Google Scholar databases was performed. The study included articles published in English from 2015 to 2023, focusing on the epidemiology and health impacts of menstrual irregularities. Articles that were reviews or duplicates were excluded to ensure data accuracy and integrity. This review highlighted that irregular menstrual cycles are linked to various health conditions, such as metabolic syndrome, type 2 diabetes, coronary heart disease, and rheumatoid arthritis. These irregularities can also lead to complications like anemia, osteoporosis, psychological challenges, diminished quality of life, and infertility. Additionally, menstrual irregularities increase the risk of hypertensive disorders during pregnancy and adverse obstetric and neonatal outcomes. Understanding the factors contributing to menstrual irregularities is crucial for developing preventive measures and treatment strategies. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024.
Short birth interval and associated factors in rural India: A cross-sectional study
(Cambridge University Press, 2023) Sourav Chowdhury; Aditya Singh; Nuruzzaman Kasemi; Mahashweta Chakrabarty; Shivani Singh
Short Birth Interval (SBI) is one of the main causes of adverse maternal and child health outcomes. A 33-month birth-to-birth interval between two successive live births should be followed to minimize the risk of adverse maternal and child health. This study aimed to examine the prevalence of SBI and the associated factors in rural India. Information on 98,522 rural mothers from the fourth round of National Family Health Survey data was analyzed. Bivariate statistics, logistic regression, Moran’s I, and Cluster and Outlier Analysis have been used to assess the prevalence and spatial pattern of SBI in rural India. Results revealed that about half of the mothers in rural India had experienced SBI. Rural Indian mothers whose child was not alive (OR = 1.76, 95% CI = 1.63–1.90), were not using any contraceptive methods (OR = 1.42, 95 % CI = 1.37–1.48) and not breastfeeding (OR = 2.73, 95% CI = 2.50–2.97) were more likely to experience SBI. On the other hand, rural mothers from the middle, richer and richest wealth quintiles (OR = 0.91, 95% CI = 0.86–0.97; OR = 0.84, 95% CI = 0.80–0.92; OR = 0.60, 95% CI = 0.55–0.66) and of age over 30 years (OR = 0.38., 95% CI = 0.36–0.39) were less likely to experience SBI. Analysis of spatial patterns revealed clear east-west differences in the prevalence of SBI. There was strong clustering of high values of SBI in most districts across the central, northern, western, and southern regions. The study suggests the need to introduce appropriate interventions and programs focused on reducing the prevalence of SBI in rural India. © The Author(s), 2022.
Utilization of full antenatal care among Scheduled Caste mothers in India, 2015–2021
(BioMed Central Ltd, 2025) Vineet Kumar; Aditya P. Singh; Harpreet Singh; Sumit Ram; Ananya Kundu; Sourav Chowdhury
Background: Despite the well-documented benefits of full ANC- which includes at least four visits starting in the first trimester, two or more tetanus shots, and over 100 days of iron-folic acid (IFA) supplementation coverage remains alarmingly low, particularly among socioeconomically disadvantaged Scheduled Caste (SC) mothers. However, there is a dearth of research focusing specifically on this population. Therefore, this study aims to investigate the change in the coverage of full ANC and its determinants among SC mothers in India. Methods: Using data from the two latest rounds of the National Family Health Survey (2015-16 and 2019-21), a pooled sample of 51,705 SC mothers was analysed. Bivariate statistics was used to assess the significance of association between full ANC utilisation and the independent characteristics. Furthermore, to investigates the net effect of the predictor variables on the receipt of full ANC, multivariable binary logistic regression was applied. Results: The coverage of full ANC in India increased from 20.7% in 2015-16 to 26.9% in 2019-21. While there were substantial gains in the coverage of ANC within the 1st trimester (68.4–74.8%) and IFA (39.1–48.6%), the coverage of two or more tetanus toxoid injections (87.1–85.2%) and 4 or more ANC visits (63.6–62.4%) registered a slight decline. Among the states, West Bengal (16.4% in NFHS-4 to 45.1% in NFHS-5) experienced the largest gain, while Gujarat had the lowest increase, 41.2% in NFHS-4 to 40.9% in NFHS-5. In South India, Kerala (59.9–75.4%) and Tamil Nadu (35.8–56.1%) saw substantial increases of 15–20 percentage points (PP), whereas Karnataka and Andhra Pradesh experienced marginal declines of 1–3PP. Rajasthan (10.0–21.0%), Madhya Pradesh (11.3–27.2%), Uttarakhand (8.7–21.4%), and Odisha (18.7–40.1%) witnessed substantial gains of 11–22 PP, while Bihar, Uttar Pradesh, Jharkhand, and Chhattisgarh had more modest increases of 1–5 PP. Mothers aged 40–44 years (Adjusted Odds Ratio: 2.18, 95% CI: 1.61–2.95), those with higher education (1.64, 1.44–1.87), and those from rich households (1.49, 1.34–1.66) were significantly more likely to receive full ANC compared to women aged 15–19 years, those with no education, and those from poor households, respectively. Similarly, women residing in the southern region (2.19, 1.99–2.41) and those with high exposure to mass media (1.53, 1.38–1.69) were more likely to receive full ANC compared to women residing in the northern region and those with no exposure to mass media, respectively. Conversely, multiparous mothers (0.57, 0.52–0.63) and women residing in rural areas (0.88, 0.81–0.95) were less likely to receive full ANC compared to women with only one parity and those residing in urban areas, respectively. Conclusions: While national coverage of full ANC has improved, significant gaps remain, particularly in states in northern, central, and northeastern India. To achieve equitable coverage, it is crucial to prioritize vulnerable groups within the SC community, such as young, impoverished, uneducated, and rural mothers. Additionally, leveraging mass media campaigns and strengthening the role of frontline healthcare workers could be effective strategies to enhance full ANC utilization among SC mothers. © The Author(s) 2025.
Wealth-based inequality in the exclusive use of hygienic materials during menstruation among young women in urban India
(Public Library of Science, 2022) Aditya Singh; Mahashweta Chakrabarty; Shivani Singh; Diwakar Mohan; Rakesh Chandra; Sourav Chowdhury
Background The exclusive use of hygienic materials during menstruation (sanitary napkins, locally made napkins, tampons, and menstrual cups) among urban women in India has been increasing over time. However, little is known about the wealth-based disparity in the exclusive use of hygienic materials during menstruation among these women. This study, therefore, measures wealth-based inequality in the exclusive use of hygienic materials during menstruation among urban women in India. Furthermore, the measured inequality is decomposed to unravel its contributing factors. Data and methods Using data from the National Family Health Survey-5 (2019–21), we calculated the Erreygers normalized concentration index (CI) for India and each of its states to measure wealth-based inequality in the exclusive use of hygienic materials during menstruation among women in urban India. Further, we decomposed the Erreygers CI to estimate the relative contribution of covariates to wealth-based inequality in the exclusive use of hygienic materials during menstruation. The analysis included 54,561 urban women aged 15–24 from 28 states and eight union territories of India. Results The Erreygers CI value of 0.302 indicated a pro-rich inequality in the exclusive use of hygienic materials among urban women in India. While all the states and UTs showed pro-rich inequality, the CI varied considerably across the country. Among the bigger states, the inequality was highest in Madhya Pradesh (CI: 0.45), Assam (CI: 0.44), Bihar (CI: 0.41), and West Bengal (CI: 0.37) and the lowest in the south Indian states of Tamil Nadu (CI: 0.10), Andhra Pradesh (CI: 0.15), Telangana (CI: 0.15), and Kerala (CI: 0.20). Erreygers decomposition revealed that wealth-based inequality in women’s education and mass media exposure contributed almost 80% of the wealth-based inequality in the exclusive use of hygienic materials during menstruation among urban women in India. Conclusion Substantial pro-rich inequality in the exclusive use of hygienic materials suggests that the policies and program initiatives should prioritize reaching out to poor women to increase the overall rate of exclusive use of hygienic materials during menstruation in urban India. Copyright: © 2022 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.