2025
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PublicationArticle Association between flood-prone geographies and incomplete ANC in India: Implications for equitable maternal care access(Elsevier Ltd, 2025) Rakesh Chandra; Jeetendra Kumar Patel; Sonal Srivastava; Saradiya Mukherjee; Aditya P. SinghThis study examines the association between floods and incomplete antenatal care (ANC) visits in India to assess the impact of floods on ANC utilization, particulary among vulnerable groups. Data from the National Family Health Survey (2019–20) and Vulnerability Atlas of India (2019) were used and merged to create individual-level data. Binary logistic regression was employed to analyze the odds of incomplete ANC visits, adjusting for relevant variables. Interaction terms were incorporated to investigate the moderating effects of wealth (poor and non-poor) and social groups [Scheduled Caste (SC)/Scheduled Tribes (ST) and non-SC/ST]. Flood-prone districts showed a 50 % higher likelihood of incomplete ANC visits. When examining the interaction effects, wealth was found to be insignificant in flood-prone regions. Women from SC/ST households in flood-prone areas were two times more likely to have incomplete ANC visits compared to the rest. Floods have a significant association with poor ANC utilization in India. The heightened odds of incomplete ANC visits in flood-prone districts underscore the need for targeted interventions. Moreover, the amplified disparity between SC/ST and non-SC/ST women in flood-prone areas emphasizes the urgency of addressing inequities. We suggest policymakers and healthcare providers to develop inclusive strategies that ensure equitable access to maternal healthcare amid the increasing risks posed by floods and other extreme events associated with climate change, with a strong emphasis on effectively prioritizing vulnerable populations. © 2025 The AuthorsPublicationBook Chapter 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 SinghScheduled 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.PublicationBook Chapter 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 ChandraDespite 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.PublicationArticle WASH, Women, and Violence: Investigating the Associations Between Households’ Access to WASH Facilities and Intimate Partner Violence in India(SAGE Publications Inc., 2025) Rakesh Chandra; Ajay Dutta; Sonal Srivastava; Saradiya Mukherjee; Aditya P. SinghPoor access to water, sanitation, and hygiene (WASH) facilities heightens women's vulnerability to partnered and non-partnered violence and disproportionately impacts their health and well-being. However, no national-level study in India explores the links between WASH access and violence against women. This research examines household WASH access and its connection with intimate partner violence (IPV) against women in India. Utilizing 46,667 married women samples from National Family Health Survey (NFHS)-5 pan-India survey, the study analyses association of IPV with WASH indicators alongside other socio-economic variables. All WASH indicators in the study significantly associate with IPV, emphasizing an urgent need for gender-sensitive WASH research and policymaking. © The Author(s) 2025PublicationArticle Understanding the drivers of urban–rural divide in women’s internet use in India: a decomposition approach(Springer Nature, 2025) Anshika Singh; Rakesh Chandra; Aditya P. Singh; Utkarsh Jain; Shivani Paratap SinghDespite SDG 9’s target of universal internet access, many women, particularly in rural India, remain offline. While digital infrastructure has expanded rapidly, sharp rural–urban disparities in women’s internet use persist, with limited research on their scale and drivers. This study addresses that gap by analysing the determinants of rural–urban differences in women’s internet use in India. We used nationally representative data from the fifth round of the National Family Health Survey (2019–21). The analysis included 1,03,119 women aged 15–49 (25,483 urban; 77,636 rural). Logistic regression identified predictors of internet use, while Fairlie decomposition quantified contributions to the rural–urban gap. Overall, 33% of women in India use the internet, with higher prevalence in urban (51.7%) than rural (24.8%) areas. Goa has the highest rural prevalence and West Bengal the lowest; in urban areas, Sikkim leads and Andhra Pradesh lags. The rural–urban gap is widest in Mizoram, Jharkhand, and Himachal Pradesh, but narrowest in Goa, Kerala, and Manipur. Education and household wealth are strong predictors of women’s internet use, with educated women and those from wealthier households more likely to be online. Decomposition analysis shows that wealth (67.4%), education (25.8%), and social group (4.5%) are the major contributors to the rural–urban gap. A pronounced rural–urban digital divide persists among Indian women, driven mainly by wealth, education, and social group. Addressing this gap requires policies that strengthen rural digital infrastructure and economic opportunities, alongside education and digital literacy initiatives. Targeted measures for disadvantaged social groups will further promote equitable and inclusive internet use. © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2025.PublicationArticle Examining the unfair concentration of non-institutional deliveries among poor households in India: a study of predictors and wealth-based inequality(BioMed Central Ltd, 2025) Rakesh Chandra; Jeetendra Kumar Patel; Sonal Srivastava; Saradiya Mukherjee; Aditya P. SinghBackground: Non-institutional deliveries, defined as childbirth outside healthcare facilities, remain a significant global concern. It poses serious maternal and child health problems and significantly contributes to maternal and infant mortality. India witnessed a sustained decrease in non-institutional deliveries in thepast 20 years. However, the rate of decline has tapered recently while the country still has a sizeable number of women delivering out of the facility. To better understand the enduring proportions of non-institutional deliveries, this study preliminarily analyses its predictors. The prime objective of the study is to unravel the inequality in the prevalence of non-institutional deliveries and understand if they are unfairly concentrated among certain households in India. It also aims to provide policy-relevant insights into the socioeconomic factors contributing to its concentration among specific households and their implications for maternal and child health. Methodology: Using the National Family Health Survey-5 (NFHS-5) data (N = 1,75,569 deliveries), we developed a regression model to understand the existing non-institutional deliveries and their predictors. We employed the Erreygers’ Concentration Index (ECI) to quantify the degree of concentration (inequality) of non-institutional deliveries among households. Furthermore, a decomposition analysis was run to analyse the factors contributing to the concentration of non-institutional deliveries in a particular groups of households. It breaks down the overall inequality at population level into its constituent parts to identify the sources of inequality. This approach helps discover prime causes of inequality, such as differences in income, education, or other relevant factors. Findings: Out of the total sampled deliveries in the reference period, around 14% were non-institutional. Inequality analysis (ECI=-0.2174; p-value < 0.0001) suggests that non-institutional deliveries were unequally and unfairly concentrated in low-income households. The concentration of non-institutional deliveries in poor households was majorly contributed by factors like education (13.85%), wealth (13.91%), mass media exposure (12.27%) region (9.76%), birth order (3.17%), distance to health facilities (2.77%), caste (2.82%), timing of first ANC visit (1.07%), and women considering having to take transport as a problem (1.60%). Conclusions: This research employs inequality analyses of non-institutional deliveries and contributes to the existing literature by establishing its unfair concentration among poor households in India. It expands our understanding of the factors driving non-institutional deliveries among the disadvantaged. The findings highlight the importance of targeted interventions and policies to reduce the concentration of last-mile non-institutional deliveries among vulnerable women living in marginalized households. © The Author(s) 2025.