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PublicationBook 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.PublicationBook Chapter Menstrual Irregularities Among Women: A Literature Review(Springer Nature, 2025) Mahashweta Chakrabarty; Subhojit Let; Sourav Chowdhury; Vineet KumarMenstrual 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.PublicationArticle 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 ChakrabartyIntimate 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.PublicationArticle 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 PakhadharaScheduled 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.PublicationArticle Wealth-based disparities in the prevalence of short birth interval in India: insights from NFHS-5(BioMed Central Ltd, 2024) Aditya Singh; Anshika Singh; Mahashweta Chakrabarty; Shivani Singh; Pooja TripathiBackground: Short birth interval (SBI) has profound implications for the health of both mothers and children, yet there remains a notable dearth of studies addressing wealth-based inequality in SBI and its associated factors in India. This study aims to address this gap by investigating wealth-based disparities in SBI and identifying the underlying factors associated with SBI in India. Methods: We used information on 109,439 women of reproductive age (15–49 years) from the fifth round of the National Family Health Survey (2019-21). We assessed wealth-based inequality in SBI for India and its states using the Erreygers Normalised Concentration Index (ECI). Additionally, we used a multilevel binary logistic regression to assess the factors associated with SBI in India. Results: In India, the prevalence of SBI was 47.8% [95% CI: 47.4, 48.3] during 2019-21, with significant variation across states. Bihar reported the highest prevalence of SBI at 61.2%, while Sikkim the lowest at 18.1%. SBI prevalence was higher among poorer mothers compared to richer ones (Richest: 33.8% vs. Poorest: 52.9%). This wealth-based inequality was visible in the ECI as well (ECI= -0.13, p < 0.001). However, ECI varied considerably across the states. Gujarat, Punjab, and Manipur exhibited the highest levels of wealth-based inequality (ECI= -0.28, p < 0.001), whereas Kerala showed minimal wealth-based inequality (ECI= -0.01, p = 0.643). Multilevel logistic regression analysis identified several factors associated with SBI. Mothers aged 15–24 (OR: 12.01, p < 0.001) and 25–34 (2.92, < 0.001) were more likely to experience SBI. Women who married after age 25 (3.17, < 0.001) and those belonging to Scheduled Caste (1.18, < 0.001), Scheduled Tribes (1.14, < 0.001), and Other Backward Classes (1.12, < 0.001) also had higher odds of SBI. Additionally, the odds of SBI were higher among mothers in the poorest (1.97, < 0.001), poorer (1.73, < 0.001), middle (1.62, < 0.001), and richer (1.39, < 0.001) quintiles compared to the richest quintile. Women whose last child had passed away were also significantly more likely to have SBI (2.35, < 0.001). Furthermore, mothers from communities with lower average schooling levels (1.18, < 0.001) were more likely to have SBI. Geographically, mothers from eastern (0.67, < 0.001) and northeastern (0.44, < 0.001) regions of India were less likely to have SBI. Conclusion: The significant wealth-based inequality in SBI in India highlights the need for targeted interventions focusing on economically disadvantaged women, particularly in states with high SBI prevalence. Special attention should be given to younger mothers and those from socially disadvantaged groups to enhance maternal and child health outcomes across the country. © The Author(s) 2024.PublicationArticle Prevalence and determinants of anaemia among women of reproductive age in Aspirational Districts of India: an analysis of NFHS 4 and NFHS 5 data(BioMed Central Ltd, 2024) Subhojit Let; Seema Tiwari; Aditya Singh; Mahashweta ChakrabartyBackground: Over one-third of women worldwide suffer from anaemia. The prevalence of anaemia is particularly pronounced among women of reproductive age (WRA) in developing countries, such as India. No prior study has ever exclusively studied the prevalence of anaemia across the Aspirational Districts of India. Therefore, the purpose of this study was to examine the prevalence of anaemia across Aspirational Districts of India and to identify the determinants of anaemia among WRA in these districts. Methods: From the National Family Health Survey (NFHS)-4 (2015-16) and NFHS-5 (2019-21), data on 114,444 and 108,782 women aged 15–49 from Aspirational Districts were analyzed in our study, respectively. Bivariate statistics and multivariable binary logistic regression were used to identify the determinants of anaemia. Results: The national prevalence of anaemia among WRA has increased from 53% in NFHS-4 to 57% in NFHS-5 whereas anaemia among WRA in Aspirational Districts has increased from 58.7% in NFHS-4 to 61.1% in NFHS-5. Between 2015 and 2021, over 60% of Aspirational Districts experienced an increase in the prevalence of anaemia and one-fourth, specifically 29 out of 112, observed a rise by at least 10 percentage points (pp). Notably, there are significant variations in anaemia prevalence among districts, with Simdega and Udalgiri having the highest anaemia prevalence in NFHS-4 and NFHS-5 at 78.2% and 81.5%, respectively. During this period, Barpeta followed by Udalgiri of Assam have witnessed the maximum increase with 29.4% and 26.7% respectively. Moreover, pooled regression results show women with three to four children [AOR: 1.13, 95% CI: 1.08–1.17], women who breastfeed [AOR: 1.17, 95% CI: 1.13–1.20], Scheduled Tribe women [AOR: 1.39, 95% CI: 1.35–1.44], poorest women [AOR: 1.27, 95% CI: 1.22–1.33] and women those who consume fish occasionally [AOR: 1.14, 95% CI: 1.12–1.17] were more likely to be anaemic. Conclusion: The significant increase in anaemia among WRA in Aspirational Districts of India is a matter of concern. Given the rise in anaemia among WRA, determinants-based and district-specific measures must be designed and implemented to reduce the prevalence of anaemia among Aspirational Districts of India. © The Author(s) 2024.PublicationArticle Spatial heterogeneity in unintended pregnancy and its determinants in India(BioMed Central Ltd, 2024) Anshika Singh; Mahashweta Chakrabarty; Aditya Singh; Shivani Singh; Rakesh Chandra; Pooja TripathiBackground: Understanding the geographic variation of unintended pregnancy is crucial for informing tailored policies and programs to improve maternal and child health outcomes. Although spatial analyses of unintended pregnancy have been conducted in several developing countries, such research is lacking in India. This study addresses this gap by investigating the geographic distribution and determinants of unintended pregnancy in India. Methods: We analysed data from the National Family Health Survey-5 encompassing 232,920 pregnancies occurring between 2014 and 2021 in India. We conducted a spatial analysis to investigate the distribution of unintended pregnancies at both state and district levels using choropleth maps. To assess spatial autocorrelation, Global Moran’s I statistic was employed. Cluster and outlier analysis techniques were then utilized to identify significant clusters of unintended pregnancies across India. Furthermore, we employed Spatial Lag Model (SLM) and Spatial Error Model (SEM) to investigate the factors influencing the occurrence of unintended pregnancies within districts. Results: The national rate of unintended pregnancy in India is approximately 9.1%, but this rate varies significantly between different states and districts of India. The rate exceeded 10% in the states situated in the northern plain such as Haryana, Delhi, Uttar Pradesh, Bihar, and West Bengal, as well as in the Himalayan states of Himachal Pradesh, Uttarakhand, Sikkim, and Arunachal Pradesh. Moreover, within these states, numerous districts reported rates exceeding 15%. The results of Global Moran’s I indicated a statistically significant geographical clustering of unintended pregnancy rates at the district level, with a coefficient of 0.47 (p < 0.01). Cluster and outlier analysis further identified three major high-high clusters, predominantly located in the districts of Arunachal Pradesh, northern West Bengal, Bihar, western Uttar Pradesh, Haryana, Delhi, alongside a few smaller clusters in Odisha, Madhya Pradesh, Uttarakhand, and Himachal Pradesh. This geographic clustering of unintended pregnancy may be attributed to factors such as unmet needs for family planning, preferences for smaller family sizes, or the desire for male children. Results from the SEM underscored that parity and use of modern contraceptive were statistically significant predictors of unintended pregnancy at the district level. Conclusion: Our analysis of comprehensive, nationally representative data from NFHS-5 in India reveals significant geographical disparities in unintended pregnancies, evident at both state and district levels. These findings underscore the critical importance of targeted policy interventions, particularly in geographical hotspots, to effectively reduce unintended pregnancy rates and can contribute significantly to improving reproductive health outcomes across the country. © The Author(s) 2024.PublicationArticle 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 SinghIn 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 LtdPublicationArticle Spatial heterogeneity in the exclusive use of hygienic materials during menstruation among women in urban India(PeerJ Inc., 2023) Aditya Singh; Mahashweta ChakrabartyBackground. Menstrual hygiene is essential for women to live with dignity. However, a large proportion of Indian women still suffer from unhygienic menstrual practices leading to reproductive tract infections. To understand the socioeconomic and biodemographic determinants of menstrual hygiene practices, various national or local level studies have been conducted in India and around the world, however, no previous study has tried to understand the spatial heterogeneity across Indian districts in the use of hygienic materials among young urban women. Methods. This study used data from 54,561 urban women aged 15–24 from the National Family Health Survey-5. Global Moran’s I was applied to assess the degree of spatial autocorrelation and cluster and outlier analyses to locate hot-spots and clod-spots in the exclusive use of hygienic materials across the districts. Ordinary least square, spatial lag, and error models were used to identify determinants of exclusive use of hygienic materials. Results. Approximately 66.8% of urban women exclusively use of hygienic materials which varied across districts. Global Moran’s I of 0.46 indicated positive spatial autocorrelation in the outcome. Cluster and outlier analysis revealed cold-spots in central Indian districts and hotspots in south Indian districts. Results of spatial error model identified women’s years of schooling, marital status, social group, and household wealth were major determinants of the exclusive use of hygienic materials among urban women across Indian districts. Conclusion. Substantial spatial heterogeneity in the outcome among urban women in India suggests the need to design targeted and context-specific behavioural interventions and programs for women in urban India. Copyright 2023 Singh et al.