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Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of 'motility' (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes. [ABSTRACT FROM AUTHOR]

Background: This paper explores the heterogeneities in antenatal care (ANC) utilization in India's most populated state, Uttar Pradesh. Taking an intersectionality lens, multiple individual- and district-level factors are used to identify segments of any antenatal care usage in Uttar Pradesh Objective: This paper seeks to understand the multilevel contexts of ANC utilization. The planning and programming challenge is that such knowledge of contextual specificity is rarely known upfront at the initial stages of planning or implementing an intervention. Exploratory data analysis might be needed to identify such contextual specificity. Methods: Tree-structured regression methods are used to identify segments and interactions between factors. The results from the tree-structured regression were complemented with multilevel models that controlled for the clustering of individuals within districts. Results: Heterogeneities in utilization of any ANC were observed. The multiple segments of ANC utilization that were developed went from a low utilization of 23.7% for respondents who were not literate and did not have home ownership to a high of 82.4% for respondents who were literate and at the highest level of wealth. Key variables that helped define the segments of ANC utilization include: woman's literacy, ownership of home, wealth index, and district-level sex ratio. Based on the multilevel model of any ANC utilization, cross-level interactions also were obtained between sex ratio and ownership of home as well as between sex ratio and literacy. Increases in sex ratio increased the influence of ownership of home on any ANC, while increases in sex ratio reduced the impact of woman's literacy on receiving any ANC. Conclusion: We argue that a focus on heterogeneous segments of utilization can help build knowledge of the mechanisms that underlie inequities in maternal health utilization. Such knowledge of heterogeneity needs to be incorporated in contextualizing interventions to meet a variety of recipients' needs. [ABSTRACT FROM AUTHOR]

There is limited research in India to understand young people's decision-making processes about intimate relationships before marriage. This paper, adopting a life course perspective, explains relationship choices and diachronic trajectories of relationships from adolescence to young adulthood. Retrospective data were collected from 1240 never married 20–29-year-old men and women living in Pune using a relationships history calendar. All the relationships from 10 years of age onwards were plotted on the calendar, and information on predictor variables was collected through structured questionnaires. Data were analysed using descriptive statistics. Sequence analysis approach was used to identify different typologies. Overall, 76% of the participants reported having at least one relationship. More women compared to men (84% vs 70%) ever had a relationship. The median age of starting the first relationship was 17 years for women and 18 for men. Different relationship types were reported, such as "serious", casual, "friends with benefit", and "exploring". The level of emotional involvement, commitment, and physical intimacy significantly differed in different relationship types with significant gender differences. Four typologies of relationships were observed, labelled as (1) Commitment–No sex (N = 187); (2) Commitment–Sex-Some exploration (N = 189); (3) No commitment–Exploration (N = 281), and (4) No relationship (N = 583). Compared to men, women were more likely to follow the trajectory of "Commitment-No sex" (RR 2.13, CI 1.5–3.03). Family environment was significantly related to young people's relationship choices. The findings strongly suggest the need to adopt a developmental perspective towards intimate relationships to understand and address the vulnerabilities of young people across the life course. [ABSTRACT FROM AUTHOR]

At the foundation of most inequalities in expression of sexuality lie social constructions of gender. In this paper, sex education is considered as a possibility to challenge sexism and promote healthy and self-affirmative sex lives. In the past decade, the discourse of sex education in India has become a ‘battle of morality’ where concerned citizens condemn sex education on the grounds it may encourage sexual activity and immoral conduct (e.g. promiscuity or infidelity). The work of non-governmental organisations (NGOs) is an alternative to the governmental national curriculum plan. This paper discusses NGO potential in terms of sexual empowerment by examining beliefs and understanding, choices of information, strategies and methods, and approaches apparent in sex education programmes and projects. Through qualitative data, findings were analysed by constructing a sexual empowerment model that divides components of sex education into four parts and utilises theories of empowerment. The main findings include that all four components of sex education – foundation, content, strategies and approaches – show great potential to challenge gender inequalities in regard to sexuality. Sexual health programmes and projects are seen to be highly participatory, deliberative and encouraging of critical thinking. Some concerns are highlighted: the strong focus on girls as the main actors of change, and external limitations such as parents and institutions. [ABSTRACT FROM PUBLISHER]

Background: Millennium Development Goal (MDG) 5 is focused on reducing maternal mortality and achieving universal access to reproductive health care. India has made extensive efforts to achieve MDG 5 and in some regions much progress has been achieved. Progress has been uneven and inequitable however, and many women still lack access to maternal and reproductive health care. Objective: In this review, a framework developed by the Commission on Social Determinants of Health (CSDH) is used to categorize and explain determinants of inequity in maternal and reproductive health in India. Design: A review of peer-reviewed, published literature was conducted using the electronic databases PubMed and Popline. The search was performed using a carefully developed list of search terms designed to capture published papers from India on: 1) maternal and reproductive health, and 2) equity, including disadvantaged populations. A matrix was developed to sort the relevant information, which was extracted and categorized based on the CSDH framework. In this way, the main sources of inequity in maternal and reproductive health in India and their inter-relationships were determined. Results: Five main structural determinants emerged from the analysis as important in understanding equity in India: economic status, gender, education, social status (registered caste or tribe), and age (adolescents). These five determinants were found to be closely interrelated, a feature which was reflected in the literature. Conclusion: In India, economic status, gender, and social status are all closely interrelated when influencing use of and access to maternal and reproductive health care. Appropriate attention should be given to how these social determinants interplay in generating and sustaining inequity when designing policies and programs to reach equitable progress toward improved maternal and reproductive health. [ABSTRACT FROM AUTHOR]

. Indian subcontinent exhibits considerable degree of ethnic heterogeneity in cardiovascular disease (CVD) risks. Given the importance of ethnicity, the present multi-ethnic study was conducted to find out the differences in body composition patterning and its influence on CVD risk variables.. Owing to considerable ethnic heterogeneity among Asian Indians the study was performed to determine the association of variability between body composition and CVD risk factors at the micro-level among different tribes by sex, province, and generation Nine tribes from three different states (provinces) were considered. Anthropometric measurements, body composition, adiposity, blood pressure, and fasting blood glucose was measured using standard technique. Body composition was measured using BIA method by means of body fat monitor. Mean differences of the body composition measures were analysed by ANOVA. Stepwise multiple regressions were done with CVD risk variables as dependent and body composition profiles as independent variables to find out the significant predictors. Those were then loaded for principal component factor analyses (PCFA).. Tribal subjects of both sexes and from both younger and older generations in Gujarat had significantly higher percentage body fat, subcutaneous fat-whole body, and subcutaneous fat-trunk as compared to tribal subjects of Odisha, and West Bengal, as well as significantly lower skeletal mass-whole body and skeletal mass-trunk. PCFA showed two components: (i) percentage body fat with muscle mass; and (ii) visceral fat with resting metabolism. These two components cumulatively explained 80–90% of the total variance associated with CVD risk variables, across the nine tribes.. Tribal subjects of Gujarat had higher CVD risks with significantly higher fat mass and lower muscle mass followed by the tribal subjects of Odisha, and West Bengal respectively. The younger generation are equally at risk as their older counterparts. The CVD risks are developing at a much faster rate resulting in a serious public health threat, even in traditional societies. Body composition measures could be considered as a better non-invasive technique for early intervention and proper risk management among the Asian Indians in general and tribal populations in particular. [ABSTRACT FROM AUTHOR]

We attempt a gendered inspection of sex differentials in care following stroke in India using data from two rounds of NSSO. While almost all men and women receive allopathic care, a higher percentage of women (51.8%) were treated in public hospitals compared to men (32.6%) in 2014 and 2017–18 (45.8% vs 41.4%). Men were preponderantly treated in private hospitals (67.4%) compared to women (48.2%) in 2014 and 2017–18 (58.6% vs 54.2%). We provide evidence that for rehabilitation, at the highest decile for expenditure, men spend more than women. This preliminary exploration is indicative of a gendered dimension in care-seeking for stroke. [ABSTRACT FROM AUTHOR]

In India, the "feminization of aging" is one of the areas in which prejudice most frequently occurs. Noticeably, poverty, isolation, changes in residential care, and weak institutional support push women into several vulnerabilities. This study demonstrates that elderly women are often denied basic rights and are compelled to reside in old-age homes; the situation is worse for elderly widowed women. We examine the claims that the lives of elderly women are more precarious due to their lower literacy, limited social exposure, and monetary dependence. Being women, old, and widowed, they are affected by triple vulnerabilities that require concrete policy implications. [ABSTRACT FROM AUTHOR]

The present research tried to find out difference in the feeling of alienation among the male and female older people. The data was collected from older people (N = 255) residing in the Urban areas of Bhopal, India. The study tried to analyse the significance difference in the feeling of alienation in male and female elderly. It was observed that females (60.33 ± 9.51) experiences more alienation than males (57.61 ± 8.85). Leven's test for equality of variance which shows [F(1,253)=.734, Sig. =.392] and t = 2.357, p=.01, (p<.05). The lower educational status of the older females makes it difficult for them to move easily along with the changing world. Also when compared to the older males, the lower degree of social contacts and activities of the older females may increase the isolation. At a time when help, care, support and presence of children, family members, friends and neighbours are most desired, the greater feelings of alienation are quite natural. [ABSTRACT FROM AUTHOR]

Background:Millennium Development Goal 4, to reduce child mortality, can only be achieved by reducing stillbirths globally. A confluence of medical and sociocultural factors contribute to the high stillbirth rates in India. The psychosocial aftermath of stillbirth is a well-documented public health problem, though less is known of the experience for men, particularly outside of the Western context. Therefore, men's perceptions and knowledge regarding reproductive health, as well as maternal-child health are important.Methods:Key informant interviews (n = 5) were analyzed and 28 structured interviews were conducted using a survey based on qualitative themes.Results:Qualitative themes included men's dual burden and right to medical and reproductive decision making power. Wives were discouraged from expressing grief and pushed to conceive again. If not successful, particularly if a son was not conceived, a second wife was considered a solution. Quantitative data revealed that men with a history of stillbirths had greater anxiety and depression, perceived less social support, but had more egalitarian views towards women than men without stillbirth experience. At the same time fathers of stillbirths were more likely to be emotionally or physically abusive. Predictors of mental health, attitudes towards women, and perceived support are discussed.Conclusions:Patriarchal societal values, son preference, deficient women's autonomy, and sex-selective abortion perpetuate the risk for future poor infant outcomes, including stillbirth, and compounds the already higher risk of stillbirth for males. Grief interventions should explore and take into account men's perceptions, attitudes, and behaviors towards reproductive decision making. [ABSTRACT FROM AUTHOR]

Gender differences are diverse between studies of unipolar and bipolar depressive disorders. Thus gender difference reported so far in depression studies might have confounded from their level of intrinsic bipolarity. The objectives of this study were to test whether there were any gender differences in the phenomenology of unipolar Major Depressive Disorder (MDD) and whether any phenomenology reliably predicted the gender of Indian patients. Patients with the diagnosis of unipolar MDD, between 18 and 60 years of age were included. A total of 32 males and 36 females were assessed with the diagnostic criteria of DSM-IV-TR, the Hamilton Depression Rating Scale, the Beck Depression Inventory-II and the Global Assessment of Functioning. Females in our study were significantly more likely to be married (p= 0.008), unemployed (p= 0.000), with lower educational qualification (p= 0.009) and belong to a lower-socioeconomical class (p= 0.003). Males had a younger age at the onset of MDD (p= 0.004) and more recurrence (p= 0.030), loss of pleasure (melancholic feature) (p= 0.030) and perceived functional impairment (p= 0.041). In females, significant greater frequency of recurrent thoughts of death (p= 0.000), perceived sense of failure (p= 0.014) and social withdrawal (p= 0.041) were found. Recurrent thoughts of death was the only phenomenon that reliably predicted gender. The uniqueness of our findings could be attributed to relatively purer unipolarity of participants and recent changes in social and individual perspectives in rapidly developing world. [ABSTRACT FROM PUBLISHER]

Many married women in India experience abortion in their second trimester of pregnancy. While there is an impression that second trimester abortions are now overwhelmingly used for sex selection, little is known about the extent to which second trimester abortions are indeed associated with son preference and sex selection motives, relative to other factors. Using data from a community-based study in rural Maharashtra and Rajasthan, research highlights the role of limited access in explaining second trimester abortion. While women with a single child who was a daughter were indeed more likely than other women to have terminated a pregnancy carrying a female foetus in the second trimester, more strikingly, exclusion from abortion-related decision-making, unsuccessful prior attempts to terminate the pregnancy, and distance from the facility in which their abortion was performed, were significantly associated with second trimester abortion, even after controlling for confounding factors. The study calls for greater efficiency in implementing the PCPNDT Act and addressing deep-rooted son preference. At the same time, findings that poverty and limited access to facilities are as, if not more, important drivers of second trimester abortion, highlight the need to meet commitments to ensure accessible abortion facilities for poor rural women. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to describe a profile of students seeking counselling at a racially diverse university in post-apartheid South Africa as a means to demonstrate the importance of routinely collecting and analysing student counselling data at university-based centres across the country. Methods: Student data were extracted from the only two counselling centres based at the University of the Witwatersrand in Johannesburg that provided services to 831 students during 2008. The 26 243 students that did not seek counselling during this period formed the comparison group. These data were analysed using logistic regression. Results: Black, female and students within the 21–25 year age category were more likely to receive counselling, and presenting problems varied by population group. Conclusions: Given the country's past and continued levels of social asymmetry, we argue that the development of standardised university-based reporting systems able to describe the characteristics and presenting problems of students seeking counselling across South African universities should be prioritised by its higher education sector. Timely access to information of this kind is crucial to the generation of evidence-based mental health interventions in a population that is especially important to the country's development vision. [ABSTRACT FROM PUBLISHER]