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Background: Utilisation of continuum of maternal health care services is crucial for a healthy pregnancy and childbirth and plays an important role in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) related to maternal and child health. This paper aims to assess the percentage of dropouts across various stages of utilization of continuum of maternal health services (CMHS) in India and also investigates the factors hindering the utilization of these services.Methods: We used recent data from National Family Health Survey(NFHS) encompassing a total sample of 1,70,937 pregnant women for the period 2015-16. The percentage of women dropping out while seeking maternal health care is measured using descriptive statistics. While, the factors impeding the utilization of maternal health services is estimated using a Multinomial Logistic Regression Model, where dependent variable (CMHS) is defined as complete care, incomplete care and no care.Results: Only17% of pregnant women availed the utilisation of complete care and 83% either did not seek any care or dropped after seeking one or two services. For instance, it is found that 79% of women who registered for antenatal care services (ANC) did not avail the same adequately. An empirical investigation of determinants of inadequate utilization of CMHS revealed that factors like individual characteristics, for instance- access to media (RRR: 2.06) and mother's education play (RRR: 3.61) a vital role in the uptake of CMHS. It is also found that the interaction between wealth index and place of residence plays a pivotal role in seeking complete care. Lastly, the results revealed that male participation (RRR: 2.69) and contacting multi-purpose worker (MPW) (RRR: 2.33) are also at play.Conclusion: The study suggests that the major determinants of utilisation of CMHS are access to media, mother's education, affordability barriers and male participation. Hence, policy recommendations should be oriented towards strengthening these dimensions and the utilisation of adequate ANC has to be considered as the need of the hour. [ABSTRACT FROM AUTHOR]

This paper examines the effect of maternal healthcare utilization on early neonatal, neonatal and post-neonatal mortality in India using the recent round of National Family Health Survey (NFHS-4) data. At the national level, for the last live birth of women during the five year preceding the survey, the early neonatal mortality rate was about 16, neonatal mortality rate was 19 and post-neonatal mortality was 7 per thousand live births. Also, only one-fifth of women who had a birth in the past five years received full antenatal care (ANC), 83 percent women received safe delivery and 65 percent women received post-natal care. Findings of the study indicate that full ANC and postnatal care were significantly associated with early neonatal and neonatal mortality. However, no significant association between safe delivery and newborn mortality were found after adjusting the socio-economic and demographic characteristics. Therefore, for a policy point of view, there is a dire need to strengthen supply dependent factors regarding public awareness, accessibility, and affordability of maternal and child healthcare services. It is also necessary to focus on increasing utilization along with continuum of care of maternal and child healthcare services to sustain the reduction in mortality during infancy. [ABSTRACT FROM AUTHOR]

Background: In 2001, India prioritized eight most socioeconomically disadvantaged states known as Empowered Action Group (EAG) states and in 2013, it prioritized 190 of the 718 as high priority districts (HPDs) to accelerate the decline in maternal and newborn mortality. This paper assesses whether the HPDs achieved a greater coverage of maternal and newborn health interventions than the non-HPDs and HPDs in EAG states achieved greater coverage than those in non-EAG states.Methods: We used data from the Sample Registration System to assess rural neonatal mortality trends in EAG states and all India. We computed a co-coverage index based on seven maternal and newborn health interventions from the 2015/16 National Family Health Survey. Difference in differences (DID) analyses were used to examine the contribution of district prioritization, considering the HPDs and the illiterate as treatment groups and 2013 as the time cut-off for the pre- and post-treatment.Results: Neonatal mortality declined in rural India from 36 to 27 per 1000 live births during 2010-2016 at 4.5% per year. Four EAG states experienced faster rates of decline than the national rate. From 2013, the co-coverage index increased significantly more in the HPDs compared to non-HPDs (DID = 0.11, P ≤ 0.005). The district prioritization effect on co-coverage was statistically significant in only EAG states (DID = 0.13, P ≤ 0.05). The coverage gains for illiterate mothers were greater than for literate mothers, especially in the HPDs.Conclusions: The district prioritization in India is associated with greater improvements in the coverage of maternal and newborn health services in EAG states and the HPDs, including reductions in inequalities within those states and districts. There are however still large gaps between states and districts and within districts by the mother's literacy status that need further prioritization to make progress towards the SDG targets by 2030. [ABSTRACT FROM AUTHOR]

Introduction: Although India has made significant progress in institutional delivery after the implementation of the National Rural Health Mission under which the Janani Suraksha Yojana (JSY) is a sub-programme which played a vital role in the increase of institutional delivery in public facilities. Therefore, this paper aims to provide an understanding of the JSY coverage at the district level in India. Further, it tries to carve out the factors responsible for the regional disparity of JSY coverage at district levels. Methods: The study used the National Family Health Survey data, which is a cross-sectional survey conducted in 2015–16, India. The sample size of this study was 148,145 women aged 15–49 years who gave last birth in the institution during 5 years preceding the survey. Bivariate and multivariate regression analysis was used to fulfill the study objectives. Additionally, Moran's I statistics and bivariate Local Indicator for Spatial Association (LISA) maps were used to understand spatial dependence and clustering of JSY coverage. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of JSY utilization. Results: The value of spatial-autocorrelation for JSY was 0.71 which depicts the high dependence of the JSY coverage over districts of India. The overall coverage of JSY in India is 36.4% and it highly varied across different regions, districts, and even socioeconomic groups. The spatial error model depicts that if in a district the women with no schooling status increase by 10% then the benefits of JSY get increased by 2.3%. Similarly, if in a district the women from poor wealth quintile, it increases by 10% the benefits of JSY also increased by 4.6%. However, the coverage of JSY made greater imperative to understand it due to its clustering among districts of specific states only. Conclusion: It is well reflected in the EAGs states in terms of spatial-inequality in service coverage. There is a need to universalize the JSY programme at a very individual level. And, it is required to revisit the policy strategy and the implementation plans at regional or district levels. [ABSTRACT FROM AUTHOR]

Context: Empathy and self-esteem are essential in delivering quality health care, particularly for women in labor and giving birth. Aims: The aim of this study was to determine the empathy quotient and self-esteem of the second-year and final-year medical and nursing students and labor room staff. Settings and Design: This cross-sectional study was conducted at a teaching hospital in southern India between September and December 2021. Materials and Methods: The inclusion criteria for the study were (i) nursing or medical students currently in their second or final year and (ii) obstetrician or nursing officer or intern currently posted in the labor room. Empathy quotient and self-esteem were measured using the Cambridge Behavioral Scale and Rosenberg's Self-Esteem Scale, respectively. Statistical Analysis Used: The scale scores were summarized as mean (standard deviation), percentages, and 95% confidence intervals. The association between empathy quotient, self-esteem, age, gender, designation, and experience duration was analyzed. We performed multivariable analysis using binary logistic regression. P <0.05 was considered statistically significant. Results: Of the 400 participants included in the study, 36.8% (42.7% - medical, 26.2% - nursing personnel) had lower than average empathy quotient scores, and 13.3% (18.4% - medical, 4.1% - nursing personnel) had low self-esteem. Self-esteem had a statistically significant, independent effect on empathy quotient, as noted in the multivariable analysis among medical and nursing personnel. There was a significant difference between empathy quotient and self-esteem scores in medical and nursing personnel across various designations (P < 0.05). Conclusion: A third of the participants had empathy quotient ratings that were below average, and one-eighth of participants had low self-esteem. Self-esteem and empathy quotient are interdependent; hence has to addressed together. The empathy quotient and self-esteem vary across different designations emphasising the need to take measures to nurture it. [ABSTRACT FROM AUTHOR]

Background: In India, more than half of the newborns experience delayed breastfeeding, and non-exclusive breastfeeding is practiced in 63% of babies below the age of six months. The goal of this study is to investigate the extent to which external environment, demographic and socioeconomic, pregnancy and birthing characteristics, as well as utilization of maternal care services, are associated with delayed initiation and non-exclusive breastfeeding among children in India. Methods: Data was gathered from the fifth round of the National Family Health Survey (NFHS), which was conducted in 2019-21. This study used information on 85,037 singleton infants aged 0–23 months and 22,750 singleton infants aged 0–5 months. Delayed initiation of breastfeeding and non-exclusive breastfeeding was used as outcome variables in this study. Unadjusted and adjusted multivariable binary logistic regression was performed to analyse the association of delayed breastfeeding and non-exclusive breastfeeding with selected background characteristics. Results: Factors significantly associated with increased risks of delayed initiation of breastfeeding included infants from in the central region (OR 2.19; 95% CI 2.09, 2.29), mothers in the 20 to 29 years age group at the time of childbirth (OR 1.02; 95% CI 0.98, 1.05), caesarean deliveries (OR 1.97; 95% CI 1.90, 2.05). The likelihoods for non-exclusive breastfeeding significantly increased among children belonging to the richest household status (OR 1.30; 95% CI 1.17, 1.45), mothers who had less than nine months of pregnancy period (OR 1.15; 95% CI 1.06, 1.25), and mothers who gave birth in non-health facility (OR 1.17; 95% CI 1.05, 1.31). Conclusions: The connections between several different categories of factors and non-exclusive breastfeeding and delayed breastfeeding initiation show the need for comprehensive public health programmes using a multi-sectoral approach to promote breastfeeding behaviours in India. [ABSTRACT FROM AUTHOR]

Despite strong policy and program commitment, essential maternal nutrition services are not reaching enough women in many countries. This paper examined multifactorial determinants (personal, family, community, and health services) associated with maternal nutrition practices in Uttar Pradesh, India. Data were from a household survey of pregnant (n = 667) and recently delivered women (n = 1,835). Multivariable regression analyses were conducted to examine the determinants of four outcomes: consumption of diverse diets, consumption of iron folic acid (IFA) and calcium tablets, and weight monitoring during pregnancy. Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal program implementation. During pregnancy, women consumed 28 IFA and 8 calcium tablets, 18% consumed diverse diet, and 17% were weighed ≥3 times. Nutrition knowledge was associated with consumption of diverse diet (odds ratio [OR] = 2.2 times), IFA (2.3 times), calcium (11.7 times), and weight monitoring (1.3 times). Beliefs and self‐efficacy were associated with IFA (OR = 2.0) and calcium consumption (OR = 4.6). Family support and adequate health services were also associated with better nutrition practices. Under optimal program implementation, we estimate that 51% of women would have adequate diet diversity, an average consumption of 98 IFA, and 106 calcium tablets, and women would be weighed 4.9 times during pregnancy. Strengthening existing program operations and increasing demand for services has the potential to result in large improvements in maternal nutrition practices from current baseline levels but may not be sufficient to meet World Health Organization‐recommended levels without creating an enabling environment including improvements in education and income levels to support behaviour change. [ABSTRACT FROM AUTHOR]

Despite the implementation of several national-level interventions, institutional delivery coverage remains unsatisfactory in India's low performing states (LPS), leading to a high burden of maternal mortality. This study investigates the levels, differentials, and determinants of institutional deliveries in LPS of India. The study also delineates a holistic understanding of barriers to delivery at health facilities and the utilization of the Janani Suraksha Yojana (JSY) specifically designed to improve maternal and child health of disadvantaged communities. A cross-sectional study was conducted using data from the National Family Health Survey (NFHS)-4, 2015–16. The study was carried out over India's nine LPS utilizing 112,518 women who had a living child in the past five years preceding the survey. Bivariate and multivariate regression analysis techniques were used to yield findings. Of the study sample, nearly three-quarters (74%) of women delivered in a health institution in the study area, with the majority delivered in public health facilities. The multivariate analysis indicates that women who lived in rural areas, belonged to disadvantaged social groups (e.g. Scheduled caste/tribes and Muslims), and those who married early (before 18 years) were less likely to utilize institutional delivery services. On the other hand, women's education, household wealth, and exposure to mass media were found to be strong facilitators of delivering in a health facility. Meeting with a community health worker (CHW) during pregnancy emerged as an important predictor of institutional delivery in our study. Further, interaction analysis shows that women who reported the distance was a 'big problem' in accessing medical care had significantly lower odds of delivering at a health facility. The study suggests emphasizing the quality of in-facility maternal care and awareness about the importance of reproductive health. Furthermore, strengthening sub-national policies specifically in underperforming states is imperative to improve institutional delivery coverage. [ABSTRACT FROM AUTHOR]

Aim: Maternal health services potentially play a significant role in improving reproductive health. Access to skilled assistance and well-equipped health institutions during delivery can reduce maternal mortality and morbidity and improve pregnancy outcomes. In this study, we examined the relationship between the use of maternal health care services and the frequency of reproductive health complications (during pregnancy, delivery and after delivery) in Assam. Subject and methods: We used data from the third round of the District Level Household and Facility Survey (DLHS, 2007-2008) which collects information about reproductive and child health services. Descriptive and multivariate analyses were used to understand the relationship between the use of health care services and the frequency of complications in pregnancy. Results: Findings show that more than half of women reported having any complication during pregnancy and delivery. Post delivery complications in Assam are reported less by women as compared to any pregnancy and delivery complications. It is also found statistically significant that women who received full antenatal care during pregnancy reported less complications during the delivery and post-partum period. We found a positive correlation in the study area between having any complication during pregnancy with higher reporting of any delivery and post-delivery complication. Conclusion: The study concludes that use of intensive health-care services reduces health complications. Therefore, it is necessary to improve community awareness on maternal health to motivate women to use more antenatal care services to reduce health complications during the reproductive time span. [ABSTRACT FROM AUTHOR]

Background: India continues to face challenges in improving key maternal health indicators with about 1/3rd of global maternal deaths happening in India. Utilization of health care services is an important issue in India with significant proportion of home deliveries and majority of mothers not receiving adequate antenatal care. Mortality among poor rural women is the highest with lowest utilization. To make maternal healthcare more equitable, numerous schemes such as Janani Suraksha Yojana, Chiranjeevi Yojana, Kasturba Poshan Sahay Yojana have been introduced. Studies suggest that utilization of such schemes by target population is low and there is a need to understand factors affecting maternal health care utilization in the context of these schemes. Current community based study was done in rural Gujarat to understand characteristics of women who utilize such schemes and predictors of utilization. Methodology: Data collection was done in two districts of Gujarat from June to August, 2013 as a pilot phase of MATIND project. Community based cross-sectional study included 827 households and socio-demographic details of 1454 women of 15-49 years age groups were collected. 265 mothers, who had delivered after 1st January, 2013 are included in the regression analyses. The data analysis carried out with R version 3.0.1 software. Results: The analysis indicates socioeconomic variables such as caste, maternal variables such as education and health system variables such as use of government facility are important predictors of maternal health scheme utilization. Results suggest that socioeconomic and health system factors are the best predictors for availing scheme. Conclusion: Health system variables along with individual level variables are important predictors for availing maternal health schemes. The study indicates the need to examine all levels of predictors for utilizing government health schemes to maximize the benefit for underserved populations such as poor rural mothers. [ABSTRACT FROM AUTHOR]

Background: Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Methods: Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3) carried out during 2007-2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes--Institutional delivery, antenatal care (ANC), and use of modern contraception--and selected intermediary and structural determinants of health using multiple logistic regression. Results: Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Discussion and conclusions: Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste) has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic education and infrastructural development to begin to remove the structural causes of non-use of maternal health services. [ABSTRACT FROM AUTHOR]

India's Integrated Child Development Services (ICDS) provides daily supplementary nutrition and other public health services to women and children. We estimated associations between exposure to early‐childhood ICDS nutrition and adult reproductive outcomes. During 1987–1990, a balanced protein–calorie supplement called "upma"—made from locally available corn–soya ingredients—was rolled out by subdistricts near Hyderabad and offered to pregnant women and children under age 6 years. In a controlled trial, 15 villages received the supplement and 14 did not. We used data from a 2010–2012 resurvey of adults born during the trial (n = 715 in intervention and n = 645 in control arms). We used propensity score matching methods to estimate the associations between birth in an intervention village and menarcheal age, age at first pregnancy, and fertility of adults. We found that women born in the intervention group during the trial, as compared with the control group, had menarche 0.45 (95% confidence interval [CI: 0.22, 0.68]; p <.001) years later and first pregnancy 0.53 (95% CI [0.04, 1.02]; p <.05) years later. Married women from the intervention group had menarche 0.36 (95% CI [0.09, 0.64]; p <.01) years later, first cohabitation with partner 0.8 (95% CI [0.27, 1.33]; p <.01) years later, and first pregnancy 0.53 (95% CI [0.04, 1.02]; p <.05) years later than married women in the control group. There was no significant difference between intervention and control group women regarding whether they had at least one childbirth or the total number of children born. The findings were similar when we employed inverse propensity score weighted regression models. [ABSTRACT FROM AUTHOR]