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Background: Ensuring comprehensive and quality healthcare access is necessary to promote good health and well-being and to secure health equity. Barriers to healthcare access result in unmet health needs. Moreover, there is limited empirical evidence on specific types of barriers to women's general health-seeking in India. This study investigates women's perceived household-level, logistic, and facility-level barriers to healthcare access and its individual, household, and community-level determinants., Methods: The study used data from the fifth round of the National Family Health Survey (NFHS-5), with a total sample of 108,785 women aged 15-49 drawn from the state module of the survey. The primary outcome variables were household, logistic, and facility-level barriers to healthcare access. A set of individual, household, and community-level predictors was assessed using multivariate binary logistic regression due to the dichotomous nature of the outcome variables. The adjusted odds ratio (AOR) with the corresponding 95% confidence intervals (CI) was used to present the regression results. The Hosmer-Lemeshow test and ROC curve statistics were carried out to enhance the robustness of the analysis and validity of the model., Results: The study found a considerable proportion of women (84%) with at least one perceived barrier to accessing healthcare, with significant inter-state variations. Facility-level (55%) and logistic barriers (51%) were the predominant obstacles to healthcare access. Women aged 35-49, with higher education levels, exposed to mass media, working in professional/technical/managerial/clerical jobs, access to bank accounts, having mobile phones, and from rich households had lower odds of perceived household, logistic, and facility-level barriers to healthcare access., Conclusion: Most women perceive barriers to healthcare access, though a wide inter-state variation exists. Facility-level barriers such as the unavailability of drugs and healthcare providers are major concerns to healthcare access. Distance to health facilities continues to be a logistic barrier, along with getting money for treatment at the household level. Illiteracy, non-exposure to mass media, working in the agricultural sector, no access to a bank account and a mobile phone, rural residency, and poor wealth status are significant factors adversely affecting the perceived barriers to healthcare access. The findings recommend strengthening the existing health system and increasing health literacy among poor, less educated, and rural women to reduce disparity in healthcare access., Competing Interests: Declarations. Ethics approval and consent to participate: The study is based on the secondary, identified publicly available survey data, and survey agencies that conducted the field survey for the data collection have also collected a prior consent from the respondents. The NFHS was approved by the Institutional Review Board of the Institutions involved, and the datasets are available on individual registration at https://www.dhsprogram.com/data/new-user-registration.cfm for broader use in social research. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. They ruled that no formal ethical consent was required to conduct research from this data source. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: Sexual autonomy is essential to women's empowerment and crucial to human rights. Measurement of women's sexual autonomy from men's perspective is rare in India, though critical for achieving the sexual and reproductive rights of women who continue to exhibit poor sexual and reproductive health (SRH) outcomes. The study assesses Indian men's attitudes toward women's sexual autonomy and associated factors using a nationally representative sample of men., Methods: This study involved a total sample of 101,839 men aged 15-54 covered in the fifth round of the National Family Health Survey (2019-21). Descriptive statistics, bivariate analysis, and binary logistic regression were used to determine predictors of men's favorable attitudes toward the sexual autonomy of women. All the statistical analyses were performed using Stata with a 5% significance level., Results: Sixty-three percent of men hold a favorable attitude toward women's sexual autonomy. Men's support for women's sexual autonomy was positively correlated with their egalitarian views on household decision-making (AOR: 1.45; CI: 1.41-1.49), higher educational attainment (AOR: 1.34; CI:1.20-1.50), currently married status, media exposure (AOR: 1.17; CI: 1.12-1.21), currently working status, and wealthier household strata (AOR: 1.17; CI: 1.11-1.23)., Conclusion: Results suggest promoting gender egalitarian norms through educational campaigns, community workshops held by local leaders, grassroots healthcare professionals, and non-governmental organizations, and broadening existing SRH strategies by including younger, non-literates, unmarried, unemployed, and rural men., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Pradhan, De. 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.)

Synovial sarcoma (SS) is a rare genitourinary malignancy with a specific SS18::SSX 1/2 gene fusion in majority of the instances. The paratesticular location of this neoplasm is extremely rare and only 4 cases are reported in the literature. Herein, we describe the clinicopathologic features and molecular profile of paratesticular SS in the largest case series to date and to the best of our knowledge, and the only series to use novel SS18-SSX antibody for immunohistochemistry. Clinicopathologic, immunohistochemical (IHC), molecular, treatment, and follow-up data of the patients were analyzed. There were 14 patients, ranging from 15 to 47 years (mean: 30 y). The tumor size ranged from 4​​​​​​ to 15 cm. The tumors were unilateral, solid, and homogeneous tan-white with monomorphic spindle cell histology. All 14 tumors expressed SS18-SSX and TLE1 IHC and harbored SS18 rearrangement. In addition, the tumor with multifocal SS18-SSX expression had lower break-apart signals in the FISH assay (38% of the tumor cells; range: 29% to 85%). Radical orchiectomy was performed in all 14 patients and adjuvant chemotherapy was administered in 9 patients. Follow-up was available in 9 patients. The follow-up duration ranged from 5 to 24 months (median=10 mo). Four patients died of metastatic disease (range: 5 to 16 mo) and 2 patients who are alive had metastatic disease at the last follow-up. Based on our experience with the largest series to date and aggregate of the published data, paratesticular SS has a poor prognosis despite aggressive therapy. Owing to its rarity, the differential diagnosis is wide and requires a systematic approach for ruling out key morphologic mimics aided with SS18-SSX IHC and molecular confirmation because this distinction carries important therapeutic and prognostic implications. Due to the excellent concordance of SS18-SSX IHC results with FISH results as observed in our study, we would like to suggest inclusion of SS18-SSX in the diagnostic immunohistochemistry panel of all spindle cell sarcomas where synovial sarcoma is considered as a morphologic differential. SS18-SSX-positive staining may be used as a surrogate for FISH assay in a resource-limited setting where molecular assay is not available. Furthermore, IHC has a fairly shorter turn-around-time, is less complex, and of low cost., Competing Interests: Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The COVID-19 pandemic affected a broad spectrum of people's lives very quickly. Although the pandemic could influence people's fertility behaviours in several ways, there is little knowledge about such influence in diverse socioeconomic and cultural settings. This study investigated the impact of the COVID-19 pandemic on fertility behaviours and desires among women in a lower-middle-income country, India., Data and Methods: Our study analyzed cross-sectional data from 13 states and union territories (UTs) in India that were surveyed in pre- and post-lockdown periods by the 2019/21 National Family Health Survey (NFHS). The data were analysed using the descriptive analysis technique and the multilevel logit model. All these analyses were performed using the technique developed for complex sample design., Results: The poverty-stricken states of Uttar Pradesh and Jharkhand and the Odisha state with moderate socioeconomic status experienced a significant decrease in contraceptive use and non-significant changes in the desire for birth and sexual activities after the lockdown. Contraceptive use significantly increased after the lockdown in the rich states of Punjab, Delhi, and Tamil Nadu, as well as in the Arunachal Pradesh state with moderate socioeconomic status. The changes in fertility behaviours in Uttar Pradesh, Jharkhand, and Odisha may influence fertility positively, while those changes in Punjab, Delhi, Tamil Nadu, and Arunachal Pradesh may influence fertility negatively., Conclusion: At the aggregate level, there was a significant increase in desire for another child and a decrease in contraceptive use after the lockdown, which may influence fertility positively but can be compensated by reduced sexual activities. The influence of the fertility trends in the states with pro-natalist changes on India's recent fertility trend could be greater than those with anti-natalist changes, which can be better understood by analyzing reliable data from a couple of years following the 2019/21 NFHS., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Rahman 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.)

Background: Early childbearing disrupts girls' otherwise healthy growth into adulthood and adversely affects their education, livelihood, and health. Individual, sociocultural, economic, environmental, and health service-related factors contribute to childbearing among young females. In India, caste affects health outcomes despite several affirmative policies aimed at improving the health and welfare of the backward castes/tribes. However, there is a dearth of empirical evidence about the impact of caste on early childbearing, more specifically, regarding the trajectory of inter-caste disparities in early childbearing., Method: This study used data from all five rounds of the National Family Health Survey (NFHS) in India to assess the association between caste and early childbearing over the last three decades. All women aged 20-24 [NFHS-1 (n = 17,218), NFHS-2 (n = 15,973), NFHS-3 (n = 22,807), NFHS-4 (n = 122,955) and NFHS-5 (n = 118,700)] were considered to create a pooled data set (n = 297,653) for analysis. Bivariate analysis and binary logistic regression were conducted using Stata (v17). ArcMap (v10.8) presented the caste-wise prevalence of early childbearing among the states and Union Territories (UTs)., Results: Many women continue to have early childbearing despite a considerable reduction over the last three decades from 47% in 1992-93 to 15% in 2019-21. Compared to NFHS-1, the odds of early childbearing increased by 15% in NFHS-2 and, after that, declined by 42% in NFHS-3 and 64% in NFHS-4 and NFHS-5. The inter-caste disparity in early childbearing persists, albeit with a narrowing gap, with the Scheduled castes (SC) remaining the most vulnerable group. Adjusting the effects of socio-demographic and economic characteristics, SC women had significantly higher odds of early childbearing (OR = 1.07, CI = 1.04-1.11) than those from the General caste., Conclusion: To decrease early childbirth, a focus on adolescent marriage prevention and increasing contraceptive use among young SC women is necessary. Strengthening ongoing programs and policies targeting educational and economic empowerment of the socially weaker castes/tribes will help in reducing early childbearing. Efforts to prevent early childbearing will accelerate the achievement of the Sustainable Development Goals (SDGs)-especially those related to health, poverty, nutrition, education, and general wellbeing, in addition to protecting women's reproductive rights., (© 2024. The Author(s).)

Minimum acceptable diet (MAD) that combines minimum dietary diversity (MDD) and minimum meal frequency (MMF) is one of the eight core indicators for assessing infant and young child feeding (IYCF) practices for children aged 6-23 months. With low MAD, young children and infants are more susceptible to undernutrition. The study assesses the prevalence and predictors of MAD among tribal children aged 6-23 months in India. Descriptive, bivariate, and multivariate analyzes were performed on data from 6326 tribal children of the National Family Health Survey (2019-21). Stata was used for the analyzes, with a 5% significance level. Only 12% of tribal children were fed with a MAD, while 24% had MDD and 34% MMF. Children aged 18-23 months had a three times higher chance of MAD than their 6-8 months counterparts. Children receiving Integrated Child Development Services (ICDS), children of mothers with ten or more years of schooling, children whose mothers were exposed to mass media, and whose mothers had 4+ antenatal care visits in their last pregnancy had a higher likelihood of MAD. The study concludes that MAD among tribal children aged 6-23 months is unsatisfactory and varies significantly by socio-demographic characteristics, suggesting targeted intervention.

Background: Intimate partner violence (IPV) is a severe human rights violation and a global burden on public health. Wife-beating is a form of IPV and an extension of the patriarchal philosophy that legitimizes men's control over their spouses. This study investigates (a) the trends and patterns of men's attitudes towards justification of wife-beating and (b) the socio-demographic factors associated with changes in men's attitudes towards wife-beating between 2005-06 and 2019-21 in India., Methods: The present study utilized data from the last three rounds of the National Family Health Survey (NFHS): NFHS-3 (2005-06), NFHS-4 (2015-16), and NFHS-5 (2019-21) with a total sample of 2,76,672 men aged 15-54. The primary outcome variable was men's attitudes toward wife-beating. Attitude towards the household and the sexual autonomy of the wife were the two key predictors, in addition to other structural factors. Descriptive, bivariate, and multivariate logistic regression analyses were performed on weighted data using Stata. Hosmer-Lemeshow test, Classification table, and ROC curve were carried out to enhance the robustness of the analysis and validity of the model., Results: In 2005-06, 50% of men justified wife-beating in at least one of the seven contexts, which reduced to 42% in 2015-16 and then marginally increased to 44% in 2019-21. Men with an authoritarian attitude toward household autonomy (AOR: 2.34; CI: 2.30,2.38) and sexual autonomy of the wife (AOR: 1.68; CI: 1.65,1.71) were more likely to justify wife-beating than their egalitarian counterparts. Inadequate education, younger age, family history of IPV, alcohol consumption, poverty, and rural settings are associated with an elevated risk of abusive attitudes towards wife-beating., Conclusion: A sizable percentage of men, more so those socio-economically marginalized, continue to justify wife-beating, albeit with considerable decline over the years. The findings suggest customized policies and programs enhancing gender egalitarian norms among young men, more opportunities to pursue higher education, alleviating poverty through employment opportunities, and raising awareness about domestic violence in rural settings would help develop more egalitarian gender norms and attitudes towards wife-beating., (© 2024. The Author(s).)

Utilization of efficient, stable and reusable catalysts for wastewater treatment and catalytic elimination of toxic pollutants is a challenge among researchers. This present work shows the synthesis of high-surface-activity Ag nanoparticle decorated gC 3 N 4 modified MCM-41 and its efficiency towards catalytic hydrogenation of organic dye in the presence of reducing agent NaBH 4 . The proposed mechanism is based on the transfer of H + and 2e - between the dye and the catalyst. Adsorption of dye stuff on the catalyst is a rate-determining step and is accelerated by the MCM-41 support which enhances the surface area. The catalytic efficiency and optimum time requirement were examined through the adsorption-desorption equilibrium, pseudo-first-order reaction kinetic model for the dye. The result obtained was 98% catalytic efficiency followed by the catalytic hydrogenation reaction., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Background: Maternal and neonatal mortality are important indicators of the development of a nation and pose a severe health concern, especially in developing and Low and Middle-Income Countries (LMICs). Healthcare providers use various mobile technologies as tools to provide antenatal, delivery, and postnatal care and thereby promote maternal and child health. We conducted a systematic review to critically assess the existing literature on the effectiveness of mobile phone technology in maternal and neonatal healthcare (MNH) utilization, especially in LMICs in Asia and Africa., Methods: A systematic search strategy was developed, and Boolean combinations of relevant keywords were utilized to search relevant literature on three electronic databases (PubMed/Medline, Scopus, and Google Scholar) from 2012 to 2022. After assessing the inclusion and exclusion criteria, 25 articles were selected for systematic review. A narrative synthesis strategy was applied to summarise the information from the included literature., Results: This review reveals that research and evaluation studies on mobile phone or Mobile Health (mHealth) and MNH service utilization substantially varied by research designs and methodology. Most studies found that mobile phone technology is highly appreciable in improving several MNH indicators, especially in LMICs. Despite the identified benefits of mobile technology in MNH utilization, some studies also mentioned challenges related to technology use and misuse, rich-poor discrimination, and disparity in phone ownership need to be addressed., Conclusion: There is constantly increasing evidence of mobile counseling and the use of digital technology in the MNH care system. Public health practitioners and policymakers need to make efforts to smooth the functioning of technology-based healthcare services, considering all the issues related to the confidentiality and safety of health-related data on the Internet., (© 2023. The Author(s).)

Objective: The first-birth interval after a marriage indicates the reproduction behavior of women and influences the population's birth rates and size. The present study assesses predictors of the interval between marriage and first childbirth in India., Materials and Methods: The study employed the Cox proportional hazard model and Kaplan Meier Survival plot based on the data collected from 79,787 ever-married women in the 15-49 age group from the National Family Health Survey 2019-2021., Results: The median age of marriage to the first birth interval was 23 months in India. The older marriage cohort had longer birth intervals than the younger. The hazard ratios (HR) showed that the risk of first birth after marriage was much higher among women with higher education (HR= 2.05, 95% confidence interval (CI) = 1.98-2.11) than women without education. Women in urban areas (HR=1.22, 95% CI = 1.20-1.25) had a higher risk of first birth after marriage earlier than women from rural areas. Women from North-east (HR=1.14, 95% CI=1.10-1.18) and South (HR=1.15, 95% CI=1.12-1.19) had a higher risk of having their first birth earlier after marriage than women in the North region. The women who married within 18-24 years of age had a 69 percent higher likelihood of first birth interval than those women who were married below the age of 18. The risk of first birth after marriage increased as women delayed marriage up to age 25 years and more (HR=3.18, 95% CI=3.02-3.35) than others., Conclusion: The timing of first birth was associated with the age at the first marital union, women's educational attainment, place of residence, region, economic status, exposure to mass media, contraception use, and history of pregnancy termination., Competing Interests: Conflict of Interests Authors declare no conflict of interests., (Copyright © 2023 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Background: Pregnancy registration is one of the most critical components of women's reproductive health because it is the gateway to entering the continuum of care services such as antenatal care, institutional delivery, and postnatal care. There is a lack of studies exploring the relationship between pregnancy intention and pregnancy registration, especially in the Indian context., Method: This study used the National Family Health Survey-5 (2019-21) data to explore the relationship between birth intention and failure of pregnancy registration. The bivariate and multivariate (binary logistic regression) analysis was carried out., Results: Adjusting the effects of socio-demographic and economic characteristics, compared with women with an intended pregnancy, the odds of failure of pregnancy registration were significantly high among women with a mistimed pregnancy (OR = 1.60, 95% CI = 1.47-1.73) and unwanted pregnancy (OR = 1.38, 95% CI = 1.26-1.52). The study found pregnancy intention as a significant predictor of pregnancy registration., Conclusions: Results suggest strengthening the interaction of grassroots-level health workers with women, especially those with possibly lower healthcare autonomy and unintended pregnancy. Higher and earlier pregnancy registration will enhance maternal healthcare utilization and reduce adverse health consequences to mothers and children, thus ensuring better maternal and child health., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Undernutrition is a significant public health problem and the leading risk factor for India's disease burden. Aim: To understand the determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Methods: The study used the National Family Health Survey-4 (2015-16) data. The analysis was carried out for under-five children who have availed of any ICDS services in the 12 months preceding the survey ( n  = 1,27,813). Stunting, wasting, and underweight were estimated following the World Health Organization guideline and used as the outcome variables. The binary logistic regression was conducted to examine the association of ICDS utilization and socioeconomic-demographic predictors with under-five children's nutritional status. STATA (V 13) was used for statistical analyses. Results: A sizable proportion of under-five children receiving any ICDS services suffer from undernutrition. The undernutrition prevalence varied considerably by socioeconomic and demographic characteristics. Logistic regression found an insignificant association of ICDS utilization with the nutritional status of under-five children. Children not immunized in ICDS centers were less likely to be stunted (OR: 0.93; P  < 0.01), wasted (OR: 0.93; P  < 0.01), and underweight (OR: 0.90; P  < 0.01) than their counterparts. The child's age and gender, maternal education and nutrition status, wealth index, social group, region, residence, and region were significant determinants of undernutrition among ICDS beneficiaries. Conclusion: The study suggests the need to ensure all available services to children enrolled in the Anganwadi Center (AWC). The program should also emphasize feeding practices and educate parents about improving child health and nutrition.

Background: Contraceptive use contributes to improved maternal and child health, education, empowerment of women, slow population growth, and economic development. The role of the family in influencing women's health and health-seeking behavior is undergoing significant changes, owing to higher education, media exposure, and numerous government initiatives, in addition to women's enhanced agency across South Asia. Against this backdrop, this study assesses the relationship between women's living arrangements and contraceptive methods used in selected south Asian countries (India, Pakistan, Nepal, and Bangladesh)., Methods: Data of currently married women aged 15-49 from the recent round of Demographic and Health Survey (DHS) of four South Asian countries, i.e., Nepal (2016), Pakistan (2017-18), Bangladesh (2017-18), and India (2019-21) had been used. Bivariate and multinomial logistic regression was performed using Stata with a 5% significance level., Results: Living arrangement of women had a significant association with contraceptive use in South Asia. The Mother-in-law (MIL) influenced the contraceptive method used by the Daughter-in-law (DIL), albeit a country-specific method choice. Modern limiting methods were significantly higher among women living with MIL in India. The use of the modern spacing method was considerably high among women co-residing with husband and/or unmarried child(ren) and MIL in Nepal and India. In Bangladesh, women living with husband and other family member including MIL were more likely to use modern spacing methods.. Women co-residing with the MIL had a higher likelihood of using any traditional contraceptive method in India., Conclusions: The study suggests family planning program to cover MIL for enhancing their understanding on the benefits of contraceptive use and modifying norms around fertility. Strengthening the interaction between the grassroots level health workers and the MIL, enhancing social network of DIL may help informed choice and enhance the use of modern spacing methods. Women's family planning demands met with modern contraception, and informed contraceptive choices, must also be achieved to reach the 2030 Agenda for Sustainable Development., (© 2023. BioMed Central Ltd., part of Springer Nature.)

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., (© 2023. The Author(s).)

Induced abortion is closely associated with maternal morbidity, mortality, and reproductive rights of women and thus continues to draw research interest. This study assesses the reasons for abortion and their predictors using India's National Family Health Survey-5 (2019-21) data. The sample of women aged 15-49 who had terminated their last pregnancy by induced abortion in the five years preceding the survey (n=5835) was considered for analysis. Multinomial logistic regression was used to check the adjusted effects of the socioeconomic predictors on the reasons for abortion. Stata (v16.0) was used for the data analysis. Women were more likely to abort their pregnancy at home/other than in the public health sector if unintended pregnancies (RR: 2.79; CI: 2.15-3.61) and sex-selective abortions (RR: 2.43; CI: 1.67-3.55) rather than life risk. The study found unintended pregnancy as the primary contributor to induced abortion. However, some women undergo the procedure due to medical reasons and the undesired gender of the unborn child. Unintended pregnancies that end in abortion are strongly correlated with gestational age, method of abortion, place of abortion, number of surviving children, religion, place of residence, and region. Again, there is a strong association between the sex-selective reason for abortion and the gestational age, method of abortion, place of abortion, number of surviving children, proper knowledge of the ovulatory cycle, religion, wealth quintile, and region. Women had abortions mainly due to unintended pregnancies, and there was socioeconomic, demographic, and geographic variation in the reasons for abortion in India. Sex-selective abortions continue to exist, especially among women of higher parity, poorest households and from the central, eastern, and north-eastern regions. The key to reducing unintended pregnancies and abortions is raising the understanding of contraception and empowering women in reproductive decisions. Reducing unintended pregnancies will contribute to lower induced abortion and thus improve women's health.

The role of household structure, especially the mother-in-law (MIL) influencing daughter-in-law's maternal health care (MHC) seeking behaviour, has been a continuing debate due to the former's advantageous position in the household. This study assesses the association of household structure and particularly the presence of MIL with MHC utilisation in India using the National Family Health Survey-4 data (2015-16). The sample of women aged 15-49 years who have given birth during the last five years preceding the survey (n=184,641) was considered for analysis. The outcome variables were full-antenatal care, institutional delivery, and postnatal care. Binary logistic regression was used to check the adjusted effects of the household structure on MHC utilisation. The analyses were done with STATA (version 13) with a significance level of 5%. Adjusting the effects of socio-demographic and economic characteristics, women from non-nuclear households with MIL had higher odds of full-antenatal care (OR= 1.04, CI= 0.99-1.08) and institutional delivery (OR=1.05, CI=1.01- 1.10) than their counterparts from nuclear households. Women from non-nuclear households without MIL had lower chances of postnatal care (OR=0.98, CI=0.96-1.00) than those from nuclear households. The study unearths a very weak association between the presence of MIL in the household and MHC services utilisation of the daughter-in-law, a notable change from the earlier literature often portraying MIL as a barrier.

Background: Women's gynecological health needs are not limited to the reproductive years of their life. Women are at risk of hormonal changes, gynecological malignancies, and various genitourinary conditions as they move toward menopause and beyond. Concerns about older women's sexual and reproductive health and rights (SRHR) continue to be taboo in many countries, of little interest to researchers and professionals in the field of healthcare, and a "blind spot" in discussions about policy as a whole. Despite the widespread agreement, the life course approach to addressing SRHR concerns has received minimal attention. The study estimates the prevalence, assesses the correlates, and treatment-seeking of gynecological morbidity (GM) among older adult women aged 45-59 years (N = 18,547) in India., Method: The analysis was based on the nationally representative Longitudinal Ageing Study (2016-2017) data that adopted a multistage stratified area probability cluster sampling to select respondents. The outcome variables used in this analysis were 'had any GM' and 'sought treatment for any GM.' Women with any morbidity such as per vaginal bleeding, foul-smelling vaginal discharge, uterus prolapses, mood swings/irritability, fibroid/cyst, and dry vagina causing painful intercourse were considered to have any GM. Of the respondents with GM, who sought a doctor's consultation or treatment were considered 'sought treatment for any GM.' Binary logistic regression was conducted to examine the adjusted effect of socioeconomic and demographic predictors of GM and treatment-seeking. Stata (V 16) was used for statistical analyses with a 5% significance level., Results: Fifteen percent of the women had any GM, and only 41% of them sought treatment. Age, marital status, education, number of pregnancies, hysterectomy, involvement in household decision-making, social group, religion, wealth status, and region were significantly associated with GM. The odds of treatment-seeking were higher among women with 10+ years of schooling (OR 1.66, CI 1.23, 2.23), with hysterectomy (OR 7.36, CI 5.92, 9.14), with five-plus pregnancies (OR 1.25, CI 0.96, 1.64), and those from the richest (OR 1.91, CI 1.40, 2.60) households than their respective counterparts., Conclusion: Many older adult women experience GM, and treatment-seeking is inadequate. The GM prevalence and treatment-seeking vary considerably by socioeconomic and demographic characteristics. Results suggest community-level awareness generation and the inclusion of this otherwise ignored group in programs targeting better health and wellbeing of women., (© 2023. The Author(s).)

Women's empowerment is fundamental for realizing unalienable human rights and is vital to sustainable development outcomes. In India, the SWABHIMAAN intervention program was an integrated multi-sectoral strategy to improve girls' and women's nutrition before conception, during pregnancy, and after childbirth. This study assesses the role of self-help-group (SHGs) in improving the effectiveness of community health interventions and its impact on their self-empowerment. Qualitative data gathered through in-depth interviews (IDI) with community-based SHG members involved as Nutrition Friend (Poshan Sakhi-PS) in the SWABHIMAAN program in 2018 was used for analysis. Informed consent procedures were followed, and only those who voluntarily consented to the interview were interviewed. Twenty-five IDIs of purposively selected PSs in three states (Bihar, n = 9; Chhattisgarh, n = 8; and Odisha, n = 8) were analyzed thematically, according to Braun & Clarke (2006). NVivo 12 software was used for organizing and coding data. Three central themes that emerged to explain women's empowerment were (1) Barriers & redressal mechanisms adopted by PS, (2) PS as a change-maker, and (3) Changes in the life of PS. The study found that women perceive themselves as more empowered through involvement in the SWABHIMAN intervention program, besides improving the community's and their households' nutritional status. The results suggest that policies and programs on health and nutrition interventions need to involve peer women from the community, leading to more effective outcomes. Empowering women and closing gender gaps in employment/work are critical to achieving the 2030 Sustainable Development Goals., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Pradhan 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.)

Background: Menstruation is a normal biological process that all women go through, yet it is shrouded in secrecy, taboos, and even stigma in many societies. Studies have shown that women from socially disadvantaged groups are more likely to have preventable reproductive health issues and have less understanding of hygienic menstrual practices. Therefore, this study aimed to provide an insight into the most sensitive issue of menstruation and menstrual hygiene practices among the women of the Juang tribe, recognized as one of the particularly vulnerable tribal groups (PVTG) in India., Methods: A cross-sectional study using a mixed-method approach was carried out among Juang women in Keonjhar district of Odisha, India. Quantitative data was gathered from 360 currently married women to assess practices associated with menstruation and its management. In addition, 15 focus group discussions and 15 in-depth interviews were conducted to explore the views of Juang women on menstrual hygiene practices, cultural beliefs, menstrual problems, and treatment-seeking behaviour. Inductive content analysis was used to analyse the qualitative data, while descriptive statistics and chi-squared tests were used to analyse quantitative data., Results: Most Juang women (85%) used old clothes as absorbents during menstruation. Distance from the market (36%), lack of awareness (31%), and high cost (15%) were cited as the contributing factors to the low level of sanitary napkin usage. Around 85% of women were restricted from participating in religious activities, and 94% avoided social gatherings. Seventy-one percent of the Juang women experienced menstrual problems, while only one-third of them sought treatment for their problems., Conclusion: Hygienic practices during menstruation are far from satisfactory among Juang women in Odisha, India. Menstrual problems are common, and the treatment sought is insufficient. There is a need for awareness generation on menstrual hygiene, the adverse effects of menstrual problems, and the provision of low-cost sanitary napkins among this disadvantaged, vulnerable tribal group., (© 2023. The Author(s).)

Background: Abortion complications can range from minor and treatable to severe but rare complications that can result in morbidity or even death. There is limited evidence on the socioeconomic and demographic correlates of post-abortion complications, though abortion is associated with pregnancy and birth-related complications and contributes to maternal mortality in India. This study thus assesses the patterns and correlates of post-abortion complications in India., Methods: This study gathered data from the cross-sectional National Family Health Survey(2019-21) on women aged 15-49 who had their last pregnancy terminated by induced abortion in the five years preceding the survey (n = 5,835). Multivariate logistic regression was used to check the adjusted association of socioeconomic and demographic characteristics with abortion complications. The data were analysed using Stata with a 5% significance threshold., Results: Post-abortion complications affected 16% of the women. Women who had an abortion with a gestational age of 9-20 weeks (AOR:1.48, CI: 1.24-1.75) and those who had an abortion due to life risk/medical reasons (AOR:1.37, CI:1.13-1.65) had higher odds of abortion complications than their respective counterparts. Women in the North-Eastern (AOR:0.67, CI:0.51-0.88) and the Southern (AOR:0.60, CI:0.44, 0.81) regions were less likely to have abortion complications than those in the Northern region., Conclusion: Many Indian women suffer from post-abortion complications, with the primary causes being increased gestational age and abortions performed due to life-threatening or medical conditions. Efforts to educate women about early abortion decision-making and improve abortion care will reduce post-abortion complications., (© 2023. The Author(s).)

Background: Cognitive impairment (CoI) is a significant risk factor for ill-health status among the older adults and a major burden on public health. This study unearths the degree of socioeconomic inequalities and assesses the determinants of CoI among the older adults in India., Methods: Data on cognitive impairment of older adults aged 60 + years (n = 31,646) gathered in a nationally representative Longitudinal Ageing Study in India (2017-18) was analyzed through STATA with a significance level of 5%. Binary logistic regression, the concentration index, concentration curve, and Shapley decomposition analysis were performed to assess the socioeconomic inequalities and the determinants of CoI., Results: Sixteen percent of the older adults had CoI. Females (OR = 1.88, 95% CI = 1.70-2.09), those aged 80 plus years (OR = 3.98, 95%CI = 3.56-4.44), from ST (OR = 2.65, 95%CI = 2.32-3.02), with perceived poor health (OR = 1.61,95%CI = 1.45-1.79), with depression (OR = 1.32, 95%CI = 1.21-1.43), with no schooling (OR = 16.46, 95%CI = 11.31-23.97) with 1 + ADL (OR = 1.43, 95%CI = 1.31-1.57) and 1 + IADL (OR = 1.30, 95%CI = 1.19-1.41) had higher odds of CoI than their respective counterparts. Older adults from urban areas (OR = 0.63, 95%CI = 0.57-0.70), higher income groups (OR = 0.61, 95%CI = 0.53- 0.70) and higher education level with sources of financial support (OR = 0.68, 95%CI = 0.61- 0.76) less likely to experience CoI. Economic inequalities exist in the distribution of CoI-the poorest being the most disadvantaged (concentration index value = -0.118)., Conclusions: There are socioeconomic-related inequalities in CoI among the older adults. The socioeconomically vulnerable older adults, including those illiterates, with poor economic status, women, not-in-union, the older, and those without social support, are more likely to develop CoI. The results suggest awareness generation and more customized policies and programs to reduce the socioeconomic inequalities in CoI among the older adults in India. The improved mental health of the older adults will contribute to achieving Sustainable Development Goals, including Goal 3 on guaranteeing good health and well-being for all., (© 2022. The Author(s).)

Aim: Contraceptive use and its correlates among young women continue to draw research attention due to its implication for fertility reduction, improved maternal and child health, and sexual and reproductive rights. This study explores the association between pregnancy history and contraceptive use among currently married young women (aged 15-24 years at childbirth) in India., Method: Data from the National Family Health Survey (2019-2021) was analyzed through STATA with a significance level of 5%. The births in the last 5 years preceding the survey to the women aged 15-24 years at childbirth (n = 127 954) were considered for analysis. Multinomial logistic regression was used to check the unadjusted and adjusted effects of the pregnancy history on contraceptive use., Results: Young women with a history of mistimed pregnancy had significantly lower odds of using modern limiting methods of contraception (odds ratio [OR] = 0.90, confidence interval [CI] = 0.82-0.98), and those with a prior unwanted pregnancy were more likely to use modern limiting methods of contraception (OR = 1.75, CI = 1.57-1.95)., Conclusion: Pregnancy history influences young married women's current contraceptive use in India. Family planning programs may use the contacts with antenatal, delivery, and post-delivery care system as an opportunity to identify women with an unwanted pregnancy, especially those educationally and economically weaker, for targeted information and service delivery. Better counseling of potential young contraceptive acceptors will ensure informed decision-making and increased use of modern spacing methods., (© 2022 Japan Society of Obstetrics and Gynecology.)

Competing Interests: I declare no competing interests.

The use of contraceptive methods and their correlates continues to be a subject of scientific interest in developing countries, including India, for its contribution to reducing fertility and improving maternal and child health. This study explores the family type and contraceptive use by analyzing the National Family Health Survey-4 data (2015-16). Multinomial logistic regression was used to check the adjusted effects of the predictor variables on contraceptive use. STATA (version 13) was used for the analysis with a significance level of 5 per cent. Adjusting the effects of socio-demographic and economic characteristics, women from nuclear family had 6 per cent lower odds of using modern limiting method (OR = 0.94, 95 per cent CI = 0.92-0.96) and 5 per cent lower odds of using any traditional method of contraception (OR = 0.95, 95 per cent CI = 0.91-0.99) than their counterparts from non-nuclear family with mother-in-law (MIL). Family type, especially the presence of MIL, was associated with daughter-in-law's (DIL) contraceptive behavior. The results based on a nationally representative recent survey contribute to the existing scanty evidence on the association between the MIL and DIL's contraceptive behavior in the Indian context. Results suggest more awareness about the benefits of modern spacing methods among the mothers-in-law, leading to their enhanced use.

Malnutrition continues to be a primary concern for researchers and policymakers in India. There is limited scientific research on the effect of agriculture on child nutrition in the country using a large representative sample. To the best of our knowledge, no study has examined the spatial clustering of child malnutrition and its linkage with agricultural production at the district-level in the country. The present study aims to examine agricultural production's role in improving the nutritional status of Indian children through child feeding practices. The nutritional indicators of children from the National Family Health Survey-4 (2015-16) and the agricultural production data for all the 640 districts of India obtained from the District-Wise Crop Production Statistics (2015-16), published by the Ministry of Agriculture, Government of India were used for the analysis. The statistical analysis was undertaken in STATA (version 14.1). ArcMap (version 10.3), and GeoDa (version 1.8) were used for the spatial analysis. The study found a higher prevalence of malnutrition among children who had not received Minimum Meal Frequency (MMF), Minimum Dietary Diversity (MDD), and Minimum Acceptable Diet (MAD). Further, child feeding practices- MMF, MDD, and MAD- were positively associated with high yield rates of spices and cereals. The yield rate of cash crops, on the contrary, harmed child feeding practices. Production of pulses had a significant positive effect on MDD and MAD. Districts with high cereal yield rates ensured that children receive MMF and MAD. There is a significant spatial association between child feeding practices and malnutrition across Indian districts. The study suggests that adopting nutrient-sensitive agriculture may be the best approach to improving children's nutritional status., Competing Interests: The authors have declared that no competing interests exist.

Background: Human papilloma virus (HPV) infection is implicated in a proportion of invasive squamous cell carcinoma of the penis (PC). A subset of PC involves dysregulation of the p53 pathway. HPV in situ hybridization (ISH) and p16 ink4a positivity are surrogate markers for HPV infection, and p53 immunohistochemistry (IHC) denotes abnormality in the p53 pathway. There remains an ambiguity with regard to the contribution of both the pathways in the prognosis of PC. We sought to analyze the clinicopathologic characteristics of a cohort of Indian PC patients with respect to p16 ink4a and p53 expression., Patients and Methods: A cohort of 123 PC patients was studied for p16 ink4a and p53IHC and HPVISH. The results of these biomarkers were correlated with various clinicopathologic parameters., Results: p16 ink4a and HPV ISH were positive in 47% and 53% of the tumors, respectively. The proportion of warty, basaloid, or mixed warty-basaloid tumor subtypes showed significant p16 ink4a positivity (P < .0001) compared to other subtypes. Twenty-eight patients were dual negative (p53- /p16 ink4a -), 32 were dual positive (p53+/p16 ink4a +), 38 were p53+/p16 ink4a -, and 25 were p53-/p16 ink4a +. In patients where p16 ink4a was negative, a p53-positive phenotype had a higher propensity for lymph node metastases (OR, 5.42; 95% CI, 1.75-16.80; P = .003). Similarly, p53 positivity dictates nodal involvement in the p16 ink4a -positive subset of tumors (OR, 5.00; 95% CI, 1.23-20.17; P = .024). On multivariate analyses, pathologic subtypes (warty, warty-basaloid, and basaloid) (P < .0001), p16 ink4a expression (P < .0001), and absence of nodal metastasis (P < .0001) were significant predictors of improved overall (OS) and cancer specific survival (CSS). In Kaplan-Meier analysis, the OS was significantly longer in patients with p16 ink4a  + tumors (P < .0001), as was the CSS (P < .0001). Patients with dual positive tumors had a significantly higher OS (P < .001) and CSS (P = .012), in the entire cohort. In the node positive patients, dual positivity was associated with significantly higher OS (P < .0001); however, the median CSS for p53+/p16 ink4a +tumors were not significantly different compared to p53- /p16 ink4a - tumors (P = .064), although there was a trend towards improved CSS., Conclusions: There is a strong concordance between p16 ink4a IHC and HPV ISH results. p16 ink4a status is an independent predictor of survival (OS and CSS) in our cohort of PCs. p53 is a predictor of nodal metastasis irrespective of p16 status. Dual positive tumors have a significantly better outcome in comparison to dual negative tumors., (Copyright © 2021. Published by Elsevier Inc.)

Objectives: To examine and compare human epidermal growth factor receptor 2 (HER2) amplification status in high-grade urothelial carcinoma (HGUCa), using both 2013 and 2018 HER2 reporting guidelines for breast carcinoma from the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP)., Methods: HER2 status by fluorescence in situ hybridization (FISH) assay in 78 cases of HGUCa was compared using 2013 and 2018 HER2 reporting guidelines., Results: HER2 amplification was observed in 22 (28.2%) of 78 tumors, of which 17 were in group 1, 1 in group 2, and 2 each in groups 3 and 4 (FISH assay, 2018). The remaining 14 HER2-amplified tumors (FISH assay, 2013) became negative, falling into group 2 (FISH assay, 2018) and were either negative or equivocal on immunohistochemistry (IHC, 2018). All FISH-negative tumors (n = 37) using 2013 criteria remained negative (group 5, 2018). FISH-equivocal tumors (2013) were further categorized into HER2 amplified (n = 1) and HER2 negative (n = 4) (2018). Overall, 20 (25.6%) tumors had discordant HER2 FISH results (2018 vs 2013)., Conclusions: Implementing 2018 guidelines, HER2 amplification decreased from 36 to 22 cases. The group with a HER2/CEP17 ratio of 2 or more and average HER2 copy number less than 4 (group 2) were predominantly negative by IHC, suggesting a biologically distinct group of HGUCa that is different from HER2-amplified tumors, which may not respond to HER2-targeted therapy., (© American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To assess the level, pattern and determinants of minimum acceptable diet (MAD) feeding in Odisha, India., Design: Utilising cross-sectional data, the MAD was estimated through a dietary assessment method wherein the child's mother was asked to recall all the food intake of the youngest child the previous day and night of the surveyed date., Setting: National Family Health Survey 2015-2016., Participants: Children aged 6-23 months, living with mother and for whom complete information on MAD was available (n 3073)., Results: Only 8·4 % of the children aged 6-23 months were fed MAD, and the MAD feeding varies considerably by socio-demographic characteristics. Children aged 12-17 months had two times (OR: 2·51, 95 % CI (1·48, 4·26)) and those aged 18-23 months had three times (OR: 3·77, 95 % CI (2·25, 6·30)) higher odds of having a MAD than their counterparts aged 6-8 months. Children whose mother was exposed to any mass media had a higher chance of MAD feeding (OR: 1·46, 95 % CI (1·01, 2·11))., Conclusions: The children of higher age, second or higher-order births, with mother exposed to mass media are significantly more likely to be fed with a MAD. At the same time, children from scheduled caste (SC) households have a lower probability of MAD feeding. The lower MAD feeding among the SC households suggests strengthening the ongoing programmes with a higher emphasis on the inclusion of this disadvantaged and marginalised group. Findings from the current study would assist policymakers, and public health managers improve MAD feeding practices in Odisha, India, in a targeted manner.

Background: Research on handwashing continues to draw researchers' interest owing to its public health importance and significance in the reduction of infectious diseases. The aims of this study are to: (1) understand the pattern and predictors of handwashing using soap/detergent and water; and (2) assess the spatial clustering of handwashing through soap/detergent and water at the district level in India., Methods: Data of households where the place for handwashing was observed by the research investigators (n = 582,064), gathered through the National Family Health Survey-4 (2015-2016), were used for this analysis. The availability of soap/detergent and water at the usual place of handwashing was assumed to be used for handwashing. Binary logistic regression was carried out to examine the adjusted effect of socioeconomic characteristics on the use of soap/detergent and water for handwashing. The univariate local indicator of spatial association (LISA) cluster map and Moran's I statistics were applied for assessing spatial autocorrelations at the district level. Analyses were carried out with IBM-SPSS Software., Results: Two-fifths of Indian households do not use both soap/detergent and water for handwashing. Households using both the cleansing elements vary considerably by socioeconomic characteristics- worse for the socioeconomically disadvantaged groups. There is spatial clustering in the use of soap/detergent and water for handwashing: lower in a cluster of districts in eastern India., Conclusion: Results suggest the need to generate awareness, particularly among the socioeconomically weaker populations, about advantages of hand hygiene, which will reduce the prevalence of infectious diseases like COVID-19 and be helpful to achieve many Sustainable Development Goals., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Research on informed choice in modern contraceptive method acceptance by young married women is pertinent in the broader context of individual freedom and reproductive rights, especially in countries where women continue to have limited control over their reproductive and contraceptive choices. This study in India asked: (1) is young married women's acceptance of specific modern contraceptive methods an informed choice? and (2) what are the enablers and barriers to informed choice? The study used data for currently married women aged 15-24 (N = 20,752) from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015-16. A Method Information Index (MII) was calculated as a measure of informed choice from the percentage of users who responded 'yes' to all three questions on: whether they were informed about methods other than the one they received, told about the method-specific side-effects, and advised what to do if they experienced side-effects. Binary logistic regression analysis was carried out to examine the adjusted effect of factors associated with the MII separately for female sterilization, the intrauterine device and the oral contraceptive pill, and a combined MII including all three methods plus injectables. One-fifth of the study women used any modern contraceptive method at the time of survey, of which only 36% had fully informed choice. The likelihood of being informed about the methods was significantly higher among those using the oral contraceptive pill (OR: 1.75, CI 1.58-1.94), IUD (OR: 2.23, CI 1.97-2.52) and injectables (OR: 1.37, CI 0.97-1.94) compared with those who were sterilized. Informed choice varied by region and the socioeconomic profile of the users. Inadequately informed choice violates the reproductive rights of young women and might result in higher post-use health problems, discontinuation of and unmet need for contraceptives, unintended pregnancies, induced abortions and regret, adversely affecting women's health. Training of health/family planning workers in India about the importance of reproductive rights is urgently required to enhance informed contraceptive choice and improve the health of young married women.

Context: Hygienic use of absorbent products during menstruation is a challenge for young women in India, especially among the underprivileged, who lack knowledge and access to resources. Reuse of menstrual absorbents can be unhygienic and result in adverse health and other outcomes., Methods: Data from the 2015-2016 National Family Health Survey-4 for 233,606 menstruating women aged 15-24 were used to examine levels and correlates of exclusive use of disposable absorbents during menstruation. Bivariate and logistic regression analyses were conducted to identify disparities in exclusive use by such characteristics as caste, mass media exposure and interaction with health workers., Results: Exclusive use of disposable absorbents was low among young women overall (37%), and varied substantially by caste and other characteristics. Compared with women from general castes, those from scheduled castes, scheduled tribes and other backward classes had reduced odds of exclusive disposable absorbent use (odds ratios, 0.8-0.9). Disposable absorbent use was negatively associated with lower levels of education and household wealth, and rural residence. Compared with women who reported daily media exposure, those exposed less frequently had reduced odds of disposable absorbent use (0.7-0.9). Among those who recently met with a health worker, odds of use were lower if menstrual hygiene had not been discussed (0.9)., Conclusions: Promoting awareness of proper menstrual hygiene-through education, media campaigns and discussion with reproductive health workers-and targeted interventions to disseminate and subsidize the purchase of disposable sanitary napkins should be pursued to address health disparities.

Objective: Although abortion has been legal in India since 1971, but very little research has been done so far on the issue of the quality of abortion services. To fill this gap, this paper examines whether the quality of abortion services provided in the country is in line with the WHO's recommendations., Study Design: We analyse a cross-sectional health facilities survey conducted in six Indian states, representing different sociocultural and geographical regions, as part of a study done in 2015., Main Outcome Measures: Percentage of facilities offering different abortion methods, type of anaesthesia given, audio-visual privacy level, compliance with the law by obtaining woman's consent only, imposing the requirement of adopting a contraceptive method as a precondition to receive abortion., Results: Except for the state of Madhya Pradesh, fewer than half of the facilities in the other states offer safe abortion services. Fewer than half of the facilities offer the WHO recommended manual vacuum aspiration method. Only 6-26% facilities across the states seek the woman's consent alone for providing abortion. About 8-26% facilities across the states also require that women adopt some method of contraception before receiving abortion., Conclusion: To provide comprehensive quality abortion care, India needs to expand the provider base by including doctors from the Ayurveda, Unani, Siddha, and Homeopathy streams as also nurses and auxiliary midwives after providing them necessary skills. Medical and nursing colleges and training institutions should expand their curriculum by offering an in-service short-term training on vacuum aspiration (VA) and medical methods of abortion., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Unsafe abortions remain a considerable public health problem and continue to be a leading cause of maternal morbidity and mortality throughout the world. This study assessed whether women's choice of type of health care facility for abortion in India varied by their socio-demographic and economic characteristics, and aimed to determine the significant predictors of choice of health care facility. Data were taken from the 2015-16 Indian National Family and Health Survey (NFHS-4). The study sample included women aged 15-49 years, irrespective of their marital status, who had terminated their last pregnancy by induced abortion in the five years before the survey (N = 6876). A bivariate analysis was carried out to assess the pattern in the choice of health care facility type for an abortion, and a multinomial logistic regression model was fitted to assess the predictors affecting the choice of health care facility type for an abortion. The results showed that, at the time of the 2015-16 survey, women in India went to private facilities more than public facilities for abortion care, irrespective of their age, distance to facility and financial constraints. The probability of visiting a private facility increased with women's age, gestational age and the wealth quintile. A wide variation in choice of health facility for abortion care by socioeconomic characteristics was observed.

Medical methods of abortion, MMA, has been legal in India since 2002. Guidelines stipulate that it should be administered by a provider or acquired via prescription. 1.2 million women having abortions in India use MMA acquired from health facilities [Singh, S., Shekhar, C., Acharya, R., Moore, A. M., Stillman, M., Pradhan, M. R., … Browne, A. (2018). The incidence of abortion and unintended pregnancy in India, 2015. The Lancet Global Health , 6 (1), e111-e120. doi: 10.1016/S2214-109X(17)30453-9 ]. We undertook a study of abortion in Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh in 2015 to better understand under what conditions and how MMA is being administered in facilities. The majority of facilities that provide MMA are in the private sector and located in urban areas. Most facilities offer MMA both at the facility and as a prescription, although some facilities only offer MMA as a prescription. A high proportion of facilities report that women typically take the medication at home. (Re)training providers in MMA protocols and counselling, increasing the number of facilities offering MMA, and stocking of the drugs would help improve women's access to MMA and the information they need to be able to use this method safely. Key Messages: In the six states in our sample, Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh, 8% of abortions in 2015 were done using medical methods of abortion (MMA) acquired from health facilities. The majority of facilities that provide MMA in the six states are in the private sector and are located in urban areas. Health facilities in Madhya Pradesh and Tamil Nadu are comparatively better in their provision of MMA with Assam, Bihar, Gujarat and Uttar Pradesh demonstrating poorer provision of MMA. There are many opportunities for improvement in the practices of MMA provision through improved training of providers, accessibility to the medications and better support of women using MMA.

The PDZ domain is one of the most widespread protein interaction domains found in nature. Due to their integral role in numerous biological functions, their ability to act as scaffolds for signal amplification, and the occurrence of mutations linked to human diseases, PDZ domains are attractive therapeutic targets. On the basis of the differential binding affinities of selected C-terminal peptides of the human proteome for one such PDZ domain (PSMD9) and by exploring structure-activity relationships, we design and convert a low-affinity tetrapeptide (∼439 μM) to a tight binding sequence (∼5 μM). The peptide inhibits PSMD9-hnRNPA1 interactions that are critical in basal and stimulus-induced NF-κB signaling and a potential therapeutic target in cancers, including chemotherapy or radiation-induced therapy resistance. Extensive application of computer modeling, including ligand mapping and all-atom molecular dynamics simulations, helps us to rationalize the structural basis for the huge differences in binding affinity and inform us about the residue-wise contributions to the binding energy. Our findings are in accord with the classical preference of the (PSMD9) PDZ domain for C-terminal sequences that contain hydrophobic residues at the P0 (C-terminal) position. In addition, for the first time, we identify a hitherto unknown occupancy for cysteine at the P-2 position that drives high-affinity interaction in a PDZ domain.

Introduction: Tobacco cessation is crucial to reduce tobacco-related diseases and premature deaths. Quitting efforts can be enhanced through brief routine interventions at health facilities because healthcare providers are highly trusted, resulting in stronger adherence to their advice., Materials and Methods: This study used data on tobacco users aged 15-49 years (n = 93,522) collected as part of the fourth round of the National Family Health Survey (NFHS) 2015-16. Bivariate and multivariate analyses were carried out using STATA (version 13) to understand the socioeconomic and demographic correlates of tobacco quit attempts and advice to quit by healthcare providers. GIS map has been used to show inter-state variations in quit attempts and advice., Results: Thirty per cent of the tobacco users were found to have attempted to quit tobacco. Education, mass media exposure, economic status, and chronic disease emerged as enablers, while alcohol use and social backwardness came out as barriers to quit attempts. Quit advice from the healthcare providers was found not to be given frequently (51%) and varied significantly by the socioeconomic and demographic profile of the users. Not all of the tobacco users attempting to quit had been advised to quit, indicating a missed opportunity to intervene and reinforce quitting at a health facility., Conclusions: Fewer attempts to quit among the adolescents, the less educated, and the users from the poorest households may increase the burden of tobacco-attributable diseases unless timely interventions are made. Better training of the healthcare providers in administering and recommending tobacco cessation and emphasizing on the value of cessation counselling is urgently required to enhance quitting practices and improve health., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Solute-solvent interactions are critical for biomolecular stability and recognition. Explicit solvent molecular dynamics (MD) simulations are routinely used to probe such interactions. However, detailed analyses and interpretation of the hydration patterns seen in MD simulations can be both complex and time-consuming. A variety of approaches/tools to compute and interrogate hydration properties in structural ensembles of proteins, nucleic acids, or in general any molecule are available and are complemented here with a new and free software package ("JAL"). Central to "JAL" is an intuitive atom centric approach of computing hydration properties. In addition to the standard metrics commonly used to understand hydration, "JAL" introduces two nonstandard utilities: a program to rapidly compute buried waters in an MD trajectory and a new method to compute multiwater bridges around a solute. We demonstrate the utility of the package by probing the hydration characteristics of the tumor suppressor protein p53 and the translation initiation factor eif4E. "JAL" is hosted online and can be accessed for free at http://mspc.bii.a-star.edu.sg/minhn/jal.html .

Stapled α-helical peptides represent an emerging superclass of macrocyclic molecules with drug-like properties, including high-affinity target binding, protease resistance, and membrane permeability. As a model system for probing the chemical space available for optimizing these properties, we focused on dual Mdm2/MdmX antagonist stapled peptides related to the p53 N-terminus. Specifically, we first generated a library of ATSP-7041 (Chang et al., 2013) analogs iteratively modified by L-Ala and D-amino acids. Single L-Ala substitutions beyond the Mdm2/(X) binding interfacial residues (i.e., Phe 3 , Trp 7 , and Cba 10 ) had minimal effects on target binding, α-helical content, and cellular activity. Similar binding affinities and cellular activities were noted at non-interfacial positions when the template residues were substituted with their d-amino acid counterparts, despite the fact that d-amino acid residues typically 'break' right-handed α-helices. d-amino acid substitutions at the interfacial residues Phe 3 and Cba 10 resulted in the expected decreases in binding affinity and cellular activity. Surprisingly, substitution at the remaining interfacial position with its d-amino acid equivalent (i.e., Trp 7 to d-Trp 7 ) was fully tolerated, both in terms of its binding affinity and cellular activity. An X-ray structure of the d-Trp 7 -modified peptide was determined and revealed that the indole side chain was able to interact optimally with its Mdm2 binding site by a slight global re-orientation of the stapled peptide. To further investigate the comparative effects of d-amino acid substitutions we used linear analogs of ATSP-7041, where we replaced the stapling amino acids by Aib (i.e., R 8 4 to Aib 4 and S 5 11 to Aib 11 ) to retain the helix-inducing properties of α-methylation. The resultant analog sequence Ac-Leu-Thr-Phe-Aib-Glu-Tyr-Trp-Gln-Leu-Cba-Aib-Ser-Ala-Ala-NH 2 exhibited high-affinity target binding (Mdm2 K d = 43 nM) and significant α-helicity in circular dichroism studies. Relative to this linear ATSP-7041 analog, several d-amino acid substitutions at Mdm2(X) non-binding residues (e.g., d-Glu 5 , d-Gln 8 , and d-Leu 9 ) demonstrated decreased binding and α-helicity. Importantly, circular dichroism (CD) spectroscopy showed that although helicity was indeed disrupted by d-amino acids in linear versions of our template sequence, stapled molecules tolerated these residues well. Further studies on stapled peptides incorporating N-methylated amino acids, l-Pro, or Gly substitutions showed that despite some positional dependence, these helix-breaking residues were also generally tolerated in terms of secondary structure, binding affinity, and cellular activity. Overall, macrocyclization by hydrocarbon stapling appears to overcome the destabilization of α-helicity by helix breaking residues and, in the specific case of d-Trp 7 -modification, a highly potent ATSP-7041 analog (Mdm2 K d = 30 nM; cellular EC 50 = 600 nM) was identified. Our findings provide incentive for future studies to expand the chemical diversity of macrocyclic α-helical peptides (e.g., d-amino acid modifications) to explore their biophysical properties and cellular permeability. Indeed, using the library of 50 peptides generated in this study, a good correlation between cellular permeability and lipophilicity was observed.

The influence of family on an individual's fertility has long been an important topic of interest in fertility research. Although studies conducted mostly in developed countries found a significant bearing of fertility of the parents on the fertility of the children, there is a lack of formal research around this topic in India. The present study analyses the effect of sibling size of husband and wife on the completed family size of women using information of 5506 ever-married women aged 45-49 years incorporated in the India Human Development Survey-II (2011-2012). Inferential statistics, bivariate, Chi-square and Poisson regression were used as the methods of analysis. The unadjusted estimates of Poisson regression reveal sibling size of women (IRR: 1.02; p < 0.001) and husband (IRR: 1.01; p < 0.001) have a positive correlation with the completed family size of women. However, in the adjusted model, the effect of sibling size especially of husband diminishes gradually in the presence of socio-economic covariates of the women.

Objective: Contraceptive use is subject of scientific interest for its contribution to reduced fertility and improved maternal and child health in India. This study answers the changes in method mix and the influence of factors associated with contraceptive use in India during 1992-93 to 2015-16., Methods: The study used data from all the four rounds of National Family Health Survey (NFHS) conducted during 1992-93 to 2015-16. Binary logistic regression was conducted in the pooled data of contraceptive users of four rounds of the survey to examine the adjusted contribution of various contraceptive methods over time. Also analysed the determinants of contraceptive use in 1992-93 and 2015-16. The pooled data of 1992-93 and 2015-16 was used to explore the change in users through creating interaction between time and predictors. STATA (V 13) was used for analyses and result was reported at 5 percent level of significance., Results: Female sterilization continued to dominate the contraceptive method mix, use of pills and condoms had considerably increased, and traditional method use had remained almost unchanged during 1992-93 to 2015-16. Age, education, surviving son, religion, social group, household size, region, and economic condition of the woman remained as significant determinants of contraceptive use during the study period., Conclusion: Contraceptive use, method mix, the profile of the users, and determinants of contraceptive use has changed significantly during 1992-93 to 2015-16 in India. Increased use of modern spacing methods albeit continuous dominance of female sterilization in method mix suggests relooking at the family planning implementation strategy., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The DNA binding domain (DBD) of the tumor suppressor p53 is the site of several oncogenic mutations. A subset of these mutations lowers the unfolding temperature of the DBD. Unfolding leads to the exposure of a hydrophobic β-strand and nucleates aggregation which results in pathologies through loss of function and dominant negative/gain of function effects. Inspired by the hypothesis that structural changes that are associated with events initiating unfolding in DBD are likely to present opportunities for inhibition, we investigate the dynamics of the wild type (WT) and some aggregating mutants through extensive all atom explicit solvent MD simulations. Simulations reveal differential conformational sampling between the WT and the mutants of a turn region (S6-S7) that is contiguous to a known aggregation-prone region (APR). The conformational properties of the S6-S7 turn appear to be modulated by a network of interacting residues. We speculate that changes that take place in this network as a result of the mutational stress result in the events that destabilize the DBD and initiate unfolding. These perturbations also result in the emergence of a novel pocket that appears to have druggable characteristics. FDA approved drugs are computationally screened against this pocket., (© The Author(s) 2019. Published by Oxford University Press on behalf of Nucleic Acids Research.)

Competing Interests: There are no conflicts of interest

Background: Reliable information on the incidence of induced abortion in India is lacking. Official statistics and national surveys provide incomplete coverage. Since the early 2000s, medication abortion has become increasingly available, improving the way women obtain abortions. The aim of this study was to estimate the national incidence of abortion and unintended pregnancy for 2015., Methods: National abortion incidence was estimated through three separate components: abortions (medication and surgical) in facilities (including private sector, public sector, and non-governmental organisations [NGOs]); medication abortions outside facilities; and abortions outside of facilities and with methods other than medication abortion. Facility-based abortions were estimated from the 2015 Health Facilities Survey of 4001 public and private health facilities in six Indian states (Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh) and from NGO clinic data. National medication abortion drug sales and distribution data were obtained from IMS Health and six principal NGOs (DKT International, Marie Stopes International, Population Services International, World Health Partners, Parivar Seva Santha, and Janani). We estimated the total number of abortions that are not medication abortions and are not obtained in a health facility setting through an indirect technique based on findings from community-based study findings in two states in 2009, with adjustments to account for the rapid increase in use of medication abortion since 2009. The total number of women of reproductive age and livebirth data were obtained from UN population data, and the proportion of births from unplanned pregnancies and data on contraceptive use and need were obtained from the 2015-16 National Family Health Survey-4., Findings: We estimate that 15·6 million abortions (14·1 million-17·3 million) occurred in India in 2015. The abortion rate was 47·0 abortions (42·2-52·1) per 1000 women aged 15-49 years. 3·4 million abortions (22%) were obtained in health facilities, 11·5 million (73%) abortions were medication abortions done outside of health facilities, and 0·8 million (5%) abortions were done outside of health facilities using methods other than medication abortion. Overall, 12·7 million (81%) abortions were medication abortions, 2·2 million (14%) abortions were surgical, and 0·8 million (5%) abortions were done through other methods that were probably unsafe. We estimated 48·1 million pregnancies, a rate of 144·7 pregnancies per 1000 women aged 15-49 years, and a rate of 70·1 unintended pregnancies per 1000 women aged 15-49 years. Abortions accounted for one third of all pregnancies, and nearly half of pregnancies were unintended., Interpretation: Health facilities can have a greater role in abortion service provision and provide quality care, including post-abortion contraception. Interventions are needed to expand access to abortion services through better equipping existing facilities, ensuring adequate and continuous supplies of medication abortion drugs, and by increasing the number of trained providers. In view of how many women rely on self-administration of medication abortion drugs, interventions are needed to provide women with accurate information on these drugs and follow-up care when needed. Research is needed to test interventions that improve knowledge and practice in providing medication abortion, and the Indian Government at the national and state level needs to prioritise improving policies and practice to increase access to comprehensive abortion care and quality contraceptive services that prevent unintended pregnancy., Funding: Government of UK Department for International Development (until 2015), the David and Lucile Packard Foundation, the John D. and Catherine T. MacArthur Foundation, and the Ford Foundation., (Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Overexpression of the eukaryotic initiation factor 4E (eIF4E) is linked to a variety of cancers. Both mitogen-activated protein kinases-interacting kinases 1 and 2 (Mnk1/2) activate the oncogene eIF4E through posttranslational modification (phosphorylating it at the conserved Ser209). Inhibition of Mnk prevents eIF4E phosphorylation, making the Mnk-eIF4E axis a potential therapeutic target for oncology. Recently, the design and synthesis of a series of novel potent compounds inhibiting the Mnk1/2 kinases were carried out in-house. Here, we describe computational models of the interactions between Mnk1/2 kinases and these inhibitors. Molecular modeling combined with free energy calculations show that these compounds bind to the inactive forms of the kinases. All compounds adopt similar conformations in the catalytic sites of both kinases, stabilized by hydrogen bonds with the hinge regions and with the catalytic Lys78 (Mnk1) and Lys113 (Mnk2). These hydrogen bond interactions clearly play a critical role in determining the conformational stability and potency of the compounds. We also find that van der Waals interactions with an allosteric pocket are key to their binding and potency. Two distinct hydration sites that appear to further stabilize the ligand binding/interactions were observed. Critically, the inclusion of explicit water molecules in the calculations results in improving the agreement between calculated and experimental binding free energies., Competing Interests: The authors declare no competing financial interest.

Summary: In this study, computational methods are applied to investigate the general properties of antigen engaging residues of a paratope from a non-redundant dataset of 403 antibody-antigen complexes to dissect the contribution of hydrogen bonds, hydrophobic, van der Waals contacts and ionic interactions, as well as role of water molecules in the antigen-antibody interface. Consistent with previous reports using smaller datasets, we found that Tyr, Trp, Ser, Asn, Asp, Thr, Arg, Gly, His contribute substantially to the interactions between antibody and antigen. Furthermore, antibody-antigen interactions can be mediated by interfacial waters. However, there is no reported comprehensive analysis for a large number of structured waters that engage in higher ordered structures at the antibody-antigen interface. From our dataset, we have found the presence of interfacial waters in 242 complexes. We present evidence that suggests a compelling role of these interfacial waters in interactions of antibodies with a range of antigens differing in shape complementarity. Finally, we carry out 296 835 pairwise 3D structure comparisons of 771 structures of contact residues of antibodies with their interfacial water molecules from our dataset using CLICK method. A heuristic clustering algorithm is used to obtain unique structural similarities, and found to separate into 368 different clusters. These clusters are used to identify structural motifs of contact residues of antibodies for epitope binding., Availability and Implementation: This clustering database of contact residues is freely accessible at http://mspc.bii.a-star.edu.sg/minhn/pclick.html., Contact: minhn@bii.a-star.edu.sg, chandra@bii.a-star.edu.sg or zhong&#95;pingyu@immunol.a-star.edu.sg., Supplementary Information: Supplementary data are available at Bioinformatics online., (© The Author (2017). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com)