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From research in central Chhattisgarh, this paper interprets the bearing that healthcare beliefs and practices may have in shaping maternal and child nutrition both in the light of biomedical recommendations and within the context and constraints of a rural village setting. It contends that health beliefs and practices that are at variance from biomedical recommendations appear to have few consequences for gestational nutrition and for child health in relation to pregnancy. In the postpartum however, health ideas at variance from biomedical recommendations appear to have an important bearing on maternal nutrition and infant feeding, and may put mothers and children at risk of nutritional deficiency. Maternal 'eating down' following a surgical procedure such as a caesarean delivery or tubectomy is especially noteworthy, since food intake quantity is reduced over an extended time frame. While caring practices are influenced by cultural formulations, they also reflect, perhaps, adaptations to health risks. [ABSTRACT FROM AUTHOR]

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

This paper presents findings on hysterectomy prevalence from a 2010 cross-sectional household survey of 2,214 rural and 1,641 urban, insured and uninsured women in low-income households in Ahmedabad city and district in Gujarat, India. The study investigated why hysterectomy was a leading reason for use of health insurance by women insured by SEWA, a women's organisation that operates a community-based health insurance scheme. Of insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women. Approximately one-third of all hysterectomies were in women younger than 35 years of age. Rural women used the private sector more often for hysterectomy, while urban use was almost evenly split between the public and private sectors. SEWA's community health workers suggested that such young women underwent hysterectomies due to difficulties with menstruation and a range of gynaecological morbidities. The extent of these and of unnecessary hysterectomy, as well as providers' attitudes, require further investigation. We recommend the provision of information on hysterectomy as part of community health education for women, and better provision of basic gynaecological care as areas for advocacy and action by SEWA and the public health community in India. L'article présente les conclusions d'une enquête transversale sur la prévalence de l'hystérectomie auprès de femmes (2214 rurales et 1641 urbaines) assurées et non assurées dans des ménages à faible revenu de la ville et du district d'Ahmedabad à Gujarat, Inde. L'étude souhaitait déterminer pourquoi l'hystérectomie était une raison majeure de recours à l'assurance maladie de la part des femmes assurées chez SEWA, une organisation féminine qui gère un plan communautaire d'assurance maladie. Parmi les assurées, 9,8% des femmes rurales et 5,3% des femmes urbaines avaient subi une hystérectomie, contre 7,2% et 4,0% respectivement des femmes non assurées. Environ un tiers des hystérectomies avait été réalisées chez des femmes de moins de 35 ans. Les femmes rurales utilisaient plus souvent le secteur privé pour l'hystérectomie, alors qu'en ville, l'utilisation était répartie de manière égale entre les secteur public et privé. Les agents de santé communautaire de SEWA ont suggéré que ces jeunes femmes avaient subi une hystérectomie pour des troubles de la menstruation et différentes morbidités gynécologiques. Il convient de réaliser des recherches complémentaires sur l'étendue de ces interventions et des hystérectomies inutiles, ainsi que sur les attitudes des prestataires. Nous recommandons la diffusion d'informations sur l'hystérectomie dans le cadre de l'éducation sanitaire communautaire des femmes, et de meilleurs soins gynécologiques essentiels comme domaines de plaidoyer et d'action de SEWA et de la communauté de santé publique en Inde. En este artículo se presentan los hallazgos sobre la prevalencia de la histerectomía de una encuesta domiciliaria transversal, realizada en 2010, de 2214 mujeres rurales y 1641 urbanas aseguradas y no aseguradas, en viviendas de bajos ingresos en la ciudad y el distrito de Ahmedabad, en Gujarat, India. El estudio investigó por qué la histerectomía era una razón principal para el uso de seguro médico por mujeres aseguradas por SEWA, una organización de mujeres que administra un plan de seguro médico comunitario. De las mujeres aseguradas, el 9.8% de las mujeres rurales y el 5.3% de las urbanas habían tenido una histerectomía, comparado con el 7.2% y el 4.0%, respectivamente, de las mujeres no aseguradas. Aproximadamente una tercera parte de todas las histerectomías se efectuaron en mujeres menores de 35 años de edad. Las mujeres rurales acudieron al sector privado con más frecuencia para una histerectomía, mientras que las urbanas se dividieron casi exactamente por la mitad entre los sectores público y privado. Los trabajadores comunitarios de la salud empleados por SEWA sugirieron que estas jóvenes tuvieron histerectomías debido a sus dificultades con la menstruación y una variedad de morbilidades ginecológicas. La gravedad de éstas y la frecuencia de histerectomías innecesarias, así como las actitudes del personal de salud, requieren más investigación. Recomendamos el suministro de información sobre la histerectomía como parte de la educación de las mujeres comunitarias sobre la salud, y mejor prestación de los servicios ginecológicos básicos, como áreas de promoción y defensa y acción por parte de SEWA y la comunidad de salud pública en India. [ABSTRACT FROM AUTHOR]

The measurement of poverty is important yet problematic and controversial. This study assesses livelihood asset indicators from the sustainable livelihood approach as a multidimensional inverse proxy for poverty. The study develops and contrasts different asset-based proxies building on the five livelihood capitals: natural, physical, human, social and financial. The Indian Indo-Gangetic Plains with 280 million rural inhabitants and covering 0.47 million km2 are used as an empirical case to illustrate and contrast the multidimensional proxies, drawing on secondary data for 18 quantitative district-level indicators. Principal components derived directly from the district-level indicators proved to be a good proxy for the district-level poverty head count ratio (adjusted R2 = 0.51). A composite livelihood asset index aided interpretation but at a significant cost of overall explanatory power (adjusted R2 = 0.42). Alternative models derived from the five livelihood assets provide more acceptable trade-offs between explanatory and interpretational power. Livelihood asset-based approaches can thus provide an inverse proxy for absolute poverty. [ABSTRACT FROM AUTHOR]

This commentary sketches out the politics of the expansion of affordable, fast-moving nutraceutical products into rural India, with a focus on fortified foods and beverages. It examines the relationships between industry, government and humanitarian organisations that are being forged alongside the development of markets for nutraceuticals; the production of evidence and the harnessing of science to support nutraceutical companies’ claims; the ways in which nutraceuticals are being marketed and distributed in rural areas; and the concepts of health and well-being that are being promulgated through those marketing campaigns. Lastly, it asks what kinds of impact fast-moving nutraceuticals are likely to have on the lives of India’s rural poor. It concludes by questioning how smooth a transition to nutraceutical consumption Big Food marketing strategies can really facilitate and how readily low-income families seeking to feed their families and safeguard health will actually adopt concepts of wellness and internalise micro-nutrient associated risks. [ABSTRACT FROM PUBLISHER]