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• Government health care services are the primary source of maternal care for the tribes (indigenous communities). • Particularly vulnerable tribal groups are at risk of foregoing antenatal care and are more likely to give childbirth at home. • Health workers' home visits and advice significantly and positively influence maternal healthcare-seeking behaviour. • Maternal education and having all-weather roads are crucial determinants for institutional childbirths. • Certain socio-cultural practices (early marriages leading to teenage pregnancies) need to be addressed. To report the utilisation of maternal healthcare services and factors associated with adequate antenatal care and institutional childbirths among mothers in the tribal communities from nine districts in India. Cross-sectional data were collected from 2636 tribal women who had a childbirth experience in the past 12 months. Socio-demographic, maternal healthcare services and health system-related details were collected. Multiple logistic regression analyses were done to identify factors associated with adequate antenatal care (receiving at least four antenatal care visits, the first visit being in the first trimester and receiving a minimum of 100 iron-folic acid tablets) and institutional childbirth (mother giving birth in a health facility). Only 23% of the mothers received adequate antenatal care. 82% were institutional childbirths. The logistic regression revealed that particularly vulnerable tribal groups (PVTGs), those lacking all-weather roads, and women of advanced age were at risk of inadequate antenatal care. Mother's education, health worker's home visits during pregnancy and reception of advice on antenatal care were significantly associated with the reception of adequate antenatal care. Having all-weather roads, and education of the mother and head of the household were positively associated with institutional childbirths, whereas PVTGs, children of birth order three or above, and working mothers were more likely to give childbirth at home. PVTGs are at risk of foregoing adequate antenatal care and are more likely to give childbirth at home. Having all-weather roads is a strong correlate of adequate maternal care. Outreach activities by the health workers are to be strengthened as they are positively and significantly associated with the reception of adequate antenatal care. Investing in education and other social determinants and addressing certain socio-cultural practices is important to improve maternal health. [ABSTRACT FROM AUTHOR]

This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2–7 days and at 2–28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality. Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used. Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths. Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2–7 days and 2–28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2–7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2–7 days and at 2–28 days. The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality. [ABSTRACT FROM AUTHOR]

Preterm birth (PTB) increases the risk of various acute and chronic morbidities and premature mortality in children under 5 years of age. The present study examines the association between different maternal obstetric factors and PTB. In addition, this study estimates the risk of neonatal mortality among children born preterm. Retrospective two-stage stratified sample design. The weighted prevalence of PTB was estimated using data on 148,746 most recent institutional births from the National Family Health Survey (NFHS)-4, 2015–16. The Poisson regression model was used to investigate the association between maternal obstetric factors and PTB. Using Cox's proportional hazard model, the risk of neonatal mortality among PTBs was estimated. Maternal obstetric factors, such as minimal antenatal care, delivery complications, history of previous caesarean delivery and delivery at private health facilities, were significantly associated with an increased risk of PTB. The survival probability of preterm babies sharply declined in the first week of life and thereafter was found to stabilise. The risk of mortality in the first 28 days of life increased 2.5-fold if the baby was born preterm. Optimising antenatal care was found to lower the likelihood of PTB and improve their chances of survival. Antenatal care services and delivery care practices in private facilities were strongly associated with the incidence and survival of PTB. Evaluating associations of history of caesarean births on future pregnancies can help understand their deleterious effects on PTB. Affordable, accessible and available antenatal care services, in both public and private facilities, can increase the survival rates of PTBs. [ABSTRACT FROM AUTHOR]

Objective(s): Obstetric Violence refers to professional deficiencies in maternity care, which can occur in both low and high resource settings. Examples include non-dignified care, lack of respect when giving care, discrimination and abandonment of care. The objective of this study was to assess knowledge and attitudes towards obstetric violence in a cohort of medical students in India and the UK.Study Design: An online survey was sent to 240 UK and 280 Indian medical students. This incorporated a video showing a dramatized scenario of obstetric violence. The survey assessed participant's demographics and prior knowledge of obstetric violence. Participants scored their perceptions of eight behaviours in the video on visual analogue scales. Participants were asked to reflect on their own practice and score this. Comparisons of survey responses between UK and Indian participants were made using chi squared/Student's t-test.Results: 62 Indian medical students and 58 UK medical students completed the survey. Indian medical students were significantly more likely to be male (p < 0.001). 26 % of UK participants had previously heard the term obstetric violence, compared to 34 % of Indian participants (p = 0.15). Both were able to correctly define obstetric violence at similar rates (32 % versus 34 %). Indian medical students were significantly less critical (p < 0.001) of all eight scored behaviours in the video of obstetric violence compared to their UK counterparts. UK medical students were significantly less likely to agree that the video had changed their perception on how teams should behave and act in this context (p < 0.001). 90 % of UK participants and 38 % of Indian participants had received training in professional behaviours. 14 % of UK participants had seen examples of obstetric violence in clinical practice compared to 49 % of Indian participants.Conclusions: UK and Indian medical students were able to identify behaviours associated with obstetric violence, although the majority were previously unaware of the term. Indian medical students in this study were less critical of obstetric violence in the video, which may be because of cultural reasons, greater numbers of male students, greater exposure to obstetric violence or less training on professional behaviours. Standardised training to prevent obstetric violence should be part of undergraduate medical training internationally. [ABSTRACT FROM AUTHOR]

This study examined the health status of tribal women and, in particular, their maternal health. This study also explored the utilization of the Janani Suraksha Yojana (JSY) scheme, the tribal motherhood scheme and the human development scheme among pregnant women. The performance of accredited social health activist (ASHA) workers was also investigated. To fulfil the study objectives, husbands and key informants were interviewed. This was a cross-sectional, community-based study. Both qualitative and quantitative methods were used for data collection. For the quantitative analysis, 385 men, aged 15–49 years, whose wives had given birth in the last 2 years, were recruited using multistage sampling. To study the qualitative aspects of the maternal health situation, 15 interviews were conducted with key informants, and four focus group discussions were conducted with a mixed-age group of men. The key informants included the dais (midwives/traditional birth attendants) and ASHAs in the villages studied. The results revealed that less than half of women delivered in health facilities, but nearly 60% of births were attended by skilled medical personnel. The utilization rates for full antenatal care (ANC) and postnatal care were 70% and 50%, respectively. Nearly 60% of men had heard about the JSY scheme; however, only 57% reported that their wives had benefited from the JSY scheme. The mean amount of money received was ₹700 ($US 11) for the most recent birth. For men whose wives did not receive the benefits of JSY, 24% reported that their wives were not eligible for the scheme, and the majority (75%) reported that they were not aware of the JSY scheme. The basic community-level issues of limited medical workforce and medical equipment should be urgently addressed. Moreover, full ANC and institutional health facilities for delivery should be provided to tribal women. When implementing National Rural Health Mission strategies, understanding the local community-driven traditional and cultural factors is important. • NRHM has contributed to increase in maternal health services. • The NRHM has failed to address the general and maternal health of tribal women. • Janani Suraksha Yojana (JSY) scheme utilization is minimal among the tribal women. • The NRHM needs to consider local community-driven traditional and cultural factors. [ABSTRACT FROM AUTHOR]

Over a quarter of UK births are to women who were born outside of the UK. Black and Minority Ethnic (BME) women are disproportionately affected by poor mental health and inequitable access to mental health care in the perinatal period, yet the influence of the migrant status (mothers' UK vs. non-UK birth) is poorly understood. This study aimed to explore the relationship between ethnicity, migration and mental health indicators among mothers participating in a large nationally representative cohort study. This is a secondary analysis of data from the Millennium Cohort Study. Logistic regression quantified the crude and adjusted effects of self-reported ethnicity and migrant status on prevalence of psychological distress and treatment for anxiety/depression at 9-month and 5-year postpartum. We found substantial variation in the prevalence of distress according to ethnicity and migrant status, with Indian and Pakistani women at greatest risk. Despite equal or greater risk, BME and migrant women were less likely to report treatment for anxiety/depression. Mutually adjusted analyses showed ethnicity to be a stronger predictor of both outcomes than migrant status; however, at 5 years, being a migrant independently predicted lower odds of treatment, for a statistically similar level of distress. Migrant women are likely to be at high risk of poor mental health in the perinatal period and beyond, yet may face significant barriers to accessing mental health care. A better understanding of ethnicity and migration as interrelated risk factors for perinatal mental ill-health is needed to help National Health Service organisations develop policy and practice that is flexible and responsive to diversity. • Migrant and ethnic minority mothers are at increased risk of psychological distress. • But are less likely than non-migrant/white British women to be treated for anxiety/depression. • Ethnicity was a stronger predictor than migrant status of these differences. [ABSTRACT FROM AUTHOR]

Abstract We assess the impact of India's National Rural Employment Guarantee (NREG) scheme, the world's largest workfare scheme, on healthcare utilisation – specifically maternal healthcare. The primary objective of NREG is to improve the income of rural households by guaranteeing 100 days of employment. We expect that by improving household income, thereby reducing some of the financial barriers, such as out-of-pocket payments, NREG can increase utilisation of maternal health services. Using a nationally representative household survey and a difference-in-differences approach that exploits the phased rollout of the scheme, we estimate the impact of NREG on utilisation of maternal health services: mainly deliveries at health facilities. We find that NREG did not increase overall facility deliveries, even though it led to an increase in deliveries at public facilities. There is weak evidence to suggest that deliveries at private facilities reduced due to NREG. Furthermore, sub-group analyses reveal that among poorer households, who are more likely to participate in NREG, there is a reduction in facility deliveries while home deliveries increased. Among richer households, NREG increased deliveries at public facilities. There was no impact on households belonging to marginalised castes. We conclude by discussing the possible mechanisms for these effects and its impact on equity in healthcare utilisation. Highlights • We study the impact of India's National Rural Employment Guarantee (NREG) scheme on utilisation of maternal health services. • We find while NREG did not increase overall facility deliveries it increased deliveries at public facilities. • Among poorer households, NREG increased home deliveries and reduced facility deliveries. • Among richer households, NREG increased deliveries at public facilities. [ABSTRACT FROM AUTHOR]

Abstract Objective The objective is to examine the spatial variations and to identify the determinants of antenatal care (ANC) utilization while controlling for the spatial dependence in the data. Study design This is an ecological study on ANC utilization data from District Level Household Survey-4 (2012–2013) in India. Methods A secondary data analysis was performed on the derived data. The unit of analysis in this ecological study was 275 districts from 20 states of India. The study comprises ever married women of reproductive age. Determinants of ANC utilization were obtained using ordinary least square (OLS), spatial lag, and spatial error models. Model adequacy check was performed using the Akaike information criterion, R-squared, log likelihood, and Schwarz criterion. The software used is GeoDa and Quantum Geographic Information System. Results The presence of spatial autocorrelation (Moron's I = 0.6210) enforces the usage of geographic properties while modeling. The geographic clustering of low-rate districts was observed in states in Northeast India. In the present study, the model adequacy check reveals that the spatial error model performs better than the spatial lag and OLS models. The spatial pattern of the percentage of pregnant women with full ANC was observed to be associated with literacy (P = 0.04), birth order (P < 0.001), Janani Suraksha Yojana beneficiaries (P = 0.048), and availability of health infrastructure, staff, and services (P = 0.023). Conclusions The present study findings provide valuable insights into factors affecting ANC utilization. In addition to available ANC services, customized safe motherhood interventions and region-specific awareness programs would enhance the utilization, ensuring better maternal and child health. Highlights • Customized safe motherhood intervention. • Need based awareness program. • Accessibility of health facility need to be reviewed. [ABSTRACT FROM AUTHOR]

Maternal health is a significant public health concern for globe and many developing countries. A country like India (with large population), there are considerable disparities in maternal health service utilisation and maternal mortality within and across states. A more than a general healthcare operational policy would suffice, but a precision healthcare strategy would be needed. This article focused on explainable machine learning models that can precisely advise health care intervention policy and medical treatment to an administrative unit rather than a generic policy suggestion for improving maternal health. This study presents an exhaustive list of factors associated with Maternal Mortality Rate (MMR) and a series of explainable AI models. One of models uses CART heuristics to categorise districts (administrative boundaries) into lower and higher MMR classes. Another explainable model, Shapley Additive Explanations (SHAP), used SVM, ANN, boosting, and random forest machine learning models to investigate higher and lower MMR regions. Further, an Explainable Boosting Machine (EBM) also used, and the results are compared for policy suggestions. Some of the ignored features from general social science studies, such as topography and agro-climatic zone characteristics of a particular district, may be crucial in the analysis. Moreover, health infrastructure, insurance, and other factors also influence policymaking. This predictive and explainable work has significant implications for precision healthcare policy design to improve maternal health compared to a broader policy approach. • A precision healthcare strategy to advise healthcare policies using explainable machine learning models. • Factors associated with Maternal Mortality Rate (MMR) are analysed using multiple explainable AI models e.g. SHAP, EBM and etc. • The study has significant implications for precision healthcare policy design to improve maternal health. [ABSTRACT FROM AUTHOR]

Not all eligible women use the available services under India's Janani Suraksha Yojana (JSY), which provides cash incentives to encourage pregnant women to use institutional care for childbirth; limited evidence exists on demand-side factors associated with low program uptake. This study explores the views of women and ASHAs (community health workers) on the use of the JSY and institutional delivery care facilities. In-depth qualitative interviews, carried out in September-November 2013, were completed in the local language by trained interviewers with 112 participants consisting of JSY users/non-users and ASHAs in Jharkhand, Madhya Pradesh and Uttar Pradesh. The interaction of impeding and enabling factors on the use of institutional care for delivery was explored. We found that ASHAs' support services (e.g., arrangement of transport, escort to and support at healthcare facilities) and awareness generation of the benefits of institutional healthcare emerged as major enabling factors. The JSY cash incentive played a lesser role as an enabling factor because of higher opportunity costs in the use of healthcare facilities versus home for childbirth. Trust in the skills of traditional birth-attendants and the notion of childbirth as a ‘natural event’ that requires no healthcare were the most prevalent impeding factors. The belief that a healthcare facility would be needed only in cases of birth complications was also highly prevalent. This often resulted in waiting until the last moments of childbirth to seek institutional healthcare, leading to delay/non-availability of transportation services and inability to reach a delivery facility in time. ASHAs opined that interpersonal communication for awareness generation has a greater influence on use of institutional healthcare, and complementary cash incentives further encourage use. Improving health workers' support services focused on marginalized populations along with better public healthcare facilities are likely to promote the uptake of institutional delivery care in resource-poor settings. [ABSTRACT FROM AUTHOR]

Under-five mortality rate (U5MR) differs by rural-urban place of residence and mother's education; however, the rural-urban gap in U5MR by mother's educational attainment is unclear in the existing literature. Using five rounds of the national family health surveys (NFHS I–V) conducted between 1992–93 and 2019–21 in India, this study estimated the main and interaction effects of rural-urban and maternal education on U5MR. The mixed effect Cox proportional hazard (MECPH) model was used to predict the risk of under-five mortality (U5M). The finding shows that unadjusted U5MR remained 50 per cent higher in rural areas than in urban areas across the surveys. Whereas, after controlling for demographic, socioeconomic, and maternal health care predictors of U5M, the MECPH regression results indicated that urban children had a higher risk of death than their rural counterparts in NFHS I-III. However, there are no significant rural-urban differences in the last two surveys (NFHS IV -V). In addition, increasing maternal education levels were associated with lower U5M in all surveys. Though, in recent years, primary education has had no significant effect. The U5M risk was additionally lower for urban children than rural children whose mothers had secondary and higher education by NFHS-III; however, this additional urban advantage was no longer significant in recent surveys. The higher impact of secondary education on U5MR in urban areas in the past may be attributed to poor socio-economic, healthcare conditions in rural areas. Overall, maternal education, particularly secondary education, remained a protective factor for U5M in both rural and urban areas, even after controlling for predictors. Therefore, there is a need to increase the focus on secondary education for girls for a further decline in U5M. • Under-five mortality (U5M) remained higher in rural India across five study surveys between 1992 and 93 to 2019–21. • After controlling for socioeconomic predictors, earlier surveys show a higher risk of U5M in urban areas. • Maternal education reduces the risk of U5M across the surveys; , primary education does not make any significant difference in recent years. • The impact of maternal education on mortality differed between rural and urban areas in the past. • Women with secondary education living in urban areas had lower U5M in the past than their rural counterparts with similar education. [ABSTRACT FROM AUTHOR]

Summary The paper evaluates an Indian maternal conditional cash transfer scheme. Launched in 2005, the program gives women cash transfers for receiving maternal and child health care services. Data are drawn from India’s District Level Household Survey to evaluate the program’s impact. Results indicate that the program had a limited overall effect: relative to the broader population, the targeted population experienced a 3 percentage point increase in medically supervised births, but no increase in ante-natal or post-natal care. We do however, find evidence of heterogeneity of impact. Women without any formal education and women in rural areas experience disproportionate gains. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Although the impact of marital violence on women’s reproductive health is recognized globally, there is little research on how women’s experience of and justification of marital violence in developing country settings is linked to sexually transmitted infection (STI) symptom reporting, and seeking care for the symptoms. Method: This study analyzes data on 9,639 currently married women from India’s 2006–2007 National Family Health Survey-3 from the Central/Northern Indian state of Uttar Pradesh. The likelihood of currently married women’s reporting STIs or symptoms, and the likelihood of seeking care for these, are analyzed using multivariate logistic regression techniques. Results: Currently married women’s experience of physical, sexual, and emotional marital violence in the last 12 months was significantly associated with greater likelihood of reporting a STI or symptom (odds ratio [OR], 1.364 [95% confidence interval (CI), 1.171–1.588] for physical violence; OR, 1.649 [95% CI, 1.323–2.054] for sexual violence; OR, 1.273 [95% CI, 1.117–1.450] for emotional violence). Experience of physical violence (OR, 0.728; 95% CI, 0.533–0.994) and acceptance of any justification for physical violence (OR, 0.590; 95% CI, 0.458–0.760) were significantly associated with decreased chance of seeking care, controlling for other factors. Conclusion: This study suggests that experiencing marital violence may have a negative impact on multiple aspects of women’s reproductive health, including increased self-report of STI symptoms. Moreover, marital physical violence and accepting justification for such violence are associated with decreased chance of seeking care. Thus, policies and programs to promote reproductive health should incorporate decreasing gender-based violence, and overcoming underlying societal gender inequality. [Copyright &y& Elsevier]

Abstract: Studies in low-income countries have shown that women''s autonomy (i.e. the freedom of women to exercise their judgment in order to act for their own interests) influences a number of reproductive and child health outcomes, including the use of pregnancy care services. However, studies have not examined the full spectrum of pregnancy care services needed for safe motherhood and have not accounted for community context. This study analyzed data on women and their villages from the cross-sectional population-based National Family Health Survey-2 (1998–1999) of rural India to investigate whether women''s autonomy (measured in the 3 dimensions of decision-making autonomy, permission to go out, and financial autonomy) was associated with the use of adequate prenatal, delivery and postnatal care. The findings indicate women''s autonomy was associated with greater use of pregnancy care services, particularly prenatal and postnatal care. The effect of women''s autonomy on pregnancy care use varied according to the region of India examined (North, East and South) such that it was most consistently associated with pregnancy care use in south India, which also had the highest level of self-reported women''s autonomy. The results regarding village level factors suggest that public investment in rural economic development, primary health care access, social cohesion and basic infrastructure such as electrification and paved roads were associated with pregnancy care use. Improvements in women''s autonomy and these village factors may improve healthier child bearing in rural India. [Copyright &y& Elsevier]

Abstract: This paper presents findings from the application of a framework for assessing the quality of care of institutional maternity services in an urban slum in India. The framework divides quality into two parts: the quality of users’ experience of care and the quality of the provision of care. Data from public and private hospitals were collected via observation, exit interviews, provider interviews, review of hospital records, the mystery client approach and a household survey of 650 women in the immediate vicinity of the case study hospitals. Findings provide evidence that quality is far from optimal in both public and private facilities. Problems identified included a lack of essential drugs, women being left unsupported, evidence of physical and verbal abuse, and births occurring in hospitals without a health professional in attendance. The paper concludes that while many governments have explicit targets to increase institutional deliveries, many do not have explicit targets or even a commitment to assess and improve the quality of institutional services for childbirth. [Copyright &y& Elsevier]

In 2003, India had over 5.1 million infected individuals living with HIV/AIDS. The percentage of all HW cases attributed to perinatal transmission has been increasing steadily from 0.33% of total cases in 1999 to 2.80% in 2004. Recent statistics indicate that over 180,000 infants have been infected through this route, Despite recent advances in reducing in utero and interbartum transmission with the use of antiretrovirals, there is a critical need to make infant feeding safer. Current UNAIDS/WHO/UNICEF recommendations stress avoidance of all breastfeeding if replacement feeding fulfills the key requirements of being affordable, feasible, acceptable, sustainable, and safe, In this paper, we examine how the UNAIDS/WHO/UNICEF recommendations have been actualized within the context of an urban government hospital in India. The documented patterns of infant feeding by HIV-positive mothers in Pune, India, from 2000 to 2004, highlight the complexities of making an informed and healthy choice under suboptimal conditions. The data indicate that interpersonal variations in the key requirements greatly influence the optimal practice to minimize mortality risks. Moreover, local information on health outcomes is crucial to tailoring policy recommendations to save lives. We propose the development of a decision-making algorithm that includes factors affecting mother-to-infant transmission, including site-specific data on health risks to the mother and the child. Such an algorithm would allow identification of the healthiest feeding choice and would minimize the pitfalls of promoting homogeneous practices lacking site-specific evidence-based evaluation. [ABSTRACT FROM AUTHOR]

The primary objective of this paper is to examine the relationship between the status of women in the household, the use of health care (demand for prenatal care and hospital delivery) and child mortality in India. Parents care about the health of their children but cannot directly affect child health by their actions. Instead they can, through their actions, control the use of health inputs. I jointly estimate the decision to use prenatal care, the decision to deliver the baby in hospital and child mortality. The estimation methodology allows us to account for unobserved heterogeneity and self-selection in the use of health inputs. The estimation results show that: (1) a woman’s education has a stronger effect on health care usage relative to that of her husband; (2) a woman’s control over household resources (ability to keep money aside) has a significant effect on health care usage; (3) both prenatal care and hospital delivery significantly reduces the hazard of child mortality; and (4) not accounting for unobserved heterogeneity and self-selection in the use of health inputs results in under-estimation of the effect of health inputs on child mortality. [Copyright &y& Elsevier]

Focuses on the demographic, antenatal care, spatial and socio-economic variables associated with caesarean section delivery in Kerala, India. Association between maternal age, birth order and births in private hospitals and caesarean section deliveries; Higher risk to have ceasarean section among older women.

• Only 16% of mothers completed full continuum of care in India. • Lower neonatal and infant mortality rates observed for births when mothers received full CoC. • Attaining full CoC by mother significantly reduces the risk of neonatal and infant mortality of children. • Findings suggest policymakers to ensure the completion of CoC by women in order to reduce infant and neonatal mortality. Mothers, new-borns and children are inseparably interconnected in life and health care needs. Therefore, poor maternal health care utilization during pregnancy, delivery and post-delivery may affect child health outcomes. The aim of the present study is to examine the association between continuum of maternal health care (CoC) and neonatal and infant mortality in India. Data for the study has been used from the fourth round of National Family Heath Survey (2015–16). The analysis has been conducted on 33,107 most recent singleton births of women aged 15–49 years. Findings reveal that neo-natal and infant mortality rates were higher for women who received no service (37 and 52 per 1000 live births respectively) than those who followed the full CoC (10 and 15 per 1000 live births respectively). Further, the bivariate and multivariate analysis showed that complete CoC by mother significantly reduced the risk of neonatal and infant mortality. The evidence from the present study gives direction for investments in intervention packages to improve the maternal health indicators which in turn may improve child health outcomes, particularly neonatal and infant deaths. [ABSTRACT FROM AUTHOR]

In the last two decades, India's central and many state governments launched several public health programs with the goal of improving maternal and child health outcomes. Many individual studies assessed the impact of these programs; however, they focused on select health programs and few specific outcomes. This paper summarizes the literature, published during 2000–2019, investigating the impacts of public health programs on both the uptake of maternal and child health services and the related-health outcomes in India. We followed PRISMA guidelines of systematic review, and carried out a narrative synthesis of the study findings. We found 66 relevant studies covering 11 health programs across India. Most studies had applied non-experimental study designs (n = 50), with few applying experimental (n = 1) and quasi-experimental (n = 15) designs. Most studies (n = 64) assessed the impact on the intermediate outcomes of the uptake of various health services rather on the long-term outcomes of improvement in health. Overall we found studies reporting positive impacts, however, we could not find any strong consensus emerging from these studies about the impact, partly due to differences in: outcome indicators; study designs; study population; data sets. Several studies also reported considerable beneficial impacts among low socioeconomic population groups. However, given that the outreach of the public health programs have been low across the country and population groups, we found that broader objectives of health programs remained unassessed: most studies assessed the impact on who actually participated in the program (average treatment effect on-the-treated) rather on the target population (intent-to-treat effect). Furthermore, there was dearth of research on the impacts of the state-level programs. Future research need to assess the impact of the programs on health outcomes, and on quality adjusted measures of maternal and child health services and its continuum of care. • Most studies have focused on the impact on maternal and child health services. • Most studies reported beneficial impact on health services and the health-related outcomes. • Impact on the intended larger target population remains unassessed. [ABSTRACT FROM AUTHOR]

• The study is conducted in the slum communities of Pune city of India. • Women's knowledge of danger signs of pregnancy complications and its association with birth preparedness. • There is strong association of knowledge of danger signs and birth preparedness. Objective of the study is to assess the knowledge about the danger signs of obstetric complications during pregnancy, childbirth and postpartum among women and its association with birth preparedness and complications readiness. A community-based cross-sectional study was conducted during January 2018 to February 2019 in the 10 urban slums of Pune. The slums were purposively selected for the study. Total of 500 women, who had given birth in the last two years, were recruited. Information about socio-demographic information, birth history, utilization of maternal care, knowledge about the danger signs of obstetric complications, and their birth preparedness collected. Descriptive statistics, bivariate analysis and logistic regression applied to examine the association. Results shows 93% of women had registered pregnancy; 67.4% had saved money for their delivery; 76% reported had made arrangements for transportation, and 84% decided on the place of delivery. Multivariate results showed that increasing educational level of women leads to increase in their birth preparedness (OR: 4.159; 95% CI: 1.794–9.644). Women with complete knowledge about obstetric complications during pregnancy are more likely to be bettered prepared for childbirth (OR: 4.235; 95% CI: 2.275–7.882); women having complete knowledge of pregnancy complication during childbirth (OR: 3.227; 95% CI: 1.953–5.332); and women with complete knowledge about post-natal complications also have higher chances of being bettered prepared (OR: 3.072; 95% CI: 1.944–4.855). Education level, knowledge about obstetric complications during pregnancy, childbirth and after delivery are important predictors for the birth preparedness of women from low-income communities in Maharashtra, India. Educating pregnant women about possible pregnancy complications could lead to birth preparedness. [ABSTRACT FROM AUTHOR]

• This study used qualitative approach to document the forced migrants pregnant women problems. • The study found that pregnant women not having adequate sanitation, nutrition and rest. • Pregnant women have missed important ANC care services. • Children in the destination missed important immunisation. It is widely acknowledged that climate change will lead to more frequent natural disasters and extreme weather events. This is a matter of concern, especially for countries like India which is amongst the most vulnerable drought-prone countries in the world. In 2015 the Government of Maharashtra had declared a drought in state. The severe drought situation forced millions of people to migrate from the Marathwada region to the bigger cities. The objective of the study was to examine the sanitation, hygiene and living conditions of migrants who were forced to leave their homes because of the drought. The focus of the study was on the health problems of pregnant migrant women and children in their destinations. The study adopted a qualitative approach to explore this phenomena. Fifteen in-depth interviews were conducted which included ten pregnant women and five women who had children less than two years of age. Data analysis were carried out with thematic analysis using NVivo software. The study shows that pregnant mothers and women with children are at greater risk of diseases at place of destination. In particular, the pregnant migrant mothers could not access the necessary antenatal care. Moreover, they could not sleep or rest during the day due to non-availability of place. [ABSTRACT FROM AUTHOR]

• Women's education positively and very significantly associated with the utilization of MHC services. • Socio-economic and demographic characteristics of women also have a significant impact on MHC services. • Betterment of women education will improve the utilization of MHC services. The present study attempts to show the influence of women's (15–49 years) education on the utilization of Maternal Health Care (MHC) services in India and also find out the other determinants for the utilization of MHC services. The entire study depends on secondary data collected from the National Family Health Survey (NFHS)-4 in the year of 2015–16 in India which was conducted on 190,898 women (15–49 years). In the present study, the last birth women (190,898) have been considered. For the proper depiction of the resulting binary logistic regression has been conducted. To show the level of utilization of MHC services in India, the highest educational level of the respondents have been considered as the explanatory variable and six outcome variables have been selected. The unadjusted odds ratio (UOR) shows that women's education positively and very significantly associated with the utilization of MHC services which indicates that the higher educated women are more likely to received at least 4 ANC visit [UOR 6.450, 95% CI (6.223–6.685) & p-value < 0.01], taking 1st antenatal visit within first trimester [UOR 2.563, 95% CI (2.458–2.672) & p-value < 0.01], ANC visit by skilled health professionals [UOR 9.139, 95% CI (8.624–9.684) & p-value < 0.01], taking 2 or more than 2 TT doses [UOR 2.348, 95% CI (2.239–2.463) & p-value < 0.01], delivered in health facility [UOR 14.64, 95% CI (13.63–15.73) & p-value < 0.01] and received PNC within 42 days of delivery [UOR 1.361, 95% CI (1.024–1.808) & p-value < 0.01] than the illiterate women. The adjusted odds ratio (AOR) was low compared to UOR which indicate that there were important effect of other variables (which have been controlled in the adjusted odds ratio) except education which also impact on the utilization of maternal health care services i.e. maternal age, age at marriage, birth order, caste, religion, wealth index, place of residence, exposure to mass media, and region. [ABSTRACT FROM AUTHOR]