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Background: Social inequities in early child bearing persist among young married people, especially among tribal populations in India. Rural women belonging to tribal groups and those coming from poor households are more likely to give birth before age 18. This paper explores the connection between ethnicity, gender and early fertility intention among young married people in rural India. Methods: The data is drawn from a cross sectional baseline evaluation of an intervention programme in rural India. A sample of 273 married young people was taken. Respondents were selected using systematic random sampling. Logistic Regression was used to assess the effect of being a tribal on early fertility intention and also to determine if covariates associated with early fertility intention differed by tribal status. Qualitative data was analysed using deductive content analysis approach. Results: Bivariate and logistic regression results indicated that young married people from tribal communities had higher odds of planning a child within one year of marriage than non-tribals (OR = 1.47, p-value-0.079). Findings further suggest that early fertility intention among tribals is driven by gender factors and higher education and among non-tribals, higher education and awareness on contraception are key predictors. Among tribals, the odds of planning a child within one year of marriage was strongly associated with inequitable gender norms (OR = 1.94, p-value-0.002). Higher education showed significant positive association with non-tribals (OR = 0.19, p-value-0.014) and positive association with tribals (OR = 0.56, p-value-0.416). Qualitative investigation confirms that fertility desires of young married people are strongly influenced by gender norms especially among tribal populations. Conclusion: Early child bearing was underpinned by complex ethnic factors and gender norms. Preference for early child bearing was seen most among tribal communities. Gender attitudes were a cause of concern especially among tribal groups. These results suggest that efforts to improve early child birth will require changing gender norms related to fertility among tribals as well as social equity issues including higher education among non-tribals and tribals. [ABSTRACT FROM AUTHOR]

The graduates of the diploma and degree programmes of nursing and midwifery in India are considered skilled birth attendants (SBAs). This paper aimed to assess the confidence of final-year students from pre-service education programmes (diploma and bachelor's) in selected midwifery skills from the list of midwifery competencies of the International Confederation of Midwives (ICM). A cross-sectional survey was conducted in Gujarat, India, involving 633 final-year students from 25 educational institutions (private or government), randomly selected, stratified by the type of programme (diploma and bachelor's). Students assessed their confidence on a four-point scale, in four midwifery competency domains – antepartum, intrapartum, postpartum, and newborn care. Explorative factor analysis was used to reduce skill statements into separate subscales for each domain. Overall, 25–40% of students scored above the 75th percentile and 38–50% below the 50th percentile of confidence in all subscales for antepartum, intrapartum, postpartum, and newborn care. The majority had not attended the required number of births prescribed by the Indian Nursing Council. The pre-service education offered in the diploma and bachelor's programmes in Gujarat does not prepare confident SBAs, as measured on selected midwifery competencies of the ICM. One of the underlying reasons was less clinical experience during their education. The duration, content, and pedagogy of midwifery education within the integrated programmes need to be reviewed. [ABSTRACT FROM AUTHOR]