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Utilization of maternal health care services by tribal population could be detrimental in reducing high maternal mortality in Madhya Pradesh, India. A growing body of evidence indicates the positive association between male involvement and increased use of antenatal care services. Further research is required to understand barriers and possible solutions to develop culturally appropriate interventions to engage men to promote the utilization of maternal health care services. The study used qualitative data collected through 8 focus group discussions with men and women and 8 key informant interviews with either a community representative or health worker in two blocks dominated by Saharia tribes in Gwalior district, Madhya Pradesh, India in 2018. Information on the perception of utilization of maternal and child health services, male involvement, challenges and opportunities were elicited using a structured guide. Framework analysis was used to analyse the data. Findings document barriers at the individual (poor knowledge, fear of loss of wage, choice of home as a place of delivery), community (practices that reinforced the prevailing gender norms) and health care facility level (quality and attitude of health care providers) to male engagement in utilization of maternal health services. Community perceptions on possible solutions to address these were more likely to be gender exploitative interventions. To promote utilization of maternal health care services among Saharia tribes, this study highlights the importance of developing gender sensitive interventions that addresses the individual, community and health care facility level barriers of male involvement and do not reinforce existing gender norms.

OBJECTIVE To assess the coverage and adequacy of antenatal care services (ANC) available to women and examine the socio-economic determinants affecting service utilisation. DESIGN Secondary data analysis of a population-based national survey. SETTING India, 2015/16. SAMPLE In all, 190 898 women between 15 and 49 years of age who had a live birth during the 5 years preceding the survey. METHODS Ordinal logistic regression. MAIN OUTCOME VARIABLE Adequacy of ANC services received was measured under four categories - delivery of services by skilled personnel, timely provision of services, sufficiency and appropriateness of content. Quality of care was categorised as adequate ANC, inadequate ANC and no ANC. RESULTS Only 23.5% (95% CI 23.1-23.9%) of all women received adequate ANC, while 58.8% (95% CI 58.4-59.2%) received inadequate and 17.7% (95% CI 17.4-18.0%) received no ANC services. Regression analysis revealed that women belonging to the adolescent age group, illiterate women, and those in the poorest wealth quintile and in rural areas were less likely to receive any ANC. CONCLUSION There is a need to improve the quality of ANC services. Currently

Objectives This article explores the consequences of hospitalization expenditure on noncommunicable diseases (NCD) and its impact on out-of-pocket expenditure (OOPE), catastrophic health expenditure, impoverishment, and hardship financing of households in India. Methods Data on hospitalized cases of NCDs from the 3 rounds of National Sample Surveys (NSS) (2004, 2014, 2018) were used. Bivariate and multivariate analyses were conducted to investigate the socioeconomic differentials of the impact of OOPE on catastrophic health expenditure, impoverishment, and exposure to hardship financing. Results Rural households had greater exposure to catastrophic health expenditure but urban households had higher risk of impoverishment due to OOPE. Older patients (aged ≥60 years) had the highest hospitalization rate per 100 000, including increase in average healthcare expenditure from 2004 to 2018. At 10% and 30% thresholds, 50% and 25% of the households, respectively, faced catastrophic health expenditure across all the 3 rounds. Due to OOPE on hospitaliation treatment for NCDs, about 3.8%, 7.4% and 4.8% of households fell below poverty line, and percentage shortfall in income for the population from the poverty line was 3%, 4.9% and 3%, in 2004, 2014 and 2018 respectively. Percentage of households facing hardship financing reduced from 49.2% in 2004 to 24.4% 2014 and 12.7% in 2018. Conclusion OOPE by households are still very high and hence the higher effects of CHE, impoverishment and exposure to hardship financing due to health expenditure in India. This study proposes that along with increase in budgetary allocations for healthcare, the government should develop suitable policies to expand the effectiveness of government-sponsored health insurance, such as developing a specific NCD service package to be included in the health insurance program.

BackgroundIndia contends with a high rate of intimate partner violence (IPV), which is associated with unintended pregnancy and reflects low levels of women’s decision-making control in relation to their reproductive health. Few studies from South Asia have examined the relationship between pregnancy decision-making, IPV and unintended pregnancy.AimThis study examined associations between unintended (mistimed and unwanted) pregnancy, women’s reports of pregnancy decided externally by husband or in-laws, and IPV, among a sample of married, postpartum women.MethodsData from the ‘Mechanisms for Relations of Domestic Violence to Poor Maternal and Infant Health in India’ study were analysed. Descriptive comparisons between levels of unintended pregnancy were run on all major variables. Unadjusted and adjusted multinomial logistic regression analyses assessed women’s reports of having externally-decided pregnancies and IPV victimisation in the year prior to pregnancy as factors in mistimed and unwanted pregnancies.ResultsMistimed and unwanted pregnancies were reported by 12.2% and 7.2% of women, respectively. Externally-decided pregnancies were reported by 8.8% of women. Some 29.4% of women reported experiencing physical and/or sexual IPV in the year prior to pregnancy. Women reporting externally-decided pregnancies were significantly more likely to have had mistimed pregnancies than intended pregnancies, as were women reporting IPV. Neither external pregnancy control nor IPV were associated with unwanted pregnancy.ConclusionsWomen’s exclusion from pregnancy decision-making and violence from husbands relate to their ability to time their pregnancies as they wish. The lack of significant association between external decision-making and IPV with unwanted pregnancy may be due to low reporting of unwanted pregnancy. The overall findings highlight the importance of integrating women’s involvement in reproductive health decision-making and IPV reduction messaging in programming for the women’s health sector.

Summary Background Documentation of the demographic and geographical details of changes in cause-specific neonatal (younger than 1 month) and 1–59-month mortality in India can guide further progress in reduction of child mortality. In this study we report the changes in cause-specific child mortality between 2000 and 2015 in India. Methods Since 2001, the Registrar General of India has implemented the Million Death Study (MDS) in 1·3 million homes in more than 7000 randomly selected areas of India. About 900 non-medical surveyors do structured verbal autopsies for deaths recorded in these homes. Each field report is assigned randomly to two of 404 trained physicians to classify the cause of death, with a standard process for resolution of disagreements. We combined the proportions of child deaths according to the MDS for 2001–13 with annual UN estimates of national births and deaths (partitioned across India's states and rural or urban areas) for 2000–15. We calculated the annual percentage change in sex-specific and cause-specific mortality between 2000 and 2015 for neonates and 1–59-month-old children. Findings The MDS captured 52 252 deaths in neonates and 42 057 deaths at 1–59 months. Examining specific causes, the neonatal mortality rate from infection fell by 66% from 11·9 per 1000 livebirths in 2000 to 4·0 per 1000 livebirths in 2015 and the rate from birth asphyxia or trauma fell by 76% from 9·0 per 1000 livebirths in 2000 to 2·2 per 1000 livebirths in 2015. At 1–59 months, the mortality rate from pneumonia fell by 63% from 11·2 per 1000 livebirths in 2000 to 4·2 per 1000 livebirths in 2015 and the rate from diarrhoea fell by 66% from 9·4 per 1000 livebirths in 2000 to 3·2 per 1000 livebirths in 2015 (with narrowing girl–boy gaps). The neonatal tetanus mortality rate fell from 1·6 per 1000 livebirths in 2000 to less than 0·1 per 1000 livebirths in 2015 and the 1–59-month measles mortality rate fell from 3·3 per 1000 livebirths in 2000 to 0·3 per 1000 livebirths in 2015. By contrast, mortality rates for prematurity or low birthweight rose from 12·3 per 1000 livebirths in 2000 to 14·3 per 1000 livebirths in 2015, driven mostly by increases in term births with low birthweight in poorer states and rural areas. 29 million cumulative child deaths occurred from 2000 to 2015. The average annual decline in mortality rates from 2000 to 2015 was 3·3% for neonates and 5·4% for children aged 1–59 months. Annual declines from 2005 to 2015 (3·4% decline for neonatal mortality and 5·9% decline in 1–59-month mortality) were faster than were annual declines from 2000 to 2005 (3·2% decline for neonatal mortality and 4·5% decline in 1–59-month mortality). These faster declines indicate that India avoided about 1 million child deaths compared with continuation of the 2000–05 declines. Interpretation To meet the 2030 Sustainable Development Goals for child mortality, India will need to maintain the current trajectory of 1–59-month mortality and accelerate declines in neonatal mortality (to >5% annually) from 2015 onwards. Continued progress in reduction of child mortality due to pneumonia, diarrhoea, malaria, and measles at 1–59 months is feasible. Additional attention to low birthweight is required. Funding National Institutes of Health, Disease Control Priorities Network, Maternal and Child Epidemiology Estimation Group, and University of Toronto.

Masculine gender ideologies are thought to underlie alcohol use, intimate partner violence (IPV) perpetration, and sexual risk of HIV and other sexually transmitted infections (STIs). We extend on studies in the Indian context by examining the roles of masculine gender ideologies, alcohol use, and IPV on three outcomes of HIV risk (condom use, genital tract infection [GTI] symptoms, and GTI diagnosis). We applied logistic regression models to cross-sectional data of men and their wives in rural Maharashtra, India ( n = 1,080 couples). We found that men with less masculine gender ideologies demonstrated greater odds of condom use (i.e., lower odds no condom use, odds ratio [OR] = 0.96, 95% confidence interval [CI] = [0.93, 0.98]). IPV perpetration was associated with increased odds of reporting ≥1 GTI symptom (adjusted OR [AOR] = 1.56, 95% CI = [1.07, 2.26]) and decreased GTI diagnosis (AOR = 0.28, 95% CI = [0.08, 0.97]). Moderate alcohol consumption was associated with increased odds of reporting ≥1 GTI symptom (AOR = 1.51, 95% CI = [1.01, 2.25]). Our findings have direct implications for men’s and women’s health in rural India, including targeted GTI diagnosis and treatment, integrated violence prevention in STI clinics, and targeted intervention on masculine gender ideologies.

Background: There is increasing programming and research on male engagement and gender-equity (GE) counselling in family planning (FP) services. However, there is a lack of data on healthcare provider’s perspectives on delivering these interventions. The objective of the paper is to present providers’ perspectives on delivering a GE-focused FP intervention, CHARM, to married couples in rural India.Methods: In-depth interviews were carried out with 22 male village health care providers who were delivering a GE-focused FP intervention, CHARM, to 428 husbands (247 couples) rural Maharashtra, India. Providers were interviewed on their experiences and perspectives during delivery of CHARM. Major domains were identified during a thematic analysis.Results: Local male health providers are interested and can be engaged in delivering a GE-focused FP intervention. Providers believed that the CHARM intervention improves couples’ communication, contraceptive use and strengthened their own capacity to provide FP services in accordance with national FP programmatic efforts. Providers found the low-tech flipchart including pictures and information helpful in supporting their service provision. Providers reported some challenges including lack of privacy and space for counselling, limited access to contraceptive options beyond pill and condom, numerous myths and misconceptions about contraceptives. Providers also reported persistent social norms related to expectancy of pregnancy early in marriage, and son preference.Conclusions:Providers in rural areas with high fertility and related maternal health complications are interested in and can successfully implement a GE-focused FP intervention. Future efforts using this approach may benefit from greater focus to support broader array of spacing contraceptives particularly among first time parents, none or one child parents. There is a need to better support engagement of wives possibly through female provider led sessions parallel to male programs, i.e. gender synchronized rather than couples’ sessions.Trialregistration: ClinicalTrials.gov NCT01593943, May 8, 2012.

The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among female sex workers (FSWs) are not well known in low prevalence states showing rising trends within the HIV epidemic. This paper studies these attributes among FSWs in three north (Punjab, Rajasthan and Uttar Pradesh) and one east Indian states (Jharkhand). Integrated Biological and Behavioural Surveillance (IBBS) data, collected from 4491 FSWs in the study states, were analysed, with HIV status as the dependent variable and several socio-demographic, sex work, knowledge and agency characteristics as independent variables. Multivariate analysis found a number of factors such as age above 25 years (adjusted odds ratio [AOR] 5.0, 95% confidence interval [CI] 1.4–18.1), client solicitation in rented rooms (AOR 2.8, 95% CI 1.2–6.4) and the use of mobile phones for client solicitation (AOR 5.1, 95% CI 1.6–16.0) to be significantly associated with HIV risk. The study found low levels of HIV programme services uptake and HIV/AIDS knowledge among FSWs in the study states. There is an urgent need to focus on these risk factors for improving the effectiveness of the ongoing HIV prevention efforts and attaining the ‘Sustainable Development Goals’ goal of ‘Ending the AIDS epidemic’ by 2030.

Husbands’ alcohol use has been associated with family-level stress and intimate partner violence (IPV) against women in India. Joint family systems are common in India and IPV often co-occurs with non-violent family maltreatment of wives (e.g., nutritional deprivation, deprivation of sleep, blocking access to health care). Alcohol use increases for some parents following the birth of a child. This study examined 1,038 postpartum women’s reports of their husbands’ alcohol use and their own experiences of IPV (by husband) and non-violent maltreatment from husbands and/or in-laws. We analyzed cross-sectional, quantitative data collected in 2008, from women (ages 15-35) seeking immunizations for their infants

To assess whether intimate partner violence (IPV) is associated with discordant reports of contraceptive use (whereby wives but not husbands report such use) among married couples in Maharashtra, India.The present cross-sectional study in rural Maharashtra, India, analyzed survey data collected in 2012 among husbands and wives aged 18-30 years, fluent in Marathi, with no prior sterilization, and with no current pregnancy or plans to conceive. Crude and adjusted logistic regression models assessed husbands' perpetration of IPV in relation to discordant reports of contraceptive use.Among 577 couples meeting the eligibility criteria, 207 (35.9%) women reported ever experiencing physical IPV from their husbands, and 183 (31.7%) reported ever experiencing sexual IPV from their husbands. In adjusted logistic regression models, discordant contraceptive use was significantly associated with wives' experiences of physical IPV (adjusted odds ratio [AOR] 1.81, 95% confidence interval [CI] 1.15-4.42) and sexual IPV (AOR 1.95, 95% CI 1.08-4.82).Women who reported IPV from their husbands might be more likely to use contraceptives without informing their husbands, possibly to redress the reproductive control often exerted by abusive male partners.

Background The use of smokeless tobacco (SLT) among women is increasing in India, especially among those with limited education and resources. Preventing the initiation of SLT among women is critical since it has known negative consequences for oral and reproductive health. Most research on tobacco initiation in India focuses on adolescents. This paper addresses the unrecognized issues of post marital initiation among women of reproductive age, highlighting the importance of reproductive stages in women's tobacco initiation. The objective is to examine the correlates of SLT initiation among low income women in Mumbai from pre-marriage through early marriage, first pregnancy and beyond, using case examples to illustrate initiation during each of these stages. Materials and methods In 2011-2012, cross-sectional community level survey data were collected from a representative sample of 409 daily SLT-using married women aged 18-40 years in a low income community in Mumbai. Information on socio-demographics, initiation by reproductive stage, types of tobacco use, childhood exposure to tobacco, learning to use, and initiation influences and reasons were collected through a researcher-administered survey. Univariate and bivariate analysis assessed factors influencing initiation of SLT use by reproductive stage. In addition 42 narratives of tobacco use were collected from a purposive sample of pregnant and non-pregnant married women addressing the same questions in detail. Narratives were transcribed, translated, and coded for key concepts including initiation of tobacco use. Results Thirty-two percent of women initiated SLT use before marriage, 44% initiated after marriage but before pregnancy, 18.1% initiated during their first pregnancy and the remainder started after their first pregnancy. Mean age of marriage among women in this study was 16 years. Younger women (i.e. age at time of the interview of less than 30 years) were 0.47 [95% CI (0.32, 0.87)] percent less likely to initiate after marriage than women aged more than 30 years. Women who got married before 18 years of age were 2.34 [95% CI (1.40, 3.93)] times more likely to initiate after marriage than their counterparts. Childhood exposure was a predictor for initiating SLT use prior to marriage but not after. Women reporting tooth and gum pain were 1.85 times more likely to initiate after marriage than their counterparts. Husband and neighbours were the most significant influences on post-marital initiation. Narratives highlighted differences in processes of initiation pre and post marriage and during pregnancy. Conclusions Most tobacco prevention interventions are directed to adolescents in school. This study suggests that especially for low literate or illiterate women, school based interventions are ineffective. To be effective strategies to prevent SLT initiation must reach women in urban areas at or immediately after marriage and during their first pregnancy. Messages must negate culturally rooted beliefs about the health benefits of SLT in order to prevent initiation and onset of daily use.

Violence against women by their husband is a pervasive public health and human rights problem1. In India, 34 per cent of women of reproductive age group have ever experienced physical domestic violence2. Women in slum areas (22.9%) in Pune were more likely to have experienced domestic violence than women in non-slum area (14%)3. Globally, the negative impact of violence on health of women has been recognized. Domestic violence increases the incidence of unintended pregnancies4,5,6,7 and abortions4, and reduces the contraceptive use8,9. Domestic violence during pregnancy increases the risk of infant and child mortality10,11,12,13. Women experiencing domestic violence during pregnancy are less likely to get antenatal care14,15. Sexual violence associated with vaginal, anal or urethral trauma leads to risk of infection and sexual health problems16,17. Not only physical but mental health of the women is also affected due to domestic violence18,19. Various studies have identified factors associated with the likelihood of domestic violence among women. Underlying factors of domestic violence are the failure to perform duties and responsibilities20, economic stress, hierarchical gender relations21, lower household income, illiteracy, belonging to lower caste22, not having male child23, age at marriage, number of living children, women employment23 and dowry21,23,24. Studies also showed a link between husband's alcohol consumption and domestic violence21,22,23,24. A few studies have also explored the relationship between domestic violence and contraceptive use in India25,26. However, the social determinants of domestic violence in urban slum community in India remain limited. Hence, the objective of this study was to know the prevalence of domestic violence and to understand the socio-demographic factors associated with it in urban slums of Mumbai, Maharashtra, India.

In order to design appropriate HIV prevention programs, it is important to examine the perception and knowledge of HIV/AIDS and methods of preventive. This article explores comprehensive knowledge of HIV/AIDS prevention methods among women and men in slum and non-slum areas in the National Capital Territory of Delhi, India. Data were drawn from the National Family Health Survey, 2005-06 (NFHS-3). The sample included 3096 women aged 15 - 49 years and 1321 men aged 15 - 54 years. Pearson Chi-square test and logistic regression analyses were conducted to examine the association between the study variables and the background characteristics of the slum and non-slum populations. Comprehensive knowledge of HIV/AIDS prevention methods was significantly lower among women and men in slum areas as compared with non-slum areas. Compared to men, women had less comprehensive knowledge of HIV/AIDS prevention methods in slum and non-slum areas, even after controlling for various demographic and socio-economic and exposure variables. Findings indicate that comprehensive knowledge of HIV prevention methods is low among women in slum areas. Interventions are needed to build knowledge of HIV transmission and prevention methods in this vulnerable group. Strategies to build awareness of HIV/AIDS could include mass media campaigns HIV/AIDS, and information, education and communication programs (IEC) on HIV/AIDS in slum areas.

Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels. Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015. Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed. Interpretation & conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.

Background: Unmet need for family planning is a tool to monitor the family planning program. Hence, the objective of study is to examine the prevalence of unmet need for family planning among women living in urban slum communities, Mumbai. Methods: The cross-sectional survey was conducted among currently married women aged 18-39 years and having at least one child. A total of 2797 women were selected using systematic random sampling. Information on demographic characteristics, their contraceptive behaviour and fertility intention were collected by face to face interview using structured questionnaire. Chi square test was applied and p

This study involved evaluation of the short-term impact of the RHANI Wives HIV intervention among wives at risk for HIV from husbands in Mumbai, India. A two-armed cluster RCT was conducted with 220 women surveyed on marital sex at baseline and 4-5 month follow-up. RHANI Wives was a multisession intervention focused on safer sex, marital communication, gender inequities and violence; control participants received basic HIV prevention education. Generalized linear mixed models were conducted to assess program impact, with cluster as a random effect and with time, treatment group, and the time by treatment interaction as fixed effects. A significant time by treatment effect on proportion of unprotected sex with husband (p = 0.01) was observed, and the rate of unprotected sex for intervention participants was lower than that of control participants at follow-up (RR = 0.83, 95 % CI = 0.75, 0.93). RHANI Wives is a promising model for women at risk for HIV from husbands.

Background: Women living in slum communities in India too often contend with depression. Local social support in other national contexts has been shown to reduce such risks. Less research in this area has been done in India and specifically with monogamous wives. Methods: This study involved a household sample of women reporting husband’s partner violence or heavy alcohol use (N ¼ 220). Participants were assessed on high social support in the community, and number of depressed days in the past 30 day (dichotomized as 10þ vs.o 10 day). Logistic regression analyses assessed associations between local social support and depression, adjusting for demographics, spousal violence, and husband risky alcohol use. Results: High local social support was reported by 40% of women; 33% reported never having local social support. Women with high local social support were significantly less likely to report depression (AOR: 0.53, 95% CI: 0.30–0.94), even after adjusting for husbands’ recent spousal violence perpetration and his risky alcohol use, both of which were also significantly associated with depression. Limitations: The data analyzed for this study are vulnerable to self-report and recall biases, as well as issues around social desirability. These analyses are further limited due to the use of single item measures to assess depression and local social support. Conclusions: Local social support reduces risk for depression among women in Mumbai contending with husbands’ spousal violence and risky alcohol use. These findings support the likely utility of community-based social support building to reduce risk for depression among this vulnerable population of women.

Domestic violence is a significant public health issue. India is uniquely affected with an estimated 1 in 3 women facing abuse at the hands of a partner. The current mixed-methods study describes violence-related coping and help-seeking, and preferences for health care—based intervention, among perinatal women residing in low-income communities in Mumbai, India. In-depth interviews were conducted with women who had recently given birth and self-reported recent violence from husbands ( n = 32), followed by survey data collection ( n = 1,038) from mothers seeking immunization for their infants ages 6 months or younger at 3 large urban health centers in Mumbai, India. Participants described fears and other barriers to abuse disclosure, and there was a low level of awareness of formal support services related to violence. Qualitative and quantitative findings indicated that formal help-seeking is uncommon and that informal help sources are most frequently sought. Quantitative results revealed that, while few (

Background & objectives: Despite various efforts by the Government of India, utilization of antenatal care (ANC) services continues to be low among women from rural areas particularly those belonging to the Scheduled Tribes. The present study was undertaken to examine the factors associated with the utilization of ANC services among women in four States including Rajasthan, Odisha, Chhattisgarh and Madhya Pradesh which constitute a good share of tribal population of the country. Methods: Data from third round of District Level Household and Facility Survey, 2007-08 (DLHS-3) have been used. Bivariate and multivariate analyses (logistic regression model) were used to study the association between the utilization of ANC services and the independent variables at individual, household and village levels along with the motivational factors (motivation by health workers and family members). Results: The utilization of ANC services among Scheduled Tribes women varied from about 4 per cent in Madhya Pradesh and Rajasthan to 10-14 per cent in Chhattisgarh and Odisha. Utilization was highest among those women with level of education 9th class and above (15-28%) and those women who visited health facility for pregnancy confirmation test (9-27%). Across the States, women who visited health facility for pregnancy testing (adjusted odds ratio, AOR = 1.5-2.5; P

Background Intimate partner violence (IPV) victimization is linked to a broad range of negative maternal health outcomes. However, it is unclear whether IPV is directly related to poor maternal outcomes or whether IPV is a marker for other forms of chronic, mundane maltreatment of women that stem from the culture of gender inequity that also gives rise to IPV. To determine the prevalence of non-violent forms of gender-based household maltreatment by husbands and in-laws (GBHM), and violence from in-laws (ILV) and husbands (IPV) against women during the peripregnancy period (during and in the year prior to pregnancy); to assess relative associations of GBHM, ILV and IPV with maternal health. Methods Cross-sectional data were collected from women

Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates womens access to and decision-making power related to family planning (FP). Womens access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of womens status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of womens social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n=855), crude and adjusted regression was used to assess womens access to their own spending money in relation to past 3month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59%) was associated with condom and other contraceptive use (AORs ranged 1.5-1.8). These findings remained significant after adjusting for womens FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase womens ability to obtain FP methods, even in contexts where social norms to support womens power in FP decision-making may not be readily adopted.

This paper examines the associations between male migration and mobility with HIV among married couples in India. Cross-sectional analyses of a nationally representative household survey conducted across all 29 states of India from 2005 to 2006 via the National Family Health Survey-3 (NFHS-3) included a subsample of 27,771 married couples who were tested for HIV as a part of their participation. Both bi-variate and multi-variate analyses were conducted. About 0.5% of the total married couples in the current study included an HIV-infected partner; 0.11% were HIV concordant and 0.38% were HIV serodiscordant couples. Adjusted logistic regression analyses demonstrated that HIV infection in couples (seroconcordant or serodiscordant) was significantly more likely among those couples where the man was migrant but not mobile and those couples where the man was migrant as well as mobile, relative to those couples where the man was neither migrant nor mobile. Male migration increases the risk for HIV among married couples in India, largely in the form of serodiscordance in which men are HIV infected. These findings document the need for not only primary prevention efforts to reduce HIV acquisition among migrant male workers, particularly more mobile migrants, but also efforts are needed to reduce subsequent transmission to their wives.

To examine experiences of perinatal (in pregnancy or post-partum) abuse from in-laws and to assess associations between such experiences and perinatal intimate partner violence (IPV) from husbands, as reported by Indian women residing in low-income communities in Mumbai. The present study includes both qualitative and quantitative research conducted across two phases of study. The qualitative phase involved face-to-face, semi-structured in-depth interviews (n = 32) with women seeking health care for their infants (6 months or younger) and self-reporting emotional or physical abuse from their husband. The quantitative arm involved survey data collection (n = 1,038) from mothers seeking immunization for their infants 6 months or younger at three large Urban Health Centers in Mumbai. Results of the qualitative study documented the occurrence of both non-physical and physical abuse from in-laws during pregnancy and post-partum. Non-physical forms of abuse included forced heavy domestic labor, food denial and efforts toward prevention of medical care acquisition. Quantitative results demonstrated that 26.3% of the sample reported perinatal abuse (non-physical and physical) from in-laws and that women experiencing perinatal sexual or physical IPV from husbands were significantly more likely to report perinatal abuse from in-laws (AOR = 5.33, 95% CI = 3.93–7.23). Perinatal abuse from in-laws is not uncommon among women in India and may be compromising maternal and child health in this context; such abuse is also linked to perinatal violence from husbands. Programs and interventions that screen and address IPV in pregnant and post-partum populations in India should be developed to include consideration of in-laws.

ObjectivesTo determine the prevalence of non-violent, gender-based forms of maltreatment of women by husbands and in-laws [i.e., gender-based household maltreatment (GBHM)] during pregnancy and postpartum; to clarify the role of GBHM in compromising infant health, and whether this role extends beyond that previously observed for intimate partner violence (IPV).MethodsCross-sectional, quantitative data were collected from women (ages 15-35) seeking immunizations for their infants

BACKGROUND: The existing literature on the intersection between women’s reports of spousal intimate partner violence (IPV) and contraceptive use in South Asia is conflicted; some studies from the region indicate that IPV is associated with increased contraceptive use, while others show the opposite relationship. Associations appear to vary based on method of contraception use, and form of violence (physical or sexual), and few examined the relationship between IPV and various methods of modern spacing contraceptive (MSC) use. This study examines associations between IPV and MSC use among a sample of married, not-currently-pregnant couples in rural Maharashtra, India (N=861). METHODS: Multinomial logistic regression models assessed wives’ physical and sexual IPV victimization (past 6-month) in relation to wives’ past 3-month MSC use [categorized as condom use, other MSCs (oral pills, IUD), and no MSCs]. RESULTS: In terms of violence, 9% (n=78) and 4% (n=34) of wives reported recent physical and sexual IPV victimization, respectively. The majority of wives (72%; n=621) did not use any MSC method in the past 3 months; 14% (n=119) reported recent condom use, and the same proportion reported other MSC use. Recent physical IPV was associated with increased likelihood of recent condom use (AOR: 2.46, 95% CI: 1.20, 5.04), and recent sexual IPV was associated with increased likelihood of recent use of other MSC (AOR: 3.27, 95% CI: 1.24, 8.56). CONCLUSIONS: These findings reinforce the need for integration of counseling around IPV prevention and intervention programming into existing family planning services targeting married couples in rural Maharashtra, India.

Background: Cervical cancer is the most common cancer among women, 80 percent of cervical cancer cases present with an advanced stage of the disease when cure is impossible. This may be due to lack of awareness and knowledge, lack of access to proper treatment including screening facility. Cervical cancer does not always cause symptoms during initial stage. Pap smear test helps in early diagnosis of cervical cancer and hence is successful in treatment. In recent years, there has been a growing interest in involving men into reproductive health to improve health outcomes as often husband is the leading decision maker in almost all the areas. The present paper examines the knowledge, attitude, practice and health seeking behaviour about sexually transmitted infections (STIs) and cervical cancer among husbands in a slum community of Mumbai. Methods: Baseline data from an intervention study entitled “Enhancing knowledge and promoting health seeking behaviour of couples on sexually transmitted infections and cervical cancer in urban slums of Mumbai” is used for this article. This data was collected from a random sample of 1958 husbands whose wives age was between 18-49 years, through a semi-structured interview schedule from two urban slums of Mumbai. Information was collected on socio-economic and demographic characters, awareness and symptoms of STIs and Cervical cancer, and health seeking behaviour. Results: About 76 percent husbands heard about the infections transmitted through sexual intercourse, 95.4 percent were aware of cancer whereas only 8.5 percent husbands were aware of cervical cancer and 0.3 percent were aware of Pap smear to detect the cervical cancer. About 3 percent husbands experienced at least one symptom of STIs six months prior to survey, 7.3 percent husbands reported of having sexual partner other than spouse. Most husbands were not aware of STIs symptoms specific to wives. Conclusions: There is a need for disseminating knowledge regarding STI symptoms, cervical cancer and Pap smear test for early detection of cervical cancer as well as promoting better health seeking behaviour with respect to cervical cancer and STIs. Considering sensitivity of the topic it is necessary to design separate programmes for men.

India is home to 33% of the 720 million women worldwide who were married before the age of 18 years [1]. Menarche has historically been viewed as an indicator of a girl’s readiness to marry [2], but recent research on this issue is limited. The present study examined associations between age at menarche and age at marriage among young wives who were baseline respondents in the CHARM study—a two-armed randomized controlled trial evaluating a male engagement-focused family planning intervention in rural Maharashtra, India.

Background: To increase the cervical cancer screening rate, various strategies are being conducted in the communities. The present study uses mixed interventional approach aiming to create awareness among couples about cervical cancer and Pap smear and to increase the rate of Pap smear screening. Methods: The study was carried out in collaboration with Municipal Corporation of Greater Mumbai (MCGM). The Dr Babasaheb Ambedkar Maternity Home under MCGM situated in Vikhroli, Mumbai was selected for the study. The study followed a quasi-experimental design. Women aged between 18 to 49 years and their husbands were randomly selected for the survey. Pre and post intervention survey was conducted to see the impact of intervention on creating awareness and utilization of Pap smear services. Multilevel intervention program was adopted to achieve the objectives. Results: Significant increase in awareness about cervical cancer among couples was observed from pre (5.5%) to post (97.7%) intervention survey. About 32.2% women were found to be infected with HPV. Conclusion: Mixed interventional approach is a good strategy for early diagnosis of cervical cancer.

Objective: The objective was to examine postpartum contraception utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai India. Study design: We conducted a cross-sectional questionnaire of low-income postpartum women seeking immunization for their infants at three large urban health centers in Mumbai. Contraceptive utilization data were collected as part of a larger study focused on the impact of postpartum domestic violence on maternal and infant health. Descriptive bivariate and multivariate analyses were conducted to describe and identify predictors of postpartum contraceptive utilization. Results: Postpartum women aged 17-45 years (N=1049) completed the survey; 44.5% (n=467) reported resuming sexual relations with their husbands. Among these women the majority (65.3%; n=305) reported not currently using contraception. In multivariate analyses women who did not discuss postpartum family planning with their husbands had not used contraception previous to the recent birth and had experienced physical violence or forced sex were more likely to not use postpartum contraception (adjusted odds ratios=1.47-1.77). Among the 162 women using contraception the most common time to initiation of contraception was 5 weeks postpartum and the most common method used was condoms 77.8% (n=126). Conclusion: Contraception nonuse was common among urban low-income postpartum women in India. This study highlights the importance of developing interventions to increase use of highly effective contraceptive methods postpartum and that spousal violence and lack of marital communication may present barriers to postpartum contraception utilization. Infant immunization may represent an opportunity for provision of contraceptives and contraceptive counseling. Implications: This original research study is a unique contribution to the literature because it presents data regarding the nonuse of postpartum contraception among women seeking immunizations for their infants in urban centers in a developing country. It also reveals barriers to not using postpartum contraception and provides data for future interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

To assess the effects of the RHANI (Reducing HIV among Non-Infected) Wives intervention on marital conflict and intimate partner violence (IPV) in urban India.A 2-armed cluster-randomized controlled trial (7 intervention, 6 control clusters) of the RHANI Wives intervention was conducted with 220 women contending with a history of IPV and/or husband's drunken behavior. Participants were surveyed at baseline and 4.5-month follow-up. Outcome measures included marital conflict (arguments with husband in past 3 months), marital IPV (physical or sexual violence from husband in past 3 months), and marital sexual coercion (husband forcing sex at last sex). Intention-to-treat logistic generalized linear mixed models were used to determine intervention impact.One-third (35.0%) of participants reported physical or sexual abuse from their husband in the past 3 months, and 58.6% reported that their husband was drunk in the past 30 days. Intention-to-treat analyses indicated time×treatment reductions in marital conflict (risk ratio [RR] 0.4; 90% confidence interval [CI], 0.1-0.9; P=0.06) and marital sexual coercion (RR 0.2; 90% CI, 0.05-0.9; P=0.08), but not IPV.The findings suggest the potential utility of this intervention in reducing marital conflict and sexual coercion among women in urban India. ClinicalTrials.gov: NCT01592994.

Background & objectives: Evidence-based planning has been the cornerstone of India's response to HIV/AIDS. Here we describe the process, method and tools used for generating the 2015 HIV estimates and provide a summary of the main results. Methods: Spectrum software supported by the UNAIDS was used to produce HIV estimates for India as a whole and its States/Union Territories. This tool takes into consideration the size and HIV prevalence of defined population groups and programme data to estimate HIV prevalence, incidence and mortality over time as well as treatment needs. Results: India's national adult prevalence of HIV was 0.26 per cent in 2015. Of the 2.1 million people living with HIV/AIDS, the largest numbers were in Andhra Pradesh, Maharashtra and Karnataka. New HIV infections were an estimated 86,000 in 2015, reflecting a decline by around 32 per cent from 2007. The declining trend in incidence was mirrored in most States, though an increasing trend was detected in Assam, Chandigarh, Chhattisgarh, Gujarat, Sikkim, Tripura and Uttar Pradesh. AIDS-related deaths were estimated to be 67,600 in 2015, reflecting a 54 per cent decline from 2007. There were variations in the rate and trend of decline across India for this indicator also. Interpretation & conclusions: While key indicators measured through Spectrum modelling confirm success of the National AIDS Control Programme, there is no room for complacency as rising incidence trends in some geographical areas and population pockets remain the cause of concern. Progress achieved so far in responding to HIV/AIDS needs to be sustained to end the HIV epidemic.

Background: The Maharashtra government has banned the production, sale, distribution and storage of gutka , and pan masala in the Maharashtra State due to the increasing burden of cancer and reproductive health problems attributable to the use of these products. In view of this, it is important to understand the way producers', sellers' and users' are adapting to the ban. Objective: During the two months following the ban (July 19 th through Sept 30, 2012), a research team studying smokeless tobacco use and promotion in a low income community of Mumbai conducted rapid surveillance to assess the impact of the ban in the study community. Materials and Methods: Assessment involved documenting new points of sale, informal observations of tobacco use, and interviews with thirteen shop owners and eight gutka users'. Overall changes in accessibility, availability, patterns of use of tobacco products, perception of ban, social norms and surveillance activities were assessed. Results: Tobacco companies were marketing new products that resembled gutka , under similar brand logos. Surveillance, financial and social cost of selling gutka or using it in public have had an immediate effect on reducing local supply, demand and use and increasing stigma associated with its use. There was an increased recognition of ill-effects of gutka on cancer among sellers' but not overall. Conclusions : To reduce the overall consumption of tobacco in the community, it is critical to include programs that create awareness about effects of smokeless tobacco on health and sustain surveillance levels. This would maintain requirements of the ban, and sustain limits on accessibility, availability and use of these products in the community and other similar communities.

Spousal violence is associated with higher gravidity, and husband’s frequent alcohol use is associated with induced abortion among women residing in Mumbai slum communities.

To assess the awareness of cervical cancer among couples, data were collected from two urban slums community in Mumbai. A total of 1958 married women aged from 18 to 49 and their husbands were selected using simple random sampling. Women (37.7%) were significantly more aware of cervical cancer than husbands (8.7%). A slight agreement (kappa statistics=0.16) was observed between husbands and wives on awareness of cervical cancer. Significantly higher percentages of wives were aware of pap smear test than husbands. Overall, awareness of cervical cancer and pap smear test among couples is low. There is need to educate and motivate both of them to participate in cervical cancer screening program.

Introduction In rural India contraceptive use remains uncommon among newly married couples. non-use in rural young couples contributes to higher fertility rates. Objectives To identify barriers of spacing contraceptive use among young married couples in rural Maharashtra. Methods In-depth interviews were conducted with husbands (N=30), wives (N=20), and village health providers (N=12); additionally, 3 focus groups were conducted with mothers of husbands (N= 42 focused on understanding contraceptive use and barriers. Interviews and focus groups ranged in length from 90-120 minutes. Detailed notes taken during interviews were analysed using a grounded theory approach and the data was analysed using atlas-ti software. Results Major barriers to spacing contraception are: pro-natal social norms, pregnancy expectations early in marriage, to produce multiple sons, limited access to modern spacing contraceptives, family resistance to adopt contraceptives, lack of husband's involvement on family planning issues, myths, misconceptions, perceived side effects and negative attitudes toward specific contraceptives. Conclusion Findings highlight the intersection of norms against spacing contraception, traditional gender ideologies and lack of male involvement as major barriers to the use of contraception. Male oriented outreach programmes on family planning. Promoting gender equity should be made through health programme deliveries with special focus in rural areas.