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This paper from India describes anxieties that pregnant and postpartum women reported to obstetricians during the COVID-19 pandemic. Of the 118 obstetricians who responded to an online survey, most had been contacted for concerns about hospital visits (72.65%), methods of protection (60.17%), the safety of the infant (52.14%), anxieties related to social media messages (40.68%) and contracting the infection (39.83%). Obstetricians felt the need for resources such as videos, websites and counselling skills to handle COVID-related anxiety among perinatal women. [ABSTRACT FROM AUTHOR]

Gestational Diabetes Mellitus (GDM) risks the affected mother-child duos not only with respect to adverse perinatal outcomes but also for chronic diseases later in life. Therefore, in 2014, the Government of India (GoI) mandated universal GDM screening for all pregnant women as a part of essential obstetric care within the Reproductive and Child Health (RCH) programme. Later in 2018, the domain experts from GoI envisaged pan India implementation of GDM screening services within its RCH framework by 2023. As Uttarakhand—a hilly, EAG state of north India—would also be part of this nation-wide drive; prior identification of RCH services coverage in the State assumes paramount importance, as it reflects probable executability of GDM screening services within its delivery platform. Therefore, the present review aims to assess the readiness of Uttarakhand maternal health functionary system in view of GDM national guidelines implementation at both state and district levels. In this regard, freely accessible, full-text GoI documents pertaining to GDM implementation guidelines and maternal health program of India and Uttarakhand available in public domain in English language were reviewed. The present review favors the pilot implementation in district Dehradun prior to implementing in all districts of the state. It may, however, require overall improvement in maternal health programmatic services in all parts of the State for much efficient service delivery. Effective implementation of GDM guidelines requires urgent correction in the background performance of RCH program. [ABSTRACT FROM AUTHOR]

Background: The Indian government has committed to implementing high‐quality midwifery care to achieve universal health coverage and reduce the burden of maternal and perinatal mortality and morbidity. There are multiple challenges, including introducing a new cadre of midwives educated to international standards and integrating midwifery into the health system with a defined scope of practice. The objective of this review was to examine the facilitators and barriers to providing high‐quality midwifery care in India. Methods: We searched 15 databases for studies relevant to the provision of midwifery care in India. The findings were mapped to two global quality frameworks to identify barriers and facilitators to providing high‐quality midwifery care in India. Results: Thirty‐two studies were included. Key barriers were lack of competence of maternity care providers, lack of legislation recognizing midwives as autonomous professionals and limited scope of practice, social and economic barriers to women accessing services, and lack of basic health system infrastructure. Facilitators included providing more hands‐on experience during training, monitoring and supervision of staff, utilizing midwives to their full scope of practice with good referral systems, improving women's experiences of maternity care, and improving health system infrastructure. Conclusions: The findings can be used to inform policy and practice. Overcoming the identified barriers will be critical to achieving the Government of India's plans to reduce maternal and neonatal mortality through the introduction of a new cadre of midwives. This is unlikely to be effective until the facilitators described are in place. [ABSTRACT FROM AUTHOR]

A growing number of studies have tested the association between intimate partner violence (IPV) and the unintendedness of pregnancy or birth, and most have suggested that unintendedness of pregnancy is a cause of IPV. However, about nine in every ten women face violence after delivering their first baby. This study examined the effects of the intendedness of births on physical IPV using data from the National Family Health Survey (2015–16). The multivariate logistic regression model analysis found that, compared with women with no unwanted births (2.9%), physical IPV was higher among those women who had unwanted births (6.9%, p<0.001), followed by those who had mistimed births (4.4 %, p<0.001), even after adjusting for several women's individual and socioeconomic characteristics. Thus, the reduction of women with mistimed and unwanted births could reduce physical IPV in India. The study highlights the unfinished agenda of family planning in the country and argues for the need to integrate family planning and Reproductive, Maternal and Child Health Care (RMNCH) services to yield multi-sectoral outcomes, including the elimination of IPV. [ABSTRACT FROM AUTHOR]

The Health and Family Welfare Department, Government of Gujarat, is implementing a program named Technology for Community Health Operation or TeCHO+ addressing state's priority health issues. This program envisages replacing the existing mother and child tracking system or e-Mamta application in the state. This program is based on ImTeCHO--Innovative Mobile Technology for Community Health Operations--which was piloted in Jhagadia, Bharuch district of Gujarat in 2013. The program showed improvements not only in terms of coverage of maternal and newborn care packages averting malnutrition but also was cost-effective. This paper details the protocol for health technology assessment to assess the impact of TeCHO+ program on data quality, improvement in service delivery coverage, reduction in morbidity and mortality as well as assess the cost-effectiveness. The study will be conducted in five districts of the state. A mixedmethod approach will be adopted. Data will be validated in a phased manner over a period of 3 years along with an assessment of key outcome indicators. Additionally, key informant interviews will be conducted and cost data will be gathered to perform cost-effectiveness analysis. The study will inform policymakers about the impact of TeCHO+ program on quality, access and cost-effectiveness of healthcare services. [ABSTRACT FROM AUTHOR]

Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these, an estimated 67,000 maternal deaths and one million newborn deaths occur each year. In addition, millions more women and newborns suffer pregnancy and birth related ill-health. Thus, pregnancy-related mortality and morbidity continues to have a huge impact on the lives of Indian women and their newborns. [ABSTRACT FROM AUTHOR]

The article informs that India's unprecedented lockdown measures and direct diversion of the country's limited financial and workforce resources to manage COVID-19 have aggravated India's pre-existing fragile health system causing immense disruption of essential healthcare services.

Background: Kangaroo Mother Care (KMC) is early, continuous and prolonged skin-to-skin contact between mother and baby, with exclusive breastfeeding. Besides preterm and low birth weight babies, even full-term healthy newborns benefit from KMC. Objective: to assess awareness and experience of KMC for full-term newborns among newly delivered mothers in a rural maternity hospital. Methods: Interventional study with interview schedule to capture awareness of KMC (25 scored items). After one hour of practicing KMC, post-intervention assessment of KMC experience (23 scored items) was done. Bivariate analysis performed to associate awareness and experience of KMC with socio-demographic and obstetric variables. Results: The 100 mothers in our study had low median KMC awareness score of 4(IQR=2,8) and were unaware of benefits of KMC. Median KMC experience score was 21(IQR=19,22), indicating highly positive experience. Mothers reported feeling happy or relaxed, found it easier to breastfeed, easy to practice KMC, and wanted to continue KMC at home. Mothers with caesarean section were more likely to experience abdominal or back pain during KMC (P=0.037) and mothers with previous abortion/stillbirth were more likely to have fear of suffocating the baby during KMC (P=0.005). Conclusion: Though awareness of KMC was found to be low, overall experience of KMC was very positive. Mothers should be educated about benefits of KMC and given an opportunity to practice KMC in hospital. Full-term healthy newborns and their mothers should not be denied the numerous advantages of KMC. There is need to create KMC-friendly hospital culture and promote KMC for all newborns. [ABSTRACT FROM AUTHOR]

Background: Women with an uncorrected single ventricle heart are at increased risk of adverse maternal and perinatal outcomes. Methods: We report our experience of managing pregnant women with uncorrected single ventricles, during the time period 2011 to 2017, in a low-resource setting and compare pregnancy outcome with healthy concurrent controls. Outcomes assessed include the mode of delivery, maternal complications, neonatal death and birth weight. Results: There were six pregnant women with uncorrected single ventricles who had a total of 14 pregnancies. There was one maternal death in a woman with atrioventricular-septal defect and Eisenmenger syndrome. Caesarean section rates and preterm delivery were similar, whereas perinatal loss and low-birth weight rates were higher among women with a single ventricle compared to healthy controls. Conclusion: Unplanned pregnancies without prenatal counselling/care pose a challenge to physicians especially in low to middle income countries and with the high risk of morbidity/mortality, pregnancy should be discouraged. [ABSTRACT FROM AUTHOR]

Background: Informal payments are unauthorised 'unregistered' out-of-pocket payments, outside the official payment system, for purchase or service meant to be covered/provided by the healthcare system. This study attempts to measure and report the extent and magnitude of informal payments based on the entitlements in Janani-Shishu Suraksha Karyakram (JSSK) in the Indian context. Methods: A cross-sectional study using convenience sampling and a semi-structured interview schedule was conducted among 281 participants in 2016 in 26 JSSK-notifying health facilities from all five divisions of Chhattisgarh. Pregnant women and women who delivered in the previous year, and provided informed consent, were included. After reviewing various definitions, informal payment was operationally defined in the context of JSSK for India as 'payments made in cash or kind, unregistered or non-reimbursed, made by/on behalf of the beneficiary or someone related thereof, for free and cashless entitlements in a JSSK-listed health facility, to an individual or institutional healthcare provider/staff who provides/arranges for provision of the service'. Results: Of 281 participants, 91.8 per cent reported informal payments across all JSSK entitlements categories. A relative majority of these payments was made at the district hospital (37%), ranging from ₹2 to ₹6,500 (US$0.03–101). Investigations incurred the greatest median amount of informal payments, at, ₹455 (US$7). Informal payments ranged between three and seven times higher than the JSSK price cap in Chhattisgarh. No significant association was found between participant characteristics and informal payments. Conclusion: Further research is required to understand the magnitude and motivation of informal payments made in programmes like JSSK. [ABSTRACT FROM AUTHOR]

Objective: The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middle-resource settings, in relation to the availability of key obstetric resources.Design: This is a secondary analysis of a stepped-wedge cluster randomised controlled trial.Setting: This trial was undertaken at ten sites across eight low- and middle-income countries in sub-Saharan Africa, India and Haiti.Population: Institutional-level consent was obtained and all women presenting for maternity care were eligible for inclusion.Methods: Pregnancy-related deaths were collected prospectively from routine data sources and active case searching.Main Outcome Measures: Pregnancy-related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome.Results: Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000-630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20-29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30-39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy-related death.Conclusions: The large variation in the rate of pregnancy-related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists.Tweetable Abstract: Inequality and inequity in pregnancy-related death persists globally, irrespective of resource availability. [ABSTRACT FROM AUTHOR]

Background: Respectful maternity care is a rightful expectation of women. However, disrespectful maternity care is prevalent in various settings. Therefore, a systematic review and meta-analysis were conducted to identify various forms of ill-treatment, determinants, and pooled prevalence of disrespectful maternity care in India. Methods: A systematic review was performed in various databases. After quality assessment, seven studies were included. Pooled prevalence was estimated using the inverse variance method and the random-effects model using Review Manager Software. Results: Individual study prevalence ranged from 20.9% to 100%. The overall pooled prevalence of disrespectful maternity care was 71.31% (95% CI 39.84–102.78). Pooled prevalence in community-based studies was 77.32% (95% CI 56.71–97.93), which was higher as compared to studies conducted in health facilities, this being 65.38% (95% CI 15.76–115.01). The highest reported form of ill-treatment was non-consent (49.84%), verbal abuse (25.75%) followed by threats (23.25%), physical abuse (16.96%), and discrimination (14.79%). Besides, other factors identified included lack of dignity, delivery by unqualified personnel, lack of privacy, demand for informal payments, and lack of basic infrastructure, hygiene, and sanitation. The determinants identified for disrespect and abuse were sociocultural factors including age, socioeconomic status, caste, parity, women autonomy, empowerment, comorbidities, and environmental factors including infrastructural issues, overcrowding, ill-equipped health facilities, supply constraints, and healthcare access. Conclusion: The high prevalence of disrespectful maternity care indicates an urgent need to improve maternity care in India by making it more respectful, dignified, and women-centered. Interventions, policies, and programs should be implemented that will protect the fundamental rights of women. [ABSTRACT FROM AUTHOR]

Background: Availability of free/low-cost treatment in higher government facilities increases maternity self-referrals circumventing the referral system. We aimed to find the sociodemographic and health-care service delivery pattern among the pregnant women referred for institutional delivery in a tertiary care center in south India and assess factors associated with maternity self-referral from the perspective of pregnant women. Materials and Methods: We conducted a cross-sectional analytical study among pregnant women attending the antenatal clinic and admitted to the obstetric and postnatal wards during the 6-month study period. Interview was conducted using a face validated structured questionnaire. Statistical Analysis: Adjusted prevalence ratio (aPR) with 95% confidence interval (CI) was calculated to assess the independent effects of the sociodemographic and health-care delivery factors on maternity self-referral. Results: Mean age of 4191 pregnant women was 24 years (3.9). Forty-one percent (1732) of them had come without any referral, i.e., self-referred. Fifty-two percent (909) of these self-referred pregnant women were primigravida, 77% (1330) belonged to joint families and had nearest health facility within half hour distance from their own house. Nuclear family (aPR: 1.56 [95% CI: 1.45–1.68]), monthly family income >Rs. 3000 (aPR: 1.38 [95% CI: 1.28-1.49], and nearest health facility more than half-hour (aPR: 1.57 [95% CI: 1.45–1.69]) were factors significantly associated with self-referral. Conclusions: The study presents the alarming maternal referral system prevailing in nation as 41% (95% CI: 39.8%–42.8%) of maternal admissions in a tertiary care institute of South India were without any documented referrals. [ABSTRACT FROM AUTHOR]

Background: The influence of health workers on uptake of maternal healthcare services is well documented; however, their outreach for family planning (FP) services and influence on the intention to use contraceptives is less explored in the Indian context. This study examined the extent of health worker outreach for FP service and its effects on intention to use contraceptives among currently married women aged 15-49 years.Methods: This study used data from two rounds of the National Family Health Survey (NFHS) of India, conducted during 2005-06 and 2015-16 respectively. Bivariate analysis and multivariate logistic regression were used to understand the level of and change in health worker outreach for FP services over time, and its association with intention to use contraceptives among currently married women.Results: In the past 10 years, health workers' outreach for FP service has significantly increased by about 10 percentage points, although the level is not optimal and only 28% of non-users were reached by health workers in 2015-16. Increase in the outreach to younger and low parity women was higher than their respective counterparts. Intention to use contraceptive among women who were not using any method was 41% when health workers contacted and discussed FP, compared to only 20% when there was no such contact with health workers. Multivariable analysis suggests that contact with health workers has significant positive effects on intention to use contraceptive (AOR = 3.05; p < 0.001; 95% CI 2.85-3.27).Conclusion: Increased scope of outreach of frontline health workers to provide FP communication and services will not only help in building knowledge of contraceptive methods but will also increase women's intention to use a method. For India, this may be the most promising way to achieve the Sustainable Development Goals 3.7, which calls for universal access to reproductive health services. [ABSTRACT FROM AUTHOR]

Despite advancement in medical care, Rh alloimmunisation remains a major cause of neonatal hyperbilirubinaemia, neuro-morbidity, and late-onset anaemia. Delayed cord clamping (DCC), a standard care now-a-days, is yet not performed in Rh-alloimmunised infants due to paucity of evidence. Hence, we randomised these infants of 28- to 41-week gestation to delayed cord clamping (N = 36) or early cord clamping (N = 34) groups. The primary outcome variable was venous packed cell volume (PCV) at 2 h of birth. The secondary outcomes were incidence of double volume exchange transfusion (DVET) and partial exchange transfusion (PET), duration of phototherapy (PT), functional echocardiography (parameters measured: superior vena cava flow, M-mode fractional shortening, left ventricular output, myocardial perfusion index, and inferior vena cava collapsibility) during hospital stay, and blood transfusion (BT) until 14 weeks of life. Neonates were managed as per unit protocol. The baseline characteristics of enrolled infants were comparable between the groups. The median (IQR) gestation and mean (SD) birth weight of enrolled infants were 35 (33-37) weeks and 2440 (542) g, respectively. The DCC group had a higher mean PCV at 2 h of life (48.4 ± 9.2 vs. 43.5 ± 8.7, mean difference 4.9% (95% CI 0.6-9.1), p = 0.03). However, incidence of DVET and PET, duration of PT, echocardiography parameters, and BT until 14 weeks of postnatal age were similar between the groups.Conclusion: DCC in Rh-alloimmunised infants improved PCV at 2 h of age without significant adverse effects.Trial registration: Clinical Trial Registry of India (CTRI), Ref/2016/11/012572 http://ctri.nic.in/Clinicaltrials, date of trial registration 19.12.2016, date of first patient enrolment 1 January 2017.What is Known:•Delayed cord clamping improves haematocrit, results in better haemodynamic stability, and decreases the need of transfusion in early infancy.•However, due to lack of evidence, potential risk of hyperbilirubinaemia, and exacerbation of anaemia (following delayed cord clamping), early cord clamping is the usual norm in Rh-alloimmunised infantsinfants.What is New:•Delayed cord clamping in Rh-alloimmunised infants improves haematocrit at 2 h of life without any increase in incidence of serious adverse effects. [ABSTRACT FROM AUTHOR]

The present study is an endeavor to understand the sociodemographic profile, reproductive health, and nutritional status of the Juangs, a particularly vulnerable tribal population of Odisha, India. A total of 435 adult males and 515 adult females (≥18 years) were considered from 15 villages under two blocks of Keonjhar district of Odisha, India. A pre-structured schedule was used to collect data on the sociodemographic profile and reproductive health. Heights and weights were recorded using the standard protocol. Statistically significant (p < 0.05) sex difference was found with respect to age, educational status, and occupational status between the males and the females. The present study reveals that the mean reproductive wastage was found to be 0.55. The maternal and child health care services unveil that only 29.9 percent of the women have taken iron and folic acid (IFA) tablets and 23.1 percent have taken at least one tetanus toxoid (TT) vaccine. Maximum percentage of women (75.9%) were assisted by elderly women during delivery, and only 35.1 percent adopted the sterilization method for fertility regulation. Among the mothers, 60.6 percent initiated breastfeeding on the third day, 55.9 percent breastfed their babies for a period of 2 years, and 66.2 percent mothers immunized their children with at least one vaccine. A significant sex difference of mean body mass index (BMI) (t -- 5.68; p < 0.001) was observed between the Juang males and females. The study reflects that the extents of undernutrition among the males (57.5%) and the females (62.9%) were very high, which indicates that the Juangs are under serious nutritional stress. Hence, immediate appropriate nutritional intervention programs are needed for implementation. [ABSTRACT FROM AUTHOR]

Background: Maternal health remains a major public health problem in India, with large inter- and intra-state inequities in maternal health service use and maternal deaths. The Commission on Social Determinants of Health provides a framework to identify structural and intermediary factors of health inequities, including maternal health, and understand their mechanism of influence, which might be important in addressing maternal health inequities in India. Our review aims to map and summarize the evidence on social determinants influencing maternal health in India and understand their mechanisms of influence by using a maternal health-specific social determinants framework. Methods: A scoping review was conducted of peer-reviewed journal articles in two databases (PubMed and Science Direct) on quantitative and qualitative studies conducted in India after 2000. We also searched for articles in a search engine (Google Scholar). Forty-one studies that met the study objectives were included: 25 identified through databases and search engines and 16 through reference check. Results: Economic status, caste/ethnicity, education, gender, religion, and culture were the most important structural factors of maternal health service use and maternal mortality in India. Place of residence, maternal age at childbirth, parity and women's exposure to mass media, and maternal health messages were the major intermediary factors. The structural factors influenced the intermediary factors (either independently or in association with other factors) that contributed to the use of maternal health service or caused maternal deaths. The health system emerged as a crucial and independent intermediary factor of influence on maternal health in India. Issues of power were observed in broader social contexts and in the relationships of health workers which led to differential access to maternal healthcare for women from different socioeconomic groups. Conclusion: The model integrates existing information from quantitative and qualitative studies and provides a more comprehensive picture of structural and intermediary factors of maternal health service use and maternal mortality in India and their mechanisms of influence. Given the limitations of this study, we indicate the areas for further research pertaining to the framework and maternal health. [ABSTRACT FROM AUTHOR]

Objective: To assess the status of utilization of Maternal Health Care (MHC) services in slums of an industrialized city and elucidating the various determinants influencing the utilization. Materials and methods: A Cross-sectional study using multi stage sampling methodology was conducted in slums of an industrialized city. The study participants were the women who had given a live birth in the last one year before 4 weeks of the study starts. Total one hundred eighty families were interviewed & analysed. Results: The utilization of MHC services was poor as compared to national averages in urban slums. There was no association between age of mother, birth order, educational and occupational status of head of family with utilization of services while education and employment of mother, category and type of family, distance and time to reach health facility, were significantly associated. Conclusion: The reduction of maternal mortality and morbidity mostly depends on the utilization of MHC services. The findings of this study have important implications for improving utilization of maternal health care services. [ABSTRACT FROM AUTHOR]

Objectives: The main aim of this study is to analyze the differentials in average expenditure on prenatal, delivery and postnatal care by socio-economic characteristics of households in EAG states and assessment of the number of households incurred catastrophic health expenditure on maternity care. Method: We have used 71st round of the NSSO data held on June 2014. For the analysis of prenatal care, delivery care, postnatal care, total maternity expenditure and Out of Pocket Expenditure (OOPE) have been taken as dependent variables and the independent variables have been chosen based on previous studies as well as socio-economic aspects, especially in EAG states of India. Bivariate analysis and binary logistic method have been used for the data analysis. Results: Results shows that MCE is high in urban sector specially in Orissa among all EAG states. We also found that Orissa has the maximum number of household that incurred high catastrophic-health-expenditure. Conclusion: We can conclude that women belong to better socio-economic condition spent more money on maternity care and incurred high OOPE where is, it is less among women who belong to poor socioeconomic condition, due to lack of awareness and other socio-economic hurdles. [ABSTRACT FROM AUTHOR]

The objectives of our study were to examine the (1) trends and patterns of caesarean deliveries in India and; (2) differentials in catestrophic household expenditure on caesarean deliveries. The paper used data from 71st round of the National Sample Survey, India. The analysis included 14,310 women, hospitalised for delivery during the last 365 days preceding the survey. The proportion of caesarean sections among institutional deliveries in India was 2.5% in 1992–1993, which increased to 23.9% in 2014. In private facilities, 47.8% deliveries were conducted through caesarean section, while in public facilities, this proportion was 8%. OOPE per delivery was US$157 which was 64.9% of the total cost of maternal health care. OOPE varied by type of delivery; US$283 for caesarean and US$77 for non-caesarean delivery. About 60% of households incurred the expenditure on caesarean section exceeding 40% of their capacity to pay. The incidence of catastrophic delivery expenditure declined with increased education and per-capita expenditure. Caesarean delivery in private facilities and a hospital stay of more than 48 h increased the chances of catastrophic expenditure. Interventions and regulations are necessary for both public and private sector to check unwarranted caesarean deliveries and hospital stays to reduce catastrophic expenditure. [ABSTRACT FROM AUTHOR]

While it is mandated that reproductive and child health services be provided for free at public facilities in India, qualitative evidence suggests it is common for facilities to request bribes and other informal payments for medicines, medical tests or equipment. This article examines the prevalence of bribe requests, total out-of-pocket expenditures (OOPEs) and associations between bribe requests and total OOPEs on the experience of quality of care and maternal complications during childbirth. Women who delivered in public facilities in Uttar Pradesh, India were administered a survey on sociodemographic characteristics, bribe requests, total OOPEs, types of health checks received and experience of maternal complications. Data were analysed using descriptive, bivariate and multivariate statistics. Among the 2018 women who completed the survey, 43% were asked to pay a bribe and 73% incurred OOPEs. Bribe requests were associated with lower odds of receiving all health checks upon arrival to the facility (aOR = 0.49; 95% CI: 0.24-0.98) and during labour and delivery (aOR = 0.44; 95% CI: 0.25-0.76), lower odds of receiving most or all health checks after delivery (aOR = 0.44; 95% CI: 0.31-0.62) and higher odds of experiencing maternal complications (aOR = 1.45; 95% CI: 1.13-1.87). Although it is mandated that maternity care be provided for free in public facilities in India, these findings suggest that OOPEs are high, and bribes/tips contribute significantly. Interventions centred on improving person-centred care (particularly guidelines around bribes), health system conditions and women's expectations of care are needed. [ABSTRACT FROM AUTHOR]

Background: In 2001, India prioritized eight most socioeconomically disadvantaged states known as Empowered Action Group (EAG) states and in 2013, it prioritized 190 of the 718 as high priority districts (HPDs) to accelerate the decline in maternal and newborn mortality. This paper assesses whether the HPDs achieved a greater coverage of maternal and newborn health interventions than the non-HPDs and HPDs in EAG states achieved greater coverage than those in non-EAG states.Methods: We used data from the Sample Registration System to assess rural neonatal mortality trends in EAG states and all India. We computed a co-coverage index based on seven maternal and newborn health interventions from the 2015/16 National Family Health Survey. Difference in differences (DID) analyses were used to examine the contribution of district prioritization, considering the HPDs and the illiterate as treatment groups and 2013 as the time cut-off for the pre- and post-treatment.Results: Neonatal mortality declined in rural India from 36 to 27 per 1000 live births during 2010-2016 at 4.5% per year. Four EAG states experienced faster rates of decline than the national rate. From 2013, the co-coverage index increased significantly more in the HPDs compared to non-HPDs (DID = 0.11, P ≤ 0.005). The district prioritization effect on co-coverage was statistically significant in only EAG states (DID = 0.13, P ≤ 0.05). The coverage gains for illiterate mothers were greater than for literate mothers, especially in the HPDs.Conclusions: The district prioritization in India is associated with greater improvements in the coverage of maternal and newborn health services in EAG states and the HPDs, including reductions in inequalities within those states and districts. There are however still large gaps between states and districts and within districts by the mother's literacy status that need further prioritization to make progress towards the SDG targets by 2030. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate the change in prevalence of low birth weight (LBW) over the last decade in India and to identify its associated factors—biological, demographic, socio‐economic, and programmatic. Methods: We used the data from the National Family Health Survey of 2005‐2006 (NFHS‐3) and 2015‐2016 (NFHS‐4). The sample of this study included 11 300 children from NFHS‐3 and 99 894 from NFHS‐4 data; all these children were the last full‐term singleton live‐births, born within the last 3 years prior to the survey. Results: In India, the prevalence of LBW has significantly declined from 20.4% (95%CI 19.4‐21.4) to 16.4% (95% CI 16.1‐16.8) in the last decade. The prevalence of LBW remained high in girl children (OR = 1.2, 95% CI 1.2‐1.3; P <.001), whose mothers were adolescent (OR = 1.2, 95% CI 1.1‐1.3; P <.001), and were stunted (OR = 1.3, 95% CI 1.3‐1.3; P <.001). Prevalence of LBW declined among second or higher birth order child (OR = 0.8, 95% CI 0.8‐0.9; P <.001), whose mothers educated up to secondary level and above (OR = 0.6 to 0.8), belonged to rich wealth quintiles (OR = 0.9 to 0.8), were from rural area (OR = 0.9, 95% CI 0.9‐1.0; P <.001), received better nutrition and adequate antenatal care (OR = 0.8, 95% CI 0.8‐0.8; P <.001), and were from eastern, northeastern, and southern regions of India (OR = 0.9 to 0.5). Conclusion: Although the prevalence of LBW in India has declined over the past decade, the extent of the decline is modest. In the coming years, health programs in India need to gear up with greater convergence between maternal health services and maternal nutrition to reduce LBW. [ABSTRACT FROM AUTHOR]

In many cultural settings worldwide, within families, men tend to be responsible for important choices relating to the allocation of household resources and care-seeking behaviour that directly impact on the health of women and newborns. This study examines the extent of male participation in antenatal care (ANC), delivery, postnatal care (PNC), household chores and providing food to wives among tribal communities in India. In addition, health care providers' views on male participation in maternal health were examined. Primary data were collected from 385 men aged 15-49 from rural Gadchiroli District in Maharashtra, India. Interviews of 385 men whose wives had delivered a child within the previous 2 years were conducted between November 2014 and March 2015. Bivariate and multivariate analyses were done. The results showed that the tribal men's participation in maternal health care was minimal. Around 22% of the men reported accompanying their wives to ANC, 25% were present at the time of delivery of their children and 25% accompanied their wives to PNC. Participation in household work, and support for wives in other ways, were slightly better. The main reason given by men for not participating in maternal health care was that they didn't think it was necessary, believing that all maternal health issues were women's concern. Health care providers among these tribal communities in India should encourage men to participate in issues related to maternal health care. [ABSTRACT FROM AUTHOR]

The Indian national health policy encourages partnerships with private providers as a means to achieve universal health coverage. One of these was the Chiranjeevi Yojana (CY), a partnership since 2006 with private obstetricians to increase access to institutional births in the state of Gujarat. More than a million births have occurred under this programme. We studied women's perceptions of quality of care in the private CY facilities, conducting 30 narrative interviews between June 2012 and April 2013 with mothers who had birthed in 10 CY facilities within the last month. The commonly agreed upon characteristics of a "good (sari) delivery" were: giving birth vaginally, to a male child, with the shortest period of pain, and preferably free of charge. But all this mattered only after the primary outcome of being "saved" was satisfied. Women ensured this by choosing a competent provider, a "good doctor". They wanted a quick delivery by manipulating "heat" (intensifying contractions) through oxytocics. There were instances of inadequate clinical care for serious morbidities although the few women who experienced poor quality of care still expressed satisfaction with their overall care. Mothers' experiences during birth are more accurate indicators of the quality of care received by them, than the satisfaction they report at discharge. Improving health literacy of communities regarding the common causes of severe maternal morbidity and mortality must be addressed urgently. It is essential that cashless CY services be ensured to achieve the goal of 100% institutional births. [ABSTRACT FROM AUTHOR]

Background: This study aims to explore the difference in the utilization pattern of dental services among pregnant, post-partum and six-month post-partum women. Methods: This cross-sectional questionnaire survey was performed at two maternity and child care hospitals in India that primarily cater to middle and low income communities. Data were collected from 3 groups: 1) pregnant women in their first trimester; 2) post-partum women (< 48 h after delivery); and 3) six-month post-partum women. The primary outcome of interest was dental service utilization during pregnancy. Self-perceived oral health (SPOH) was calculated based on the four global dimensions- knowledge, function, quality of life and social. Multiple logistic regression analysis was carried out to assess the effect of each independent variable after adjustment for the effect of all other variables in the model. Results: Responses of 450 (150 pregnant, 150 post-partum and 150 six-month post-partum) women were analyzed (response rate = 72%). Significant differences in the dental attendance pattern was observed between the study groups (p < 0.01). Dental attendance among pregnant and six-month post-partum women were 60 and 75%, respectively, however, only about 15% of the post-partum women reported to have sought dental care within the 6 months prior to the study. Post-partum women had the highest SPOH scores, indicating poor self-perceived oral health, followed by pregnant and then six-month post-partum women, which was statistically significant (p < 0.05). A significantly higher percentage of post-partum women reported to have poor oral and general health, as compared to both, pregnant and six-month post-partum women (p < 0.01). Higher percentage of women reporting 'good' oral and general health had sought dental care compared with others (p < 0.01). After adjusting for all the other variables in the model, women with lower levels of education (ORa = 1.42; 95% CI: 1.01–2.00), women with poor self-perceived oral health (ORa = 1.08; 95% CI: 1.02–1.14) and post-partum women (ORa = 0.15; 95% CI: 0.09–0.24) were found to be less likely to seek regular dental care. Conclusion: Pattern of dental service utilization among women in this population varied according to their pregnancy status, level of education and self-perceived oral health. [ABSTRACT FROM AUTHOR]

Problem The proliferation of information and communication technologies in India has enabled the emergence of health-related digital applications, from which important ethical issues arise. Approach The Aadhaar identification system provides each resident in India with a 12-digit unique identification number, linked to demographic and biometric data. Identification by Aadhaar in welfare programmes has the important advantage of ensuring targeted benefits reach the intended recipients. Local setting Some of the major issues faced by the public health sector in India are inadequate funding and inefficient utilization of the funds allocated. The enhancement of currently available digital health records will greatly increase the efficiency of the health care services. Relevant changes The Aadhaar identification system has been linked to several health programmes since 2013. Success was achieved in a programme encouraging pregnant women to undergo delivery at a health facility, as use of Aadhaar number ensured that cash incentives reached the correct recipient. However, interruptions in the treatment of patients with tuberculosis and acquired immunodeficiency syndrome have been reported in other health programmes, due to patients fearing a breach of their confidentiality. Lessons learnt Although the proposed merging of the Aadhaar identification system with digital health care records could enable greater efficiency in monitoring public health and welfare programmes, important ethical issues of privacy and data ownership and use must be considered. In joining the digital revolution, low- and middle-income countries must also develop strict legal regulation to protect data and avoid information technology companies exploiting such databases for profit. [ABSTRACT FROM AUTHOR]

Introduction: There is poor penetration of evidence-based maternal health care provided under national health programs in resource-poor underserved regions. A well-planned locally acceptable community-driven comprehensive health promotion strategy and quality health care delivery mechanism is necessary to improve the situation. Objective: The main objective was to find the gaps in the existing system and promote health literacy and health-seeking behavior. Methodology: 80,000 tribal population living in isolated conflict zone of Bastar district was covered for 5 years between 2012 and 2017. An integrated health-care plan was developed with community leaders, panchayat, and the local government to promote and provide quality evidence-based maternal health care. Available resources were mobilized and health technologies introduced. Results: Regular home visits, point of care diagnostics, identification of high-risk mothers and their timely referral, and behavioral change communication increased the trust of the community. It resulted in higher demand for evidence-based health interventions. The adolescent pregnancy rate (<19 years) reduced to 6.8% (2016) from 13.5% (2012). Hemoglobin level >9 g% (third trimester) improved. Supervised births and high-risk referrals increased from 19.5% (2014) to 58% (2017) and 8.5% (2014) to 13.1% (2017), respectively. Although significant improvement was noted, key indicators continued to remain below rural Bastar (National Family Health Survey-4). Conclusion: Promotion of existing good practices, behavior change, health technologies, and evidence-based emergency care improved the maternal health status of the secluded and underserved tribal community, but persistent effort is needed to enable women access the quality maternal health services provided under National Health Mission. [ABSTRACT FROM AUTHOR]

Background: Maternal death review (MDR) is a strategy that helps in identifying gaps in the care of a pregnant mother. Objectives: The objective is to assess the quality of MDR, causes of maternal mortality, and finding corrective action in 10 high-priority districts of Odisha. Materials and Methods: MDR was undertaken by our team in 4-month timeline (August to November 2014). It included the development of tools, desk reviews, training of staffs, and data handling. The maternal deaths were estimated from the Annual Health Survey. It was compared to estimated maternal death of each district to get the under reporting/over reporting districts. A report was generated on MDR process indicators and program indicators after completion of the assessment. Results: Only 129 (52%) of the 247 deaths found suitable for community-based MDR. The proportion of maternal death reported versus estimated was 247 versus 367. Correct diagnoses were reported in 120 cases. The classification of deaths was not mentioned in 74 cases. Maximum deaths (55%) were in 18–25 years of age group (the most common cause being anemia). Majority (50%) of the deaths occurred during the postnatal period and majority (67%) at the health facility. Only 61 (47%) had received antenatal check-ups. Facility-based MDR showed, Type 1 delay (denotes about seeking care) being the most common (53%). Inaccurate and incomplete information available was also found to compound the above problems in addition. Conclusions: The present study could contribute to a larger extent to address some of the gaps in the MDR process in the Odisha state. [ABSTRACT FROM AUTHOR]

Background: Maternal health is severely affected by home deliveries because it contributes to maternal mortality, especially if home births are not made safer. Objectives: The present study aimed to assess the determinants of home delivery among mothers in urban and rural Vadodara district, Gujarat. Materials and Methods: This community-based, cross-sectional study was carried out during April 2017–July 2017. The mothers who delivered at home and hospital in urban and rural Vadodara district between April 15 and March 16 were included in the study. A semi-structured questionnaire was used for interviewing all the mothers. Information regarding sociodemographic and obstetrics characteristics of mothers was recorded. The study finding was presented in the form of frequencies and percentages, and the association was found with Chi-square test.P ≤0.05 was considered statistically significant. Results: The present study was carried out among 138 mothers, of them, 71.7% were in the age group of 20–25 years. The mean age of mothers was 24.5 ± 4.4 years. The analysis of sociodemographic and obstetric factors revealed that mothers age more than 25 years, mothers from nuclear family, illiterate mothers, late antenatal care registration by mothers, mothers not registered in Janani Suraksha Yojna/Chiranjeevi Yojana scheme, and prior experience of home delivery by mothers were significantly associated with home delivery (P < 0.05 each). Conclusions: This study highlighted that several sociodemographic and obstetrics determinants related to mother were associated with home delivery in the study setting. Taking these findings into consideration, it is recommended that appropriate maternity services should be designed with a special focus on poor, uneducated, and multiparous women as well as it should ensure early registration of pregnancy for every pregnant woman. Institutional delivery should be encouraged and advocated among mothers having all previous deliveries at home. [ABSTRACT FROM AUTHOR]

Background: The Mother and Child Tracking System (MCTS) portal captures and tracks all pregnant women right from conception up to 42 days after delivery and all children below five years. Objectives: This study was conducted to find out the technical, behavioral and organizational factors that affect the process and performance of MCTS. Material and Methods: This was an exploratory qualitative study conducted in Varanasi district by using multistage random sampling method. Data were collected by in-depth interviews of 48 health care providers. Results: Majority of the ANMs and ASHAs were not aware of the meaning of "Tracking System" and the use of MCTS ID. Inappropriate training of ASHAs, absence of supervision and monitoring by ANMs, overburdened DEOs and ANMs, poor internet connection, slow server speed, software problem and frequent power failures were identified as major factors for poor performance of MCTS. Conclusion: The most effective measure to improve the performance of MCTS would be to properly train grass root level workers so that more efficient data can be fed into MCTS. [ABSTRACT FROM AUTHOR]

The study to assess Knowledge on maternal and child health services among women in reproductive age group in Mahabalipuram, Kanchipuram District, Tamil Nadu, India" The objectives were to assess the knowledge of women regarding maternal and child health services and associate the level of knowledge with selected demographic variables among women in reproductive age group. 184 samples were selected by convenient sampling technique. Data collected by structured questionnaire. The collected data was tabulated and analysed. Descriptive and inferential statistical were used. The results are majority 60% of women had moderate knowledge where as minority 12% had inadequate knowledge. Demographic variables like Age χ²=12.14, Educational status χ²=16.572, Monthly income χ²=16.4828, Type of family χ²=23.788(p≤0.05) were significant where as Marital status χ²=1.0432, Occupational status χ²=0.7601, Number of pregnancy χ²=0.8079 (p≤0.05) not significant with the selected demographic variables among women in reproductive age group. [ABSTRACT FROM AUTHOR]

This study examines associations between fertility intentions and maternal health behaviours during and after pregnancy among a nationally representative sample of 3,442 women from India. Two waves of data (2005, 2012) from the India Human Development Survey were analyzed to investigate the influence of unwanted births on women's use of antenatal care, timely postnatal care, and the delivery setting using binary and ordered logistic regression, partial proportional odds models, and propensity score weighting. Fifty-eight per cent of sample births were unwanted. Regression results show that, net of maternal and household characteristics, women with unwanted births were less likely to obtain any antenatal care and had fewer antenatal tests performed. Unwantedness was also associated with a lower likelihood of delivering in an institutional setting and of obtaining timely postnatal care. The relationships between unwantedness and antenatal care, postnatal care, and delivery setting were robust to models accounting for propensity weighting. [ABSTRACT FROM AUTHOR]

Objective: To study obstetric and perinatal outcomes among pregnant women with Takayasu arteritis (TA), attending our hospital for pregnancy and childbirth between January 2011 to December 2016. Material and Methods: Retrospective study was carried out by abstracting clinical charts on all pregnant women with TA who underwent antenatal care and/or delivery in our hospital during this period. American College of Rheumatology criteria was used for diagnosis of TA. Sixteen women with TA were included in the study. Maternal demographic data, stage of disease, complications related to disease, details of treatment taken prior to pregnancy, pregnancy outcomes, and neonatal outcomes were studied. Results: Forty-four percentage (7/16) belonged to type 5 angiographic type, however the same proportion (7/16) had undergone surgical corrections prior to pregnancy and the majority (15/16) were on medical management. Only three women (19%) were diagnosed during pregnancy. Most did not have active disease measured by Kerr's criteria (n=12; 75%), and Indian Takayasu clinical activity scores A. Chronic hypertension was the commonest antenatal complication (56.2%), nearly one-third had growth restricted babies and 25% had preterm labour. There were no cardiovascular events, no maternal deaths, nor fetal or neonatal deaths. Two-thirds of our women were delivered by caesarean section. Conclusion: Preconceptional counselling is of paramount importance in women with TA. Good maternal and fetal outcomes are observed with close antenatal surveillance and multidisciplinary care. Pregnancy should be planned during disease remission, with good antenatal care, close monitoring of clinical symptoms, early diagnosis and treatment of complications. [ABSTRACT FROM AUTHOR]

Since the implementation of the National Health Mission (NHM) in India there has been a noticeable improvement in the utilization of maternal care, namely antenatal care (ANC), skilled birth attendants (SBA) and postnatal care (PNC) in the country. The increase in utilization of these services is expected to reduce inequality across geographies and population sub-groups, but little is known about the extent of inequality in maternal care use across socioeconomic groups over time. Using data from the last two rounds of National Family Health Surveys conducted in 2005-06 and 2015-16, this study examined the extent of inequality in utilization of full ANC, SBA and PNC in India and its states. Descriptive statistics were used, a concentration index was computed and decomposition analyses performed to understand the pattern and change of inequality in use of maternal care. The results suggest that the gap in maternal care utilization across socioeconomic groups has reduced over time. The concentration index for SBA showed a decline from 0.49 in 2005-06 to 0.08 by 2015-16, while that of PNC declined from 0.36 to 0.13 over the same period. The reduction in inequality in utilization of full PNC was the least. The results of the decomposition analysis revealed that urban residence, education and belonging to Scheduled Caste and Scheduled Tribes positively contributed to the inequality. Based on these findings, it is suggested that the Janani Suraksha Yojana and Janani Sishu Suraksha Karyakaram schemes be continued and strengthened for poor mothers to reduce maternal health inequality, particularly in full ANC and PNC. [ABSTRACT FROM AUTHOR]

Background: Indian Public Health Standards (IPHS) evaluates supply side compliance of Primary Health Centers (PHCs). Patient Satisfaction (PS) on the other hand, assesses the demand side. Objective: Examining the supply side compliance and relating it to PS in the domain of Reproductive Health (RH). Methods: Using multistage stratified sampling, six rural and three urban PHCs in sub-districts, Ramanagara and Channapatna, in District Ramanagara, state of Karnataka, India, were chosen. Information collected using IPHS proforma for PHCs was compared with PS questionnaire (PSQ 18) data, collected from 398 patients visiting these facilities. Results: Using descriptive and inferential analysis, sub-optimal compliance levels in ease of access, physical & human infrastructure, patient data and usage of untied funds was found. Existing behavioral compliance was found to be optimal. These findings were in alignment with PS findings. Conclusion: Results call for PHC capacity building, incentivization and a crucial need to look into PS side, before passing judgement about performance standard. [ABSTRACT FROM AUTHOR]

Introduction: The maternal health generally refers to the health of women during pregnancy, childbirth and postpartum period. Utilization of maternal health care services has been recognized as a significant factor in influencing maternal and child mortality. The Maternal Mortality Ratio (MMR) estimate for the country indicates an overall decline from 212 in 2007-09 to 178 per one lack live births in 2012, resulting in saving lives of about 9,000 mothers per year 2. The aim of maternal health care services to reduce infant mortality, maternal morbidity and mortality was recognized at the Cairo Conference on Population. Materials and Method: This paper has utilized the data collected by the National Sample Survey Organization (NSSO) during January -June, 2014. It is a cross sectional dataset available in public domain. The dataset provides information on Social Consumption and Health scenario of the population. To carryout the research, descriptive statistics, bivariate and logistic regression analysis has been used. Findings: The study shows that place of residence, marital status, educational status and wealth index plays an important role in determining the utilization of ante-natal care and post-natal care services. Utilization of services from private sector increases with the increase in the level of socio-economic characteristics. Southern and Western regions of India have 97 percent utilization of ante-natal care and more than 90 percent utilization of post-natal care services in India. Multivariate analysis also depicts close relationship with different predictors as urban place of residence, currently married women, higher educational status and richest wealth category. Conclusion: Place of residence, educational status and wealth index plays an important role in determining the utilization of maternal health care. Western and Southern regions have better utilization of maternal health care services. [ABSTRACT FROM AUTHOR]

Introduction: Catastrophic health expenditure is defined as payments for health services exceeding 40% of household disposable income after subsistence needs are met. Utilization of maternal health care services has been recognized as a significant factor in influencing maternal and child mortality. India continues to account for a quarter of all maternal and child deaths at the world level. The cost of health care is comparatively higher in private sector than the public health facilities. Households using private inpatient services are more likely to face catastrophic expenditure. Materials and Method: This paper has utilized the data collected by the National Sample Survey Organization (NSSO) during January-June, 2014. It is a cross sectional dataset available in public domain. The dataset provides information on Social Consumption and Health scenario of the population. To carry out the research, descriptive statistics, bivariate and logistic regression analysis has been used. FINDINGS The study shows that urban sector, primary educated and women belonging to poorest wealth quintile bear high catastrophic health expenditure than their other counterparts. Western and Southern region have low percentage of women going for catastrophic expenditure on maternal health care. The likelihood of catastrophic health expenditure on maternal health care decreases with the increase in wealth quintile from poorest to richest. Conclusion: Place of residence, educational status and wealth index plays an important role in determining the catastrophic health expenditure on maternal health care. Further research needs to be done in exploring the factors that leads to inequity of the expenditure used in the utilization of maternal health care. [ABSTRACT FROM AUTHOR]

Aim: Considering the burden of cervical cancer in India, innovative approaches are needed to improve coverage of cervical cancer screening. Methods: From May 2014 to January 2017, we implemented a project in 10 cities in Uttar Pradesh, India using World Health Organization‐recommended 'screen and treat' approach for cervical cancer prevention. We involved private practitioners (obstetricians and gynecologists and general practitioners) in these cities to provide affordable cervical cancer screening to women mobilized by our community health workers. A pilot phase was implemented in three cities during May 2014 and December 2015 and the project was scaled‐up to additional seven cities between January 2016 and January 2017. Results: A total of 100 836 women aged between 30 and 60 years were screened with visual inspection with acetic acid (VIA) of which 5477 (5.4%, 95% confidence interval (CI) 5.29, 5.57) were VIA positive. Treatment with cryotherapy was given to 3735 (68.2%, 95% CI 66.96, 69.43) women. In the three cities that piloted the program, VIA positivity rates significantly declined from 6.6% (95% CI 6.31, 6.84) to 4.0% (95% CI 3.82, 4.24) during the scale‐up phase (P < 0.0001) and the rates of cryotherapy significantly increased from 66.8% (95% CI 64.78, 68.77) to 76.7% (95% CI 74.42, 78.96) (P < 0.0001). Conclusion: We observed a significant decline in the VIA positivity rates during the scale‐up phase in the three cities that participated in the pilot phase. We have reported successful engagement of private practitioners to provide affordable cervical cancer screening and it is possible to replicate it in other states in India as well. [ABSTRACT FROM AUTHOR]

Quantitative survey findings are important in measuring health-related phenomena, including on sensitive topics such as respectful maternity care (RMC). But how well do survey results truly capture respondent experiences and opinions? Quantitative tool development and piloting often involve translating questions from other settings and assessing the mechanics of implementation, which fails to deeply explore how respondents understand survey questions and response options. To address this gap, we conducted cognitive interviews on survey questions (n = 88) adapted from validated RMC instruments used in Ethiopia, Kenya and elsewhere in India. Cognitive interviews with rural women (n = 21) in Madhya Pradesh, India involved asking the respondent the survey question, recording her response, then interviewing her about what the question and response options meant to her. We analysed the interviews to revise the tool and identify question failures, which we grouped into six areas: issues with sequencing, length and sensitivity; problematic response options; inappropriate vocabulary; temporal and spatial confusion; accessing different cognitive domains; and failure to resonate with the respondent's worldview and reality. Although women tended to provide initial answers to the survey questions, cognitive interviews revealed widespread mismatch between respondent interpretation and question intent. Likert scale response options were generally incomprehensible and questions involving hypothetical scenarios could be interpreted in unexpected ways. Many key terms and concepts from the international RMC literature did not translate well and showed low resonance with respondents, including consent and being involved in decisions about one's care. This study highlights the threat to data quality and the validity of findings when translating quantitative surveys between languages and cultures and showcases the value of cognitive interviews in identifying question failures. While survey tool revision can address many of these issues, further critical discussion is needed on the use of standardized questions to assess the same domains across contexts. [ABSTRACT FROM AUTHOR]

Background: As India already missed maternal and child health related millennium development goals, the maternal and child health outcomes are a matter of concern to achieve sustainable development goals (SDGs). This study is focused to assess the gap in coverage and inequality of various reproductive, maternal, neonatal and child health (RMNCH) indicators in 640 districts of India, using data from most recent round of National Family Health Survey.Methods: A composite index named Coverage Gap Index (CGI) was calculated, as the weighted average of eight preventive maternal and child care interventions at different administrative levels. Bivariate and spatial analysis were used to understand the geographical diversity and spatial clustering in districts of India. A socio-economic development index (SDI) was also derived and used to assess the interlinkages between CGI and development. The ratio method was used to assess the socio-economic inequality in CGI and its component at the national level.Results: The average national CGI was 26.23% with the lowest in Kerala (10.48%) and highest in Nagaland (55.07%). Almost half of the Indian districts had CGI above the national average and mainly concentrated in high focus states and north-eastern part. From the geospatial analysis of CGI, 122 districts formed hotspots and 164 districts were in cold spot. The poorest households had 2.5 times higher CGI in comparison to the richest households and rural households have 1.5 times higher CGI as compared to urban households.Conclusion: Evidence from the study suggests that many districts in India are lagging in terms of CGI and prioritize to achieve the desired level of maternal and child health outcomes. Efforts are needed to reduce the CGI among the poorest and rural resident which may curtail the inequality. [ABSTRACT FROM AUTHOR]

Background: Despite substantial progress on maternal and child mortality, neither the Millennium Development Goal 4 nor 5 targets could be met. The global maternal mortality ratio declined by 44% between 1990 and 2015, short of the targeted 75% fall. Objectives: The objective of the study is to evaluate the maternal health services being provided to the high-risk mothers (HRMs) of Bhavnagar district. Methodology: It was a cross-sectional study conducted among the HRMs of Bhavnagar district during the period from March 2017 to August 2018. A total of 90 HRMs were selected and interviewed. Results: All the HRMs were measured for blood pressure and weight; tested for hemoglobin, blood group, and HIV; and examined for pedal edema. None of the HRMs were tested for sickle cell anemia. In the best performing primary health centers (PHCs), all the HRMs were tested for venereal disease research laboratory and hepatitis B surface antigen as against 79.5% of the HRMs from the worst-performing PHCs. About 47.7% of the HRMs from the worst-performing PHCs and 13.3% of the HRMs from the best-performing PHCs made <4 antenatal care (ANC) visits. Conclusions: For most of the ANC services, reason for nonreceipt of the service as given by the HRMs was "service not offered." [ABSTRACT FROM AUTHOR]

The objective of the present study was to find out the trends in utilization of maternal health care services by the Lodha women. Furthermore, attempt has also been made to identify the factors contributing to the utilization of maternal health services. The study has been conducted among the Lodha women residing in the district of Jhargram, West Bengal, India. Participants were married, aged between 15 and 44 years, have experienced at least one pregnancy during the last five year period, prior to the date of study. Pretested structured questionnaires were used to obtain the socio-demographic characteristics and utilization of maternal health care services. Three components of utilization of maternal healthcare services were measured: antenatal care (ANC), skilled birth attendants and post-natal care (PNC). Result shows that 88.7% of the participants received ANC service, 62.7% used SBA and 32.0% received PNC service. Bivariate analyses found significant association between utilization of maternal health care services and socio-demographic factors. Multivariate analysis revealed that apart from individual level factors (such as, age, education, parity, total number of pregnancy and women autonomy), supply-side/contextual level factors [such as availability of health care providers (ASHA worker), availability of transport facility and distance to sub centre] have a significant bearing on the utilization of maternal health care services. [ABSTRACT FROM AUTHOR]

Background: Better quality of care around the time of childbirth can significantly improve maternal and newborn survival. In countries like India, where the private sector contributes to a considerable proportion of institutional deliveries, it is important to assess the quality of maternity care offered by private sector healthcare facilities. This study seeks to fill that information gap by analysing baseline assessments conducted for the Manyata program, which aims to improve the quality of maternity care at private facilities.Methods: An observation checklist based on 16 clinical standards endorsed by the Federation of Obstetric and Gynaecological Societies of India (FOGSI) was used to assess 201 private sector healthcare facilities in Maharashtra, Jharkhand, and Uttar Pradesh. Data on facility characteristics came from profiles completed when facilities enrolled in Manyata. Differences in the mean number of standards met were analysed by facility characteristics and the availability of essential supplies.Results: Around half (47.1%) of all nursing staff engaged in maternity care services at these private healthcare facilities were under qualified. The mean number of clinical standards met by facilities was 3.2 (SD 2.4). Facilities with a monthly delivery load between 20 and 50 met a significantly higher number of standards, as did facilities that had more than 70% of essential supplies available. Both these factors were also significant in a multiple linear regression analysis.Conclusions: The overall quality of maternity care in private healthcare facilities is poor in all three states, especially for clinical standards related to management of complications. [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]

Since its establishment in 1980, all biennial conferences of The International Marcé Society for Perinatal Mental Health had been convened in high-income nations. Relatively little consideration had been given to the experiences and needs of most women who live in the world's low- and middle-income countries (LMICs). The aim is to provide an account of the first conference convened in India, a middle-income country. The Global Experiences, Global Dialogues, Global Responses Biennial Conference of the International Marcé Society for Perinatal Health was convened at the National Institute for Mental Health and Neurosciences (NIMHANS) held in Bengaluru 26th–28th September 2018. The conference achieved all its aims of maximizing access for people living and working in LMICs through scaled registration fees, building capacity through a young professionals' program, promoting collaboration through symposia co-convened by South Asian and other international experts, and visits to NIMHANS' clinical services. It made an impact on the agendas of sister expert professional societies, and public policies in India and generated significant public interest. It was appraised as pivotal, transformative and presenting exceptionally high-quality science. It was financially successful in making the largest contribution to date from a biennial conference to the Society's resources. We commend this initiative to other international expert professional societies seeking to benefit from the opportunities for mutual learning that conferences convened in low- and middle-income countries can provide, and to reduce disparities in access to evidence to address health inequalities. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality and morbidity continues to remain high in India, despite the existence of successive national programs for improving maternal and child health since the 1980s. In 2005, the Government of India launched the National Rural Health Mission to provide accessible, affordable and quality health care to the rural population, especially the vulnerable populations. Reduction in MMR to 100/100,000 is one of its goals and the Janani Suraksha Yojana is the key strategy to achieve this reduction. But the awareness of scheme is low in women from rural areas and urban slums, especially in low performing states. Aims: To study the comparative awareness of JSY and the socio-demographic factors influencing it, among the recently delivered women (RDWs). Methodology: A community based cross-sectional study was carried out in the ten rural areas and urban slums coming under the practice areas of JNMC, AMU, Aligarh for a period of one year. The prevalence of institutional delivery in Uttar Pradesh as found in a study by UNFPA 2008 (50.2%) was used for calculation of sample size. The yielded sample size 300 was selected proportionately from these areas. The study subjects were interviewed by a pre-designed and pre-tested questionnaire. Statistical analysis used: MS excel, chi square and logistic regression. Results: Awareness regarding the existence of a monetary scheme related to institutional delivery was more in rural areas i.e 75%. Regarding components of JSY maximum people (78%) were aware about the cash component. Religion, caste, parity, socio-economic status and place of residence showed a significant statistical association with the level of awareness of JSY. Conclusions: There is an urgent need to strengthen IEC campaigns and monitoring strategies for JSY as well as regularize the monetary flow for the health workers [ABSTRACT FROM AUTHOR]