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Women in India experience high rates of intimate partner violence (IPV) and low rates of adherence to World Health Organization (WHO) breastfeeding guidelines, contributing to poor maternal and child health outcomes. However, there is little evidence for how IPV might influence ability to adhere to these guidelines in India. This study examines how different forms and severity levels of IPV are associated with current infant feeding behavior throughout the first year of life in an effort to begin to fill this gap in the literature and provide information to improve infant feeding programs. Data are analyzed from the 2015 Indian National Family Health Survey. The sample comprised women who reported initiating breastfeeding in the past 12 months and who were selected for the Domestic Violence Module (n = 6812). Two outcome variables were created to measure current adherence to the WHO breastfeeding guidelines for mothers of 1) infants 6 months and younger and 2) infants 7 to 12 months. Two logistic regression models were fit to measure associations between the outcome variables and non-severe physical violence, severe physical violence, and sexual violence. Less than one-third of women reported adhering to WHO breastfeeding guidelines. Only severe physical violence was significantly associated with lower odds of current exclusive breastfeeding among mothers of infants 0 to 6 months. This analysis advances the understanding of how IPV is associated with suboptimal breastfeeding behavior by categorizing the severity of violence and including infants through the first year of life. The results suggest it may be crucial to focus intervention efforts on mothers with younger infants if the negative health effects of early weaning are to be avoided. Additional study of IPV in mothers of older infants should focus on the temporality of violence, which may elucidate additional findings regarding IPV and breastfeeding in this population. [ABSTRACT FROM AUTHOR]

Domestic violence (DV) is prevalent in low-income and slum-dwelling communities in India. To date, the focus of DV prevention in resource-poor settings has largely been with women. We herein aim to identify correlates of DV perpetration to help inform future primary prevention efforts that focus on behavioral change in men. Utilizing a cross-sectional design, potential correlates of DV perpetration were explored among a geographically-clustered random sample of 100 recently-married men residing in slums in Pune, India. In multivariable regression, DV perpetration was associated with less time spent alone in the relationship post-marriage (standardized β = -0.230, p<0.01), not attaining the “husband ideal” (standardized β = -0.201, p<0.05), poor resilience (standardized β = -0.304, p < .01), having limited definitions of behaviors constituting DV (standardized β = -0.217, p<0.05), and reporting greater jealousy if the participant’s spouse were to talk to men outside the family (standardized β = 0.272, p<0.01). The identified correlates should inform components of future DV primary prevention interventions that target men as potential perpetrators or the couple as a unit. [ABSTRACT FROM AUTHOR]

The high risk of experiencing domestic violence (DV) among married women in India who reside in slum communities underscores the need for effective, evidence-based, and culturally-tailored primary prevention. To inform such DV primary prevention strategies for this population, we herein aimed to identify correlates of DV experience in early marriage. Utilizing a cross-sectional design, potential correlates of DV experience were explored among a geographically-clustered random sample of 100 recently-married women residing in slums in Pune, India. In multivariable regression, DV experience was associated with less educational attainment by the participant’s spouse (standardized β = -0.281, p = 0.004), less satisfaction of the spouse’s family with the maanpaan (wedding-related gifts provided by the bride’s family) they received at the time of marriage (standardized β = -0.298, p<0.001), poorer conflict negotiation skills (standardized β = -0.308, p<0.001), and greater acknowledgement of DV occurrence in family and friends (standardized β = 0.436, p<0.001). These correlates suggest strategies that could be incorporated into future DV primary prevention interventions for this vulnerable population (i.e. promoting completion of formal education of boys alongside girls, mitigating causes of familial dowry harassment, improving conflict negotiation skills, and challenging norms surrounding DV). [ABSTRACT FROM AUTHOR]

Domestic violence (DV) is prevalent among women in India and has been associated with poor mental and physical health. We performed a systematic review of 137 quantitative studies published in the prior decade that directly evaluated the DV experiences of Indian women to summarise the breadth of recent work and identify gaps in the literature. Among studies surveying at least two forms of abuse, a median 41% of women reported experiencing DV during their lifetime and 30% in the past year. We noted substantial inter-study variance in DV prevalence estimates, attributable in part to different study populations and settings, but also to a lack of standardisation, validation, and cultural adaptation of DV survey instruments. There was paucity of studies evaluating the DV experiences of women over age 50, residing in live-in relationships, same-sex relationships, tribal villages, and of women from the northern regions of India. Additionally, our review highlighted a gap in research evaluating the impact of DV on physical health. We conclude with a research agenda calling for additional qualitative and longitudinal quantitative studies to explore the DV correlates proposed by this quantitative literature to inform the development of a culturally tailored DV scale and prevention strategies. [ABSTRACT FROM AUTHOR]

Domestic violence (DV) is reported by 40% of married women in India and associated with substantial morbidity. An operational research definition is therefore needed to enhance understanding of DV epidemiology in India and inform DV interventions and measures. To arrive at a culturally-tailored definition, we aimed to better understand how definitions provided by the World Health Organization and the 2005 India Protection of Women from Domestic Violence Act match the perceptions of behaviors constituting DV among the Indian community. Between September 2012 and January 2013, 16 key informant interviews with experts in DV and family counseling and 2 gender-concordant focus groups of lay community members were conducted in Pune, India to understand community perceptions of the definition of DV, perpetrators of DV, and examples of DV encountered by married women in Pune, India. Several key themes emerged regarding behaviors and acts constituting DV including 1) the exertion of control over a woman’s reproductive decision-making, mobility, socializing with family and friends, finances, and access to food and nutrition, 2) the widespread acceptance of sexual abuse and the influences of affluence on sexual DV manifestations, 3) the shaping of physical abuse experiences by readily-available tools and the presence of witnesses, 4) psychological abuse for infertility, dowry, and girl-children, and 5) the perpetration of DV by the husband and other members of his family. Findings support the need for a culturally-tailored operational definition that expands on the WHO surveillance definition to inform the development of more effective DV intervention strategies and measures. [ABSTRACT FROM AUTHOR]

CONTEXT: The literature on intimate partner violence in resource-poor contexts relies primarily on cross-sectional studies. Because changes in women's status and empowerment are hypothesized to influence violence vulnerability, longitudinal studies are needed to determine the potential benefits and harms associated with such changes. METHODS: Data were collected prospectively from a representative cohort of 4,749 married women in rural areas of four socially and demographically diverse states in India in 1998-1999 and 2002-2003. A multinomial regression model including social and demographic characteristics and intersurvey changes and events related to functional autonomy and reproduction was fitted to a categorical outcome measuring the absence (reference), initiation, cessation and continuation of intimate partner violence. RESULTS: Continued freedom of movement, increased freedom of movement and continued financial autonomy between baseline and follow-up were associated with a lower risk of violence initiation rather than no violence (relative risk ratio, 0.7 for each). Having a first child was associated with lower risk of violence initiation and continuation rather than no violence (0.6 and 0.2, respectively). Women who reported that their relative economic contribution to the household decreased or increased and women who experienced an unwanted pregnancy had a higher risk of violence continuation rather than no violence (1.8, 1.8 and 1.5, respectively). The death of a child was associated with higher risk of violence initiation rather than no violence (1.4). CONCLUSION: Future research to inform interventions to reduce intimate partner violence should consider how changes in women's reproductive experiences and functional autonomy may be linked to changes in intimate partner violence. [ABSTRACT FROM AUTHOR]

This study examines the association between self-reported frequency of verbal, physical, and sexual intimate partner violence (IPV) and mental health among 6,303 rural married women (age 15-49), in four Indian states: Bihar, Jharkhand, Maharashtra, and Tamil Nadu. Data are taken from the 2002-2003 National Family Health Survey-2 Follow-Up Survey. The results indicate that experiencing physical, verbal, or sexual IPV is associated with an increased risk of adverse mental health outcomes. Our results provide support for the importance of screening for IPV in mental health settings, especially in resource-poor settings where both IPV and mental health are often overlooked. [ABSTRACT FROM AUTHOR]

The role of physical violence during pregnancy on receipt of prenatal care is poorly understood, particularly for South Asian countries that have high levels of both fertility and domestic violence. Data from the 1998/1999 Indian National Family Health Survey and a 2002/2003 follow-up survey that re-interviewed women in four states were analyzed, examining the association between physical violence during pregnancy and the uptake of prenatal care. Women who experienced physical violence during pregnancy were less likely to receive prenatal care, less likely to receive a home-visit from a health worker for a prenatal check-up, less likely to receive at least three prenatal care visits, and less likely to initiate prenatal care early in the pregnancy. This study highlighted the constraining effect that the experience of physical domestic violence during pregnancy had on the uptake of prenatal care for women in rural India. Maternal health services must recognize the unique needs of women experiencing violence from their intimate partners. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between domestic violence and perinatal, neonatal and infant mortality in rural India using prospective data.Methods: The study is based upon a prospective follow-up study of a cohort selected from the 1998-99 National Family and Health Survey-2 (NSFS-2), which was carried out in 2002-03 in four Indian states. Data for a total of 3909 birth outcomes that took place during this 4-year period were analysed using bivariate analysis and hazards regression analysis to control for truncated observations and possible other confounding factors. Findings After controlling for other potentially confounding factors, births to mothers who experienced two or more episodes of recent domestic violence experienced higher perinatal [hazards ratio (HR) = 1.85, 95% confidence interval (CI) = 1.12, 2.79] and neonatal (HR = 1.62, 95% CI = 1.11, 2.53) mortality, relative to births to women whose mothers reported no violence. Overall, these births to women who experienced violence had 68% higher risk of infant mortality compared with the 'no violence' group. Births to women who experienced a single episode of violence were not at higher risk of mortality.Conclusions: Our study provides additional and more conclusive evidence on the importance of domestic violence for early childhood mortality in low-resource settings such as rural India. The results argue for a greater focus upon such violence within current child survival programmes. [ABSTRACT FROM AUTHOR]

This study uses qualitative methods to examine how domestic violence affects the use of contraceptives by women in a rural village in India. The study highlights how multilevel factors are linked to a woman's ability to contracept and make fertility decisions in a context where being a wife implies obedience, limited mobility, sexual availability, and high fertility. The authors find that violence is normalized, or considered acceptable, if women do not adhere to expected gender roles. Although women's ability to make autonomous decisions is shown to be limited, the study explores covert strategies used to avoid pregnancy, which also tend to increase women's risk of experiencing domestic violence. [ABSTRACT FROM AUTHOR]

This study examines the relationship between male-to-female physical domestic violence and unwanted pregnancy among women in three economically and culturally diverse areas of India. A central methodological focus of the study is the examination of retrospective and prospective measures of pregnancy unwantedness, contrasting their usefulness for specifying levels of unwanted pregnancy and its relationship with domestic violence. Data from India's 1998-99 National Family Health Survey and a 2002-03 follow-up survey for which women in four states were reinterviewed are analyzed, and the factors associated with the intersurvey adoption of contraception and the experience of an unwanted pregnancy are examined. Women who experience physical violence from their husbands are significantly less likely to adopt contraception and more likely to experience an unwanted pregnancy. A prospectively measured indicator of unwanted pregnancy identifies a higher prevalence of unwanted pregnancies than do the traditionally employed retrospective measures and is more successful in establishing a relationship between unwanted pregnancies and domestic violence. The results demonstrate a clear relationship between a woman's experience of physical violence from her husband and her ability to achieve her fertility intentions. The need to improve the measurement of pregnancy intendedness is clear, and a move toward using prospective measures as the standard is necessary. [ABSTRACT FROM AUTHOR]

CONTEXT: Although there is increasing recognition of the global scope of domestic violence and the potential reproductive health consequences of violence, little is known about the relationship between physical and sexual domestic violence and gynecologic morbidity in developing country settings. METHODS: A sample of 3,642 couples from northern India was created by matching husbands and wives who responded to the men's and women's surveys of the 1995-1996 PERFORM System of Indicators Survey. The association between men's reports of physical and sexual violence they had perpetrated against their wives and wives' reports of gynecologic symptoms was analyzed in bivariate and multivariate analyses. RESULTS:Overall, 37% of men said they had committed one or more acts of physical or sexual violence against their wives in the past 12 months, with 12% reporting physical violence only, 17% sexual violence only and 9% both physical and sexual violence. Thirty-four percent of women reported at least one symptom of gynecologic morbidity. Compared with women whose husbands reported no violence, those who had experienced both physical and sexual violence and those who had experienced sexual violence only had elevated odds of reporting gynecologic symptoms (odds ratios, 1.7 and 1.4, respectively). CONCLUSIONS: Plausible mechanisms through which domestic violence may influence gynecologic morbidity include physical trauma, psychological stress or transmission of STIs. Reproductive health care that incorporates domestic violence support services is needed to meet the special needs of abused women. [ABSTRACT FROM AUTHOR]

Objective. We examined the effect of physical violence during pregnancy on perinatal and early-childhood mortality. Methods. We estimated the prevalence of domestic violence during pregnancy among a population-based sample of 2199 women in Uttar Pradesh, India. We used a survival regression model to examine the risks for perinatal, neonatal, postneonatal, and early-childhood (aged 1-3 years) mortality by mother's exposure to domestic violence, after we controlled for other sociodemographic and maternal health behavior risk factors. Results. Eighteen percent of the women in our study experienced domestic violence during their last pregnancy. After we adjusted for other risk factors, births among mothers who had experienced domestic violence had risks for perinatal and neonatal mortality that were 2.59 (95% confidence interval [CI] = 1.35, 4.95) and 2.37 (95%CI = 1.21, 4.62) times higher, respectively, than births among mothers who had not experienced violence. We found no significant associations between domestic violence and either postneonatal or early-childhood mortality. Conclusions. Domestic violence is a significant risk factor for perinatal and neonatal mortality. (Am J Public Health. 2006;96:1423-1428. doi10.2105/AJPH.2005.066316) [ABSTRACT FROM AUTHOR]

This study examines the association between domestic violence and the subsequent adoption of modern contraception in North India. Matched data on married couples who were not practicing contraception are analyzed from companion surveys of married husbands and wives in five districts of Uttar Pradesh. By means of hazard modeling, a significant negative association was found between a husband's reporting of using physical domestic violence against his wife and the couple's adoption of a modern method of contraception. Community norms that were more tolerant of domestic violence were, in contrast, not a significant predictor of subsequent method adoption. The results highlight the need to address the issue of support for women experiencing domestic violence within existing family planning services and to sensitize service providers to the specific needs of women experiencing such violence. [ABSTRACT FROM AUTHOR]

Objectives. We examined individual- and community-level influences on domestic violence in Uttar Pradesh, North India. Methods. Multilevel modeling was used to explore domestic violence outcomes among a sample of 4520 married men. Results. Recent physical and sexual domestic violence was associated with the individual-level variables of childlessness, economic pressure, and intergenerational transmission of violence. A community environment of violent crime was associated with elevated risks of both physical and sexual violence. Community-level norms concerning wife beating were significantly related only to physical violence. Conclusions. Important similarities as well as differences were evident in risk factors for physical and sexual domestic violence. Higher socioeconomic status was found to be protective against physical but not sexual violence. Our results provide additional support for the importance of contextual factors in shaping women's risks of physical and sexual violence. (Am J Public Health. 2006;96:132-138.) [ABSTRACT FROM AUTHOR]

Objectives. There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India. Methods. Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. Results. The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities. Conclusions. Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes. (Am J Public Health. 2003;93:1820-1829) [ABSTRACT FROM AUTHOR]

The detrimental impact of short preceding birth intervals on infant and early childhood mortality is well documented in demographic literature, although the pathways of influence within the relationship remain an area of debate. This paper examines the impact of the length of the preceding birth interval on under-two mortality in India, and examines the pathways through which short preceding birth intervals may lead to an increased risk of mortality. Three mortality periods are examined: neonatal, early post neonatal and late post-neonatal and toddler, using the 1992 Indian National Family Health Survey. A multilevel modelling approach is used to account for the hierarchical nature of the data. The determinants of infants following a short or long birth interval are also examined. The results show that short preceding birth intervals (<18 months) are associated with an increased risk of mortality in all three age groups, and the effect is particularly marked in the early post-neonatal period. Significant interactions were found between the length of the preceding birth interval and maternal education, gender and the survival status of the previous child. The significance of these interactions varied with the age of the child. The results highlight the diluting effect that a higher level of maternal education has on the relationship between short preceding birth intervals and mortality risk. There is evidence to suggest that sibling rivalry is a pathway through which short birth intervals influence mortality, with the death of the previous sibling removing the competition for scarce resources, and resulting in lower risks of mortality than if the previous sibling was still alive. The greatest risks of an infant following a short birth interval are among those whose previous sibling died, high parities, those with young mothers, and those whose previous sibling was breastfed for a short duration. [Copyright &y& Elsevier]

This study examines the determinants of the use of four types of reproductive health-care services in Uttar Pradesh, India: contraceptive services, antenatal care, delivery in a medical institution, and services dealing with reproductive tract and sexually transmitted infections. The analysis uses a multilevel modeling strategy to assess the presence of household- and community-level variation in service use. The influence of community-level characteristics and reproductive health-care service attributes on service use is examined. The results highlight strong community-level influences on service use, although the type of community effect varies by service type. The role of some individual and household factors in determining a person's use of services is mediated by the characteristics of the community in which the individual lives. The results demonstrate the need to look beyond individual factors when examining health-care-seeking behavior, and illustrate that there is no singular "community" effect on service use. [ABSTRACT FROM AUTHOR]

This article promotes a more complete understanding of social change by analyzing spatial patterns of contraceptive use in Bangladesh and the contiguous state of West Bengal in India. Multilevel analyses that control for variations in individual- and household-level correlates show an important role for cross-border influences only in those districts that share a common language across the border. The districts that are positive outliers in contraception hug the Bangladesh-West Bengal border. A map of outliers shows that the positive outliers form a contiguous band in a manner suggestive of a role for contagion. [ABSTRACT FROM AUTHOR]

Background: The high global prevalence of intimate partner violence (IPV) and its association with poor physical and mental health underscore the need for effective primary prevention. We previously developed Ghya Bharari Ekatra (GBE), a couples-based primary prevention intervention for IPV among newly married couples residing in slum communities in Pune, India. Objective: Through this pilot study, we aimed to explore the acceptance, safety, feasibility, and preliminary efficacy of GBE. Methods: Between January and May 2018, we enrolled and assigned 20 couples to receive GBE plus information on IPV support services and 20 control couples to receive information on IPV support services alone. The GBE intervention was delivered over 6 weekly sessions to groups of 3 to 5 couples by lay peer educators in the communities in which the participants resided. Intervention components addressed relationship quality, resilience, communication and conflict negotiation, self-esteem, sexual communication and sexual health knowledge, and norms around IPV. Outcome evaluation included exit interviews with participants and peers to examine acceptance and feasibility challenges and baseline and 3-month follow-up interviews to examine change in IPV reporting and mental health (by women) and alcohol misuse (by men). The process evaluation examined dose delivered, dose received, fidelity, recruitment, participation rate, and context. Results: Half (40/83) of the eligible couples approached agreed to participate in the GBE intervention. Retention rates were high (17/20, 85% across all 6 sessions), feedback from exit interviews suggested the content and delivery methods were very well received, and the community was highly supportive of the intervention. The principal feasibility challenge involved recruiting men with the lowest income who were dependent on daily wages. No safety concerns were reported by female participants over the course of the intervention or at the 3-month follow-up. There were no reported physical or sexual IPV events in either group, but there were fewer incidents of psychological abuse in GBE participants (3/17, 18%) versus control participants (4/16, 25%) at 3-month follow-up. There was also significant improvement in the overall mental health of female intervention participants and declines in the control participants (change in mean General Health Questionnaire-12 score: –0.13 in intervention vs 0.13 in controls; P =.10). Conclusions: GBE has high acceptance, feasibility, and preliminary efficacy in preventing IPV and improving mental health among women. Next steps include refining the intervention content based on pilot findings and examining intervention efficacy through a large-scale randomized trial with longer follow-up. Trial Registration: ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134. Clinical Trials Registry of India CTRI/2018/01/011596; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=21443 International Registered Report Identifier (IRRID): RR2-10.2196/11533 JMIR Form Res 2021;5(2):e26130 doi:10.2196/26130 [ABSTRACT FROM AUTHOR]

Background: Maternal anaemia prevalence in Bihar, India remains high despite government mandated iron supplementation targeting pregnant women. Inadequate supply has been identified as a potential barrier to iron and folic acid (IFA) receipt. Our study objective was to examine the government health system's IFA supply and distribution system and identify bottlenecks contributing to insufficient IFA supply.Methods: Primary data collection was conducted in November 2011 and July 2012 across 8 districts in Bihar, India. A cross-sectional, observational, mixed methods approach was utilized. Auxiliary Nurse Midwives were surveyed on current IFA supply and practices. In-depth interviews (n = 59) were conducted with health workers at state, district, block, health sub-centre, and village levels.Results: Overall, 44% of Auxiliary Nurse Midwives were out of IFA stock. Stock levels and supply chain practices varied greatly across districts. Qualitative data revealed specific bottlenecks impacting IFA forecasting, procurement, storage, disposal, lack of personnel, and few training opportunities for key players in the supply chain.Conclusions: Inadequate IFA supply is a major constraint to the IFA supplementation program, the extent of which varies widely across districts. Improvements at all levels of infrastructure, practices, and effective monitoring will be critical to strengthen the IFA supply chain in Bihar. [ABSTRACT FROM AUTHOR]

The high prevalence of domestic violence (DV) among married women in India and associated negative health repercussions highlight the need for effective prevention strategies and tools to measure the efficacy of such interventions. Literature supporting differing manifestations of DV by culture underscores the need for a culturally-tailored scale to more effectively measure DV in the Indian context. We therefore aimed to develop and validate such a tool, the Indian Family Violence and Control Scale (IFVCS), through a mixed-methods study. The psychometric development of IFVCS is herein discussed. After field pre-testing and expert review, a 63-item questionnaire was administered to a random sample of 630 married women from May-July 2013 in Pune, India. The item response theory approach for binary data to explore the IFVCS structure suggested that IFVCS is reliable, with the majority of items having high (>0.5) and significant factor loadings. Concurrent validity, assessed by comparing responses to IFVCS with the validated, abridged Conflict Tactics Scale-2, was high (r = 0.899, p<0.001) as was the construct validity, demonstrated by its significant association with several established DV correlates. Therefore, initial assessment of the IFVCS psychometric properties suggests that it is an effective tool for measuring DV among married women in India and speaks to its capacity for enhancing understanding of DV epidemiology and for evaluating the effectiveness of future DV interventions.

Background: In Bihar, India, high maternal anemia prevalence and low iron and folic acid supplement (IFA) receipt and consumption have continued over time despite universal IFA distribution and counseling during pregnancy., Purpose: To examine individual and facility-level determinants of IFA receipt and consumption among pregnant women in rural Bihar, India., Methods: Using District Level Household Survey (2007-08) data, multilevel modeling was conducted to examine the determinants of two outcomes: IFA receipt (any IFA receipt vs. none) and IFA consumption (≥90 days vs. <90 days). Individual-level and facility-level factors were included. Factor analysis was utilized to construct antenatal care (ANC) quality and health sub-center (HSC) capacity variables., Results: Overall, 37% of women received any IFA during their last pregnancy. Of those, 24% consumed IFA for 90 or more days. Women were more likely to receive any IFA when they received additional ANC services and counseling, and attended ANC earlier and more frequently. Significant interactions were found between ANC quality factors (odds ratio (OR): 0.37, 95% confidence interval (CI): 0.25, 0.56) and between ANC services and ANC timing and frequency (OR: 0.68, 95% CI: 0.56, 0.82). No HSC factors were significantly associated with IFA receipt. Women were more likely to consume IFA for ≥90 days if they attended at least 4 ANC check-ups and received more ANC services. IFA supply at the HSC (OR: 1.37, 95% CI: 1.04, 1.82) was also significantly associated with IFA consumption., Conclusions: Our findings indicate that individual and ANC factors (timing, frequency, and quality) play a key role in facilitating IFA receipt and consumption. Although HSC capacity factors were not found to influence our outcomes, significant variation at the facility level indicates unmeasured factors that could be important to address in future interventions.

Objective: To assess the association of 3 types of intimate partner violence (IPV)-verbal, physical, and sexual-with self-reported symptoms of reproductive tract infections (RTIs) among married Indian women., Methods: A cross-sectional analysis of population-based data from the 2005-2006 Indian National Family Health Survey-3 was conducted. The sample comprised 65610 married Indian women of reproductive age (15-49years)., Results: Overall, 23.9% of women experienced at least 1 type of IPV, and 9.6% reported at least 1 RTI symptom in the year preceding the survey. Verbal, physical, and sexual IPV each demonstrated a significant independent effect on the reporting of genital sores and abnormal genital discharge. Additionally, the more types of IPV a woman experienced, the higher her odds of also reporting genital sores and abnormal genital discharge., Conclusion: No single type of IPV explains women's risk of RTIs; rather, there are multiple pathways by which women's experience of IPV can result in RTIs. Sexual and reproductive healthcare that incorporates IPV support services is needed to meet the special needs of abused women. Additionally, RTI screening should be considered by non-governmental organizations providing care for women who have experienced IPV, especially those who report multiple types of violence., (Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Women in a small coastal village in western India were asked to explain their preference for female sterilization over modern reversible contraceptive methods. Married women aged 19+ years were interviewed in six focus groups (n=60) and individually (n=15) regarding contraceptive methods and their use and side-effects. Women publicly denied contraceptive use but privately acknowledged limited use. They obtained contraceptive information from other village women and believed that modem reversible methods and vasectomy have high physical and social risks, and fertility goals could be achieved without their use. Women felt that reversible contraception is undesirable, socially unacceptable, and usually unnecessary, although the achievement of fertility goals is likely due to the use of female sterilization with abortion as a back-up method. Economic migration of village men may also play a role. Although women with high social capital can effectively disseminate correct knowledge, the impact on the uptake of reversible method is uncertain.

This paper examined the influence of religion on the adoption of female sterilization, using data from the 1992/93 Indian National Family Health Survey. The influence of religion at both individual and district levels was examined, and a multi-level modelling methodology was used for assessing community variations in the influence of religion on the adoption of sterilization. Individual religion was a strong predictor of the decision to adopt sterilization, and residence in a district in which more than 20% of the people were Muslims significantly lowered the odds of adoption of sterilization. There was more variation in the adoption of sterilization between districts for Muslim women and women from minority religious groups. The results demonstrate the influence of community conservatism on the choice of contraceptive methods and point to the mediating effects that community characteristics can have on access to sterilization services for women from religious minority sub-groups.

This paper examines the impact of 'low' levels of maternal education on the proximate determinants of child mortality using data from the 1992/93 Indian National Family Health Survey. Twenty-two outcomes are investigated, representing child mortality and morbidity, illness management, service utilization and health behaviours. Maternal education is a significant correlate of each of the outcomes, and even low levels of education increase child survival prospects and health-related behaviours, except for neonatal mortality and the effective management of diarrhoea. We speculate on some of the possible mechanisms behind such impressive findings and suggest that rather than female autonomy, it may be the 'hidden curriculum' values of discipline and obedience of authority that account for them.

This paper examines the impact of rural-urban migration on under-two mortality in India, using data from the 1992/93 Indian National Family Health Survey. Multilevel logistic models are fitted for mortality in three age groups: neonatal, early post-neonatal, and late post-neonatal and toddler. Migration status was not a significant determinant of mortality in any of the three age groups. Further analysis shows that a relationship between migration status and mortality exists when socioeconomic and health utilization variables are omitted from the models. The relationship between migration and mortality is thus explained by differences in socioeconomic status and use of health services between rural-urban migrant and nonmigrant groups. The selectivity of rural-urban migrants on socioeconomic characteristics creates mortality differentials between rural-urban migrants and rural non-migrants. Problems faced by migrants in assimilating into urban societies create mortality differentials between rural-urban migrants and urban non-migrants. These results highlight the need to target migrants in the provision of health services, and demonstrate that rural areas continue to have the highest levels of infant-child mortality. Further research is needed to understand the health care needs of rural-urban migrants in order to inform the provision of appropriate health care.

We set out to explore the influence of environment on ethnic inequalities in health. Studies exploring the relationship between environment and health have tended to ignore the role of ethnicity, and the health impact of the residential concentration of ethnic minority groups in disadvantaged areas. Those that have explored the role of ethnicity tend to focus on the way in which residential concentration may promote a sense of community among ethnic minority groups, and, consequently, may be protective of health (the 'ethnic density effect'). Again, they have tended to ignore the health impact of the concentration of ethnic minority groups in areas of social and economic disadvantage. We undertook a factor analysis to determine aspects of perception of 'quality' of the local environment, followed by multi-level analyses to explore the relationship between self-reported fair or poor health and individual- and ward-level characteristics among four ethnic groups (Caribbean, Indian, Pakistani and Bangladeshi, and white) in the UK. Results of the factor analysis suggested three underlying dimensions of perception of quality of the local area, related to the quality of the local environment, the provision of local amenities and local problems of crime and nuisance. These factors were entered into the multi-level models at level 2, along with indicators of ward-level ethnic density and Townsend's deprivation score, with age, gender and household social class entered at level 1. In general, there was a residual random ward-level effect suggesting an area influence on self-assessed health. However, on the whole, none of the ward-level indicators showed any statistically significant association with self-assessed health, making it difficult to precisely determine the mechanisms operating. These findings suggest, though, that there is no ethnic density effect on self-assessed health for ethnic minority groups.