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Undesired and unintended pregnancies increase unwanted births or induced abortions, consequently increasing maternal morbidity and mortality. Postpartum insertion of the intra uterine contraceptive device (PPIUCD) is an effective method for population control. The researchers conducted the study to assess the determinants of PPIUCD services by identifying beneficiaries and healthcare workers' perceptions. We conducted this study in Maharashtra state, India having five geographical divisions and 36 districts. The researchers visited 10 primary health centers and three community health Centers from five districts, randomly selecting one from each division. We interviewed 45 women who had undergone insertion one day to one year prior and 17 health care workers. About one-third of women received counseling during pregnancy. The medical officers obtained the consents mostly during delivery. They inserted about 85% of devices within one hour of delivery. About 38% of women had at least one complication. Lower abdominal pain (22.22%), irregular bleeding (20.00%), the expulsion of CuT (13.33%), pain during periods (13.33%) were common. The removal rate was 6.67%. The complication rates observed in the present study are comparable to the hospital studies. Thus, the study reassures that the services in small institutions are very safe, and governments can fearlessly implement the program.

Background: In India the proportion of early initiation of breastfeeding is hovering around 50% and the proportion of cesarean deliveries is increasing substantially. Objectives: To compare the prevalence of early initiation of breastfeeding (EIBF) among cesarean and vaginally delivered women in hospitals in Pune District, Maharashtra State, India and to measure any association between EIBF and various socio-demographic, maternal and fetal factors. Methods: This was a multi-site study conducted in 13 selected hospitals in Pune District in 2017-18. Pune District by population is the fourth largest in India. All women delivered by cesarean section in these hospitals and an equal number of age and parity matched vaginally delivered women were enrolled. They were interviewed before discharge by obstetricians or nurses under the supervision of obstetricians, using a structured, validated tool. The data were analyzed by using Statistical Package for Social Sciences, version 25. Results: In each group, 1,556 women were enrolled. The prevalence of EIBF was 81.5% and 63.6% among vaginally and cesarean delivered women. There was a significant association between EIBF and the place of residence, mode of delivery, gestational period, parity, and presence of some disease. Residence in the rural area was the strongest enabling factor with an adjusted odds ratio of 29.6 (95% C.I.; 18.7-46.9) whereas cesarean section, preterm delivery and first para were impeding factors. Conclusions: Among institutional delivered women EIBF was about 70%. Health care workers need to strongly promote EIBF awareness, especially among women from urban areas, and undergoing cesarean section.

Context: Many women have postpartum sexual dysfunction. The mode of delivery is an important determinant. Aims: To calculate the risk ratio of non-resumption of vaginal sex and dyspareunia during the postpartum period among cesarean-delivered women. Settings and Design: This large multisite study was conducted in 13 selected hospitals in Pune District during 2017–19. Methods and Material: A total of 3,112 women (half cesarean delivered and half vaginally) were interviewed by trained health workers using a structured questionnaire. Women were interviewed at 4 weeks, 6 weeks, and 6 months. Statistical analysis used: Chi-square test was applied. A risk ratio with a 95% confidence interval was calculated. Results: At 6 weeks, the risk ratio of non-resumption of vaginal sex was significantly high among cesarean-delivered participants (1.14). Cesarean-delivered women had a lesser risk ratio of dyspareunia at both follow-ups (0.59, 0.49). Even at 6 months, about one-third vaginally delivered women had dyspareunia. The proportion of women non-resuming vaginal sex gradually decreased from 6 weeks to 6 months. The proportion of women having dyspareunia also decreased from 6 weeks to 6 months following childbirth. Residence in the rural area and cesarean delivery were the significant determinants of an early resumption of vaginal sex. Dyspareunia was significantly high among vaginal delivered than cesarean. About 25% of women continued to have dyspareunia up to 6 months. Conclusions: A large number of women suffer from dyspareunia; hence antenatal and postnatal care should include some counseling and management about the resumption of sex and dyspareunia.

Background Health of women during preconception phase though critical is comparatively ignored period in her life cycle. Presence of health risks are judged as hazardous to well-being of women and her forthcoming progeny. The objective of the study was to measure the prevalence of health risks and its comparison between blocks.Methods A cross sectional study was conducted in two tribal and two non-tribal blocks in Nasik district, Maharashtra, India. Currently married women desiring conception within one year were included as study participants. Sample size was estimated to be 6,951. Data was collected by trained Accredited Social Health Activists using validated interview schedule. Anthropometric measures of women were recorded in standard manner. Body Mass Index criteria were used to assess the nutritional status.Results Mean age of women was 23.19 ± 3.71 years and 16% of them were adolescents. Illiteracy rate was higher in tribal than non-tribal women. Commonest reported occupation was farming. Despite being high parity and gravida status more tribal women desired pregnancy. Substance abuse was high among tribal women. Majority of women consumed meal with family members or with husband. Although 35% of women had low consumption of protein and calorie, yet most of them perceived to have abundant food.Conclusion Health risks namely younger age, illiteracy, farming with moderate to high-intensity work, high parity, low consumption of protein and calories and undernutrition were found to be prevalent and the risks were significantly more among tribal women. “Continuum of care” must include preconception care.

Background: Timely administration of vaccines, particularly for hepatitis B birth dose within 24 hours of birth is of immense importance. It is considered as an indicator of quality of immunization programme. This study aimed to assess effect of mode of delivery and type of hospital on immunization among newborns. Methods: This large multi-site study was conducted in Pune district having population of 9.43 million. A total of 13 hospitals were selected which included all government hospitals performing more than five cesarean sections per month, and one government and one private medical college hospital. Cesarean section and vaginally deliveries were enrolled in 1:1 ratio. Their children were followed till discharge. Data were collected by obstetrician or qualified nurse.Results: During study period 3,112 women were enrolled. The relative risk of not getting vaccine Hepatitis B birth dose before 24 hours among cesarean delivered newoborns was 1.08. The relative risk of not getting zero polio and BCG among cesarean delivered newborns was 0.71 and 0.76 respectively. All these differences were significant. The coverage for all vaccines was better in sub district hospitals than others. Coverage of all vaccines in government teaching hospital was better than private.Conclusions: Cesarean section enabled better coverage among newborns probably due to length of stay. Whereas the physical and mental stress after cesarean section resulted lesser coverage of hepatitis B birth dose within 24 hours. Opportunities of timely Hepatitis B birth dose administration were missed probably due to lack of knowledge among health workers about ideal timing.

Background According to WHO estimates, 35% of global measles deaths in 2011 occurred in India. In 2013, India committed to a goal of measles elimination by 2020. Laboratory supported case based measles surveillance is an essential component of measles elimination strategies. Results from a case-based measles surveillance system in Pune district (November 2009 through December 2011) are reported here with wider implications for measles elimination efforts in India. Methods Standard protocols were followed for case identification, investigation and classification. Suspected measles cases were confirmed through serology (IgM) or epidemiological linkage or clinical presentation. Data regarding age, sex, vaccination status were collected and annualized incidence rates for measles and rubella cases calculated. Results Of the 1011 suspected measles cases reported to the surveillance system, 76% were confirmed measles, 6% were confirmed rubella, and 17% were non-measles, non-rubella cases. Of the confirmed measles cases, 95% were less than 15 years of age. Annual measles incidence rate was more than 250 per million persons and nearly half were associated with outbreaks. Thirty-nine per cent of the confirmed measles cases were vaccinated with one dose of measles vaccine (MCV1). Conclusion Surveillance demonstrated high measles incidence and frequent outbreaks in Pune where MCV1 coverage in infants was above 90%. Results indicate that even high coverage with a single dose of measles vaccine was insufficient to provide population protection and prevent measles outbreaks. An effective measles and rubella surveillance system provides essential information to plan, implement and evaluate measles immunization strategies and monitor progress towards measles elimination.