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ObjectivesEfforts to understand the factors influencing the uptake of reproductive, maternal, newborn, child health and nutrition (RMNCH&N) services in high disease burden low-resource settings have often focused on face-to-face surveys or direct observations of service delivery. Increasing access to mobile phones has led to growing interest in phone surveys as a rapid, low-cost alternatives to face-to-face surveys. We assess determinants of RMNCH&N knowledge among pregnant women with access to phones and examine the reliability of alternative modalities of survey delivery.ParticipantsWomen 5–7 months pregnant with access to a phone.SettingFour districts of Madhya Pradesh, India.DesignCross-sectional surveys administered face-to-face and within 2 weeks, the same surveys were repeated among two random subsamples of the original sample: face-to-face (n=205) and caller-attended telephone interviews (n=375). Bivariate analyses, multivariable linear regression, and prevalence and bias-adjusted kappa scores are presented.ResultsKnowledge scores were low across domains: 52% for maternal nutrition and pregnancy danger signs, 58% for family planning, 47% for essential newborn care, 56% infant and young child feeding, and 58% for infant and young child care. Higher knowledge (≥1 composite score) was associated with older age; higher levels of education and literacy; living in a nuclear family; primary health decision-making; greater attendance in antenatal care and satisfaction with accredited social health activist services. Survey questions had low inter-rater and intermodal reliability (kappaConclusionsPhone surveys are a reliable modality for generating population-level estimates data about pregnant women’s knowledge, however, should not be used for individual-level tracking.Trial registration numberNCT03576157.

IntroductionMobile Vaani was implemented as a pilot programme across six blocks of Nalanda district in Bihar state, India to increase knowledge of rural women who were members of self-help groups on proper nutrition for pregnant or lactating mothers and infants, family planning and diarrhoea management. Conveners of self-help group meetings, community mobilisers, introduced women to the intervention by giving them access to interactive voice response informational and motivational content. A mixed methods outcome and embedded process evaluation was commissioned to assess the reach and impact of Mobile Vaani.MethodsThe outcome evaluation, conducted from January 2017 to November 2018, used a quasi-experimental pre–post design with a sample of 4800 married women aged 15–49 from self-help group households, who had a live birth in the past 24 months. Surveys with community mobilisers followed by meeting observations (n=116), in-depth interviews (n=180) with self-help group members and secondary analyses of system generated data were conducted to assess exposure and perceptions of the intervention.ResultsFrom the outcome evaluation, 23% of women interviewed had heard about Mobile Vaani. Women in the intervention arm had significantly higher knowledge than women in the comparison arm for two of seven focus outcomes: knowledge of how to make child’s food nutrient and energy dense (treatment-on-treated: 18.8% (95% CI 0.4% to 37.2%, pConclusionLow population awareness and programme exposure are underpinned by broader population level barriers to mobile phone access and use among women and missed opportunities by the programme to improve targeting and programme promotion. Further research is needed to assess programmatic linkages with changes in health practices.

Introduction Millions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children

This paper examines the intergenerational transmission of gender attitudes in India, a setting with severe discrimination against women and girls. We use survey data on gender attitudes (specifically, about the appropriate roles and rights of women and girls) collected from nearly 5500 adolescents attending 314 schools in the state of Haryana, and their parents. We find that when a parent holds a more discriminatory attitude, his or her child is about 11 percentage points more likely to hold the view. We find that parents hold greater sway over students’ gender attitudes than their peers do, and that mothers influence children’s gender attitudes more than fathers. Parental attitudes influence child attitudes more in Scheduled Caste communities and student gender attitudes are positively correlated with behaviours such as interacting with children of the opposite gender.

Tarun Jain.September, 2020.Reshaping adolescents' gender attitudes,Report,Indian Institute of Management Ahmedabad

BackgroundThe disruptive potential of mobile phones in catalyzing development is increasingly being recognized. However, numerous gaps remain in access to phones and their influence on health care utilization. In this cross-sectional study from India, we assess the gaps in women's access to phones, their influencing factors, and their influence on health care utilization.MethodsData drawn from the 2015 National Family Health Survey (NFHS) in India included a national sample of 45,231 women with data on phone access. Survey design weighted estimates of household phone ownership and women's access among different population sub-groups are presented. Multilevel logistic models explored the association of phone access with a wide range of maternal and child health indicators. Blinder-Oaxaca (BO) decomposition is used to decompose the gaps between women with and without phone access in health care utilization into components explained by background characteristics influencing phone access (endowments) and unexplained components (coefficients), potentially attributable to phone access itself.FindingsPhone ownership at the household level was 92·8% (95% CI: 92·6-93·0%), with rural ownership at 91·1% (90·8-91·4%) and urban at 97.1% (96·7-97·3%). Women's access to phones was 47·8% (46·7-48·8%); 41·6% in rural areas (40·5-42·6%) and 62·7% (60·4-64·8%) in urban. Phone access in urban areas was positively associated with skilled birth attendance, postnatal care and use of modern contraceptives and negatively associated with early antenatal care. Phone access was not associated with improvements in utilization indicators in rural settings. Phone access (coefficient components) explained large gaps in the use of modern contraceptives, moderate gaps in postnatal care and early antenatal care, and smaller differences in the use of skilled birth attendance and immunization. For full antenatal car, phone access was associated with reducing gaps in utilization.InterpretationWomen of reproductive age have significantly lower phone access use than the households they belong to and marginalized women have the least phone access. Existing phone access for rural women did not improve their health care utilization but was associated with greater utilization for urban women. Without addressing these biases, digital health programs may be at risk of worsening existing health inequities.

Background Respectful maternity care (RMC) is a key barometer of the underlying quality of care women receive during pregnancy and childbirth. Efforts to measure RMC have largely been qualitative, although validated quantitative tools are emerging. Available tools have been limited to the measurement of RMC during childbirth and confined to observational and face-to-face survey modes. Phone surveys are less invasive, low cost, and rapid alternatives to traditional face-to-face methods, yet little is known about their validity and reliability. Objective The primary objective of this study was to develop validated face-to-face and phone survey tools for measuring RMC during pregnancy and childbirth for use in India and other low resource settings. The secondary objective was to optimize strategies for improving the delivery of phone surveys for use in measuring RMC. Methods To develop face-to-face and phone surveys for measuring RMC, we describe procedures for assessing content, criterion, and construct validity as well as reliability analyses. To optimize the delivery of phone surveys, we outline plans for substudies, which aim to assess the effect of survey modality, and content on survey response, completion, and attrition rates. Results Data collection will be carried out in 4 districts of Madhya Pradesh, India, from July 2018 to March 2019. Conclusions To our knowledge, this is the first RMC phone survey tool developed for India, which may provide an opportunity for the rapid, routine collection of data essential for improving the quality of care during pregnancy and childbirth. Elsewhere, phone survey tools are emerging; however, efforts to develop these surveys are often not inclusive of rigorous pretesting activities essential for ensuring quality data, including cognitive, reliability, and validity testing. In the absence of these activities, emerging data could overestimate or underestimate the burden of disease and health care practices under assessment. In the context of RMC, poor quality data could have adverse consequences including the naming and shaming of providers. By outlining a blueprint of the minimum activities required to generate reliable and valid survey tools, we hope to improve efforts to develop and deploy face-to-face and phone surveys in the health sector. International Registered Report Identifier (IRRID) DERR1-10.2196/12173

BACKGROUND Respectful maternity care (RMC) is a key barometer of the underlying quality of care women receive during pregnancy and childbirth. Efforts to measure RMC have largely been qualitative, although validated quantitative tools are emerging. Available tools have been limited to the measurement of RMC during childbirth and confined to observational and face-to-face survey modes. Phone surveys are less invasive, low cost, and rapid alternatives to traditional face-to-face methods, yet little is known about their validity and reliability. OBJECTIVE The primary objective of this study was to develop validated face-to-face and phone survey tools for measuring RMC during pregnancy and childbirth for use in India and other low resource settings. The secondary objective was to optimize strategies for improving the delivery of phone surveys for use in measuring RMC. METHODS To develop face-to-face and phone surveys for measuring RMC, we describe procedures for assessing content, criterion, and construct validity as well as reliability analyses. To optimize the delivery of phone surveys, we outline plans for substudies, which aim to assess the effect of survey modality, and content on survey response, completion, and attrition rates. RESULTS Data collection will be carried out in 4 districts of Madhya Pradesh, India, from July 2018 to March 2019. CONCLUSIONS To our knowledge, this is the first RMC phone survey tool developed for India, which may provide an opportunity for the rapid, routine collection of data essential for improving the quality of care during pregnancy and childbirth. Elsewhere, phone survey tools are emerging; however, efforts to develop these surveys are often not inclusive of rigorous pretesting activities essential for ensuring quality data, including cognitive, reliability, and validity testing. In the absence of these activities, emerging data could overestimate or underestimate the burden of disease and health care practices under assessment. In the context of RMC, poor quality data could have adverse consequences including the naming and shaming of providers. By outlining a blueprint of the minimum activities required to generate reliable and valid survey tools, we hope to improve efforts to develop and deploy face-to-face and phone surveys in the health sector. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12173

This paper examines the intergenerational transmission of gender attitudes in India, a setting with severe discrimination against women and girls. We use survey data on gender attitudes (specifically, about the appropriate roles and rights of women and girls) collected from nearly 5500 adolescents attending 314 schools in the state of Haryana, and their parents. We find that when a parent holds a more discriminatory attitude, his or her child is about 11 percentage points more likely to hold the view. We find that parents hold greater sway over students’ gender attitudes than their peers do, and that mothers influence children’s gender attitudes more than fathers. Parental attitudes influence child attitudes more in Scheduled Caste communities and student gender attitudes are positively correlated with behaviours such as interacting with children of the opposite gender.

This paper examines the intergenerational transmission of gender attitudes in India, a setting where discrimination against women and girls is severe. We use survey data on gender attitudes (specifically, views about the appropriate roles and rights of women and girls) collected from adolescents attending 314 schools in the state of Haryana, and their parents. We find that when a parent holds a more discriminatory attitude, his or her child is about 15 to 20 percentage points more likely to hold the view. As a benchmark, classmates' average gender attitudes have a similar effect size. We find that mothers influence children's gender attitudes more than fathers do. Parental attitudes also affect their children's aspirations; girls with more discriminatory parents are less likely to want to continue their schooling beyond high school.

The major markets for Indian RMG products are United States, European Union, Canada, United Arab Emirates, and Australia. With the phaseout of the MFA in 2005, Indian exporters performed better than competitors from most countries to make significant inroads in the U.S. and EU markets. In 2005, RMG exports from India to the United States and to the European Union, two markets that account for over 70 percent of Indian textile and clothing exports, grew at 34.2 percent and 30.6 percent respectively (refer to Table 4.2). India’s share of the global apparel market stands at 4 percent, and it is the best performer in South Asia post-MFA (Table 2.3). The market indications and trends are positive and very much in favor of India being recognized as a manufacturing hub for apparels, especially in the higher value-added segment.

The textile industry in general and garments, as the most labor-intensive sector, have been the road taken by most countries in their path to manufacturing and industrialization.1 This was the case with the currendy high-income countries (HICs), and the trend continued with Japan and East and South East Asia. This chapter will start with a discussion of the rise of textile and clothing industries in the latter regions. Historically, as some nations lost comparative advantage due to rising unit labor costs, other countries, in a flying geese pattern, assumed the competitive mantle, and these have more recendy included China, Vietnam, and Cambodia.2 The second section of this chapter briefly narrates this changing pattern of comparative advantage.

At the beginning of the study, following the procedure oudined in chapter 1, two products from the RMG sector were selected for Nepal, based on the criteria of high export growth rate and high volume of exports.1 As in the chapters on other countries in this volume, the original study plan here too was to delve into processes, including linkages and partnerships, to explain the reason for the export success of these two products. However, preliminary fieldwork indicated a dramatically different situation on the ground relative to the trend indicated by the secondary UN data over the past decade (1994–2003).2 With the phaseout of the quota system under the MFA, the RMG sector was unraveling in Nepal. Only 99 garment factories remained registered in 2006, compared to a peak of 234 in 1990–1991, out of which barely 25 were operational. The share of RMG sector in exports had also declined from over 25 percent throughout the 1990s to about 10 percent in 2005- The RMG sector could not be characterized as a “success,” as will be explained in this chapter.

This book has sought to explore the processes that explain the export success and the state of the RM G sector in South Asia, such as industrial policy; business, structural, and institutional factors; and various forms of linkages and partnerships including backward and forward (induced by industrial policy or spontaneous), public-private, domestic-foreign (in a value chain context), South-South, and intracluster or intrasector. While South Asian countries have, in keeping with the prediction of mainstream trade theory, specialized in this sector given their advantage in cheap labor and also in some cases the availability of raw materials, we sought to go beyond “what” (countries specialize in) to “why” (they select particular products), but more important “how” (this works in practice).

The RMG sector has been one of the most important sectors in Pakistan’s textile industry. Spurred by the MFA quota allocation system (refer to endnote 10), the garment sector emerged in the late 1970s and expanded rapidly (Annexure 2.1). It constituted 8.3 percent of total exports in 2005–2006. At the beginning of the MFA phaseout on January 1, 2005, Pakistan’s share was 1 percent of the global apparel market.1

The RMG sector represents the manufacturing export success story of Bangladesh and, indeed, of South Asia (see Annexure 2.1).1 It accounted for 3 percent of GDP in 1991, and this share dramatically increased to 13 percent by 2006.2 This sector has occupied a dominant position among manufactured exports since 1988, when it overtook the traditionally flourishing jute exports. During 1983–1984, the RMG sectors share of total exports was 3.89 percent, whereas by 2006–2007, it had grown to 76.04 percent.3 In 2006, the RMG sector provided direct employment for 2 million workers (about 90 percent of whom were female), and the apparel supporting industry employed 0.8 million workers. This was about 3.6 percent of the total labor force.5

Neoclassical economic trade theory suggests that countries, on an aggregate level, specialize in products that are consistent with their particular advantages; this book suggests that the predictions of this theory are broadly borne out.1 However, this theory is cast on a very aggregate level for sectors such as textiles and steel and the theory provides litde guidance on process.2 Thus, there is little one learns from this theory about business, structural, and institutional practices that make a particular country more successful than others even if their broad comparative advantage is similar. Similarly, one learns little about the various forms of critical linkages or partnerships, backward and forward (induced by industrial policy or spontaneous), public-private, domestic-foreign (in a value chain context), South-South, and intracluster or intrasector, that result in export success.3 In a nutshell, with reference to products, existing trade theory focuses on the “what” while this book focuses on the “how” and in some cases addresses the “why.”

As in the other South Asian countries we studied, in Sri Lanka too, the textile and garment industry has played, and continues to play, a significant role in the economy. Kelegama (2005, pp. 51–53) reported that by the 1990s, garments had replaced tea as the country’s highest foreign exchange earner. By 2002, textiles and garments, predominandy the latter, accounted for “6 percent of GDP, 39 percent of industrial production, 33 percent of manufacturing employment,1 52 percent of total exports, and 67 percent of industrial exports.” As is the case with other South Asian economies, with the phasing out of the MFA on January 1, 2005, the Sri Lankan economy, highly reliant on RMG exports, has become vulnerable to the changing global circumstances affecting the RMG sector. In such a trade milieu, strengthening the competitiveness of the garment sector and addressing various constraints have become critical, and we address this issue in this chapter.