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Low-and-middle-income countries (LMICs) bear a high burden of intimate partner violence (IPV). However, there are no reviews assimilating the factors affecting risk of IPV in LMICs. This systematic review (2010–20) identifies risk and protective factors of IPV in LMICs. We followed the PRISMA guidelines to review 399 studies and included 32 studies. Studies were of ever-partnered women living in an LMIC, aged 15 years and above, who had ever faced IPV from a male partner. Disaggregating factors using the ecological framework, we found that women less than 45 years of age face increased risk of IPV. Secondary and higher education levels of men lower the risk. Both employment and unemployment of women increase the risk. Male partner's dependence on alcohol or substances increases the risk. Prior exposure to abuse of either partner increases risk of IPV. Similarly, justification of wife-beating by any partner increases risk. Intimate relations which are more gender-equal experience lowered risk. Women who have no children, stay in smaller-sized families and reside in rural areas, face lower risks. The review found that risk factors outnumber protective factors. Protective factors are much more context-dependent, while risk factors are more universalizable for the LMIC world. [ABSTRACT FROM AUTHOR]

especially in medical ethics. It is important to understand this relation from the perspectives of all stakeholders. This article derives from a qualitative study conducted across six obstetric care providing institutions in the cities of Mumbai and Navi Mumbai, India, over a period of 10 months. Thirty obstetricians were interviewed in-depth to understand what they perceived as the most important aspect in developing a good provider-patient relationship. The study found that while most providers highlighted the point of communication as the most critical part of the provider-patient relationship, they admitted that they could not engage in communication with the patients for various reasons. Obstetric consultants and residents said that they were too overburdened to spend time communicating with patients; providers working in public hospitals added that the lack of education of their patients posed a hindrance in effective communication. However, providers practicing in private institutions explained that they faced a challenge in communicating with patients because their patients came from educated families who tended to trust the provider less and were generally more critical of the provider's clinical judgement. The article shows how provider-patient communication exists as an idea among medical providers but is absent in daily clinical practice. This gives rise to a discourse shaped around an absence. The authors conclude by decoding the term 'communication' - they read the word against the context of its use in the interviews, and argue that for the providers 'communication' was not intended to be a trope towards setting up a dialogue-based, egalitarian provider-patient relationship. Providers used the word in lieu of 'counselling', 'guiding', 'talking to'. It concludes that, despite the providers' insisting on the significance of communication and complaining about its absence, what they desired in reality was not the possibility of a dialogue with the patient or a chance to be able to share decision-making power with the patient, but to be able to provide better instructions and chart out what was best for them in a more detailed way. [ABSTRACT FROM AUTHOR]

Background: India's caesarean delivery (CD) rate of 21.5% suggests adequate national access to CD but may mask significant disparities. We examined variation in CD rates across states (geography), wealth, and health care sector (public versus private). We also aimed to determine relative inequality in CD rates across wealth quintiles., Methods: The current study was a cross-sectional analysis of CD rates from the National Family Health Survey-5 (2019-2021) disaggregated by asset-based household wealth quintiles for each state and by healthcare sector (public versus private). Data from 724,115 women aged 15-49 years across 28 states and eight union territories were analysed. Women who reported their most recent live birth within the past five years were included. Relative inequality was measured by comparing CD rates in the richest versus the poorest quintiles., Findings: Disaggregating the national CD rate of 21.5% showed substantial variation in CD rate across states, ranging from 5.2% in Nagaland to 60.7% in Telangana and across wealth quintiles, ranging from 0% to 76.7% (Assam). CD facility rates were higher in private than public facilities across all wealth quintiles. Over two-thirds of states (69%) had at least twice the CD rate in the richest wealth quintile versus the poorest quintile. Relative inequality in CD rates between the richest and poorest was 5.3 nationally and was higher in public (4.0) versus private (1.4) facilities., Interpretation: The national CD rate in India masks complex geographical, wealth, and sector-related inequalities in CD utilisation. Accounting for these variations is imperative when interpreting national-level rates to better assess the equity in the distribution of CD services., Funding: None., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s).)

This piece critically reflects on the growing Indian desire for fairer shades of skin. While skin-whitening products vanish off store shelves, notwithstanding protests against such products, the event that generated a storm some time ago in the media was the Garbha Sanskar workshops. In these workshops, women were allegedly taught methods to purify their wombs and beget fairer (and taller) children. In this article I argue that not only is it simplistic to label this ideology regressive, but that it becomes rather difficult to criticise the sanskaris because of the "register" they employ, ie the language they use to rationalise and explain their actions. The sanskaris use the rhetoric of modern medical science to justify their methods, while the same science tells us that their logic is not scientific; consequently, we are stranded between a paradox and a dead-end. A step-wise, critical look at this discourse reveals how complex its nature is, especially its attempt to lay simultaneous claims to different (and contradictory) epistemologies. I offer no easy solution, for there is none. I map some of the complexities and contradictions of the scenario as a first step.