ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

Reproductive HealthSubscribe to Reproductive Health

Infant Mortality Rate

Infant mortality rate has been improving in India for a considerable time now. From 2009 to 2018, India has improved the IMR from 50 to 32. This article aims to understand the underlying improvement in the IMR at the state level and establish whether there is convergence. For this exercise, the article uses health inequality measures like standard deviation, coeffi cient of variation, rate of improvement differences, β convergence and Gini coeffi cient. The fi ndings reveal that all states show improvement in IMR over 10 years, but the rate of improvement is varying amongst state and there is no convergence amongst the states. Small states and union territories improve the IMR at a higher rate compared to that of the national improvement rate.

Regulating Reproductive Technologies

The Assisted Reproductive Technology (Regulation) Bill, 2020 was tabled in the Lok Sabha in September 2020. It was referred to the department-related Parliamentary Standing Committee on Health and Family Welfare, which submitted its 129th report on the ART Bill, 2020 on 17 March 2021. This article critically engages with the recommendations of this report.

Too Much Care

In the context of India where public expenditure on healthcare is low, the private sector plays an important role in delivering healthcare during childbirth. An analysis of the latest round of National Family Health Survey data to estimate the differential probability of caesarean sections in private medical facilities relative to government facilities, and focusing on unplanned C-sections, reveals that the probability of an unplanned C-section is 13.5–14 percentage points higher in the private sector. These results call for a critical assessment of the role of private sector in healthcare in the context of inadequate public provision, expanding private provision and weak governance structures.

Birth Pangs

In June 2018, a small survey of the Pradhan Mantri Matru Vandana Yojana in two blocks of Jharkhand—Manika in Latehar district and Khunti in Khunti district—examined the status of the scheme and the problems faced by women at the time of pregnancy and delivery, such as health expenditure, inadequate nutrition, and loss of income. The findings call for better implementation of the scheme, as well as make a case for maternity benefits to be raised to a minimum of ₹6,000 per child for all pregnancies and not just for the first living child.

Gamechanger or a Trojan Horse?

The Maternity Benefit Act, 1961, a key legislation in India that enables women to transcend the public–private dichotomy and stake their claim for productive participation in the labour force, saw major amendments in 2017. Four aspects of the amendments—increased maternity leave, maternity leave for adoption and surrogacy, provision of crèche, and paternity leave—are juxtaposed with feminist and constitutional principles as well as ground-level realities and practices. An increase in maternity benefits in law with a neglect of paternity leave and benefits is a lopsided approach that further reinforces gendered division of labour and care work as the domain of women. The social responsibility of employers is emphasised, and a deeper engagement of the state with the policy of parental benefits is advocated.

Making Rural Healthcare System Responsive to Domestic Violence: Notes from Patan in Gujarat

Domestic violence affects more than one-third of the women population in India, causing physical, mental, and psychological trauma to the survivors. While there have been specific interventions in urban India to combat gender violence, rural India is still in want of such initiatives. Against such a backdrop, the Society for Women’s Action and Training Initiatives has devised a novel initiative to tackle domestic violence in rural Patan district of Gujarat by collaborating with the existing healthcare system. Since 2012, it has been able to offer counselling, mediation, relief, and legal recourse to the victims of violence.

Women’s Education and Fertility in the Hindi Heartland

Using evidences from the Sample Registration System and the third and fourth rounds of the National Family Health Survey, this article shows that the fertility rate continues to be high in the Hindi heartland of the country, and that too among educated women. It also proposes some plausible hypotheses in this regard, which would require validation through further research.

Intimate Partner Violence

Unless India acts on all important causes, including intimate partner violence, that are hindering improvements in reproductive, maternal, and child health outcomes, the sustainable development goals related to health will remain difficult to achieve. Using the National Family Health Survey 2015–16, it is found that intimate partner violence has adverse impacts on the pregnancy outcomes, maternal and newborns’ health, and related healthcare access.

Stagnancy in the Unmet Need for Family Planning in India

Though addressing the unmet need for contraception was one of the immediate objectives of India’s National Population Policy 2000, the available evidence shows that there has been stagnancy in the level of the unmet need for family planning for quite some time. Data from the fourth round of the National Family Health Survey carried out during 2015–16 show that about 13% of couples of reproductive ages wanted to stop childbearing or delay the next birth but did not get the contraceptive services they desired to have. Trends in the level and nature of the unmet need for contraception, whether for spacing or limiting, are examined here on the basis of the data from the series of NFHS rounds. Further, socio-economic and regional differentials in the unmet need have been assessed. It is seen that while socio-economic differentials in the unmet need exist but are not large, there are notable interstate differences, and some states have a high unmet need. Besides, the unmet need has risen in a few states in the recent years. The paper also provides estimates of implications of the unmet need in terms of unwanted births and fertility.

Interpretations and Implications of Increasing Obesity in India

The National Family Health Survey-3 and 4 data show that in the past 10 years, overweight/obesity among women in terms of Body Mass Index has increased quite sharply. In the Indian context, undernutrition and obesity are not separate problems. A large proportion of overweight/obese women are undernourished, with small stature, food transition towards more fats and increasingly sedentary lifestyles making them vulnerable towards being overweight/obese. More diversified diet reduces the risk of overweight/obesity. It is suggested that adequate and good quality diversified diets need to be ensured for comprehensive energy and nutrient adequacy. This requires an overhaul of India’s food programmes.

Has the National Health Mission Improved Utilisation of Maternal Healthcare Services in Bihar?

Based on data from the National Sample Survey Office’s surveys on healthcare, this study critically evaluates the impact of the National Health Mission on improving utilisation of maternal healthcare services in Bihar, which had very poor maternal and child health outcomes at the start of the mission. In particular, it investigates factors affecting the utilisation of maternal care services and choice of facilities between the pre- and post-NHM periods; assesses the success of the Janani Suraksha Yojana in enhancing institutional delivery, particularly in public facilities; and estimates the out-of-pocket expenditure on maternal care in the pre- and post-NHM periods and identifies factors affecting such expenditure levels.

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