Sex-disaggregated data matters: tracking the impact of COVID-19 on the health of women and men.

Sex and gender matter to health outcomes, but despite repeated commitments to sex-disaggregate data in health policies and programmes, a persistent and substantial absence of such data remains especially in lower-income countries. This represents a missed opportunity for monitoring and identifying gender-responsive, evidence-informed solutions to address a key driver of the pandemic. In this paper we review the availability of national sex-disaggregated surveillance data on COVID-19 and examine trends on the testing-to-outcome pathway. We further analyse the availability of data according to the economic status of the country and investigate the determinants of sex differences, including the national gender inequality status (according to a global index) in each country. Results are drawn from 18 months of global data collection from over 200 countries. We find differences in COVID-19 prevention behaviours and illness outcomes by sex, with lower uptake of vaccination and testing plus an elevated risk of severe disease and death among men. Supporting and maintaining the collection, collation, interpretation and presentation of sex-disaggregated data requires commitment and resources at subnational, national and global levels, but provides an opportunity for identifying and taking gender-responsive action on health inequities. As a first step the global health community should recognise, value and support the importance of sex-disaggregated data for identifying and tackling an inequitable pandemic.

Family planning campaigns on television and contraceptive use in India.

OBJECTIVE: The paper examines the association between viewing family planning campaigns on television and being aware, improved intention to use, and current usage of modern contraceptives in India. DATA: The study uses detailed data of the currently married women from the current round of the National Family Health Survey. METHODS: We use the instrumental variable approach, propensity score matching method, besides the ordinary least square regression technique to estimate the association between viewing family planning campaigns on television and knowledge, intention to use, and current usage among the currently married women. CONCLUSION: The overall results suggest that currently married women who have seen family planning campaigns on television in the last few months are more likely to know, have a higher intention to use and use modern family planning methods. The effectiveness gets amplified when exposure to such campaigns is complemented with motivation provided by frontline health workers.

Spatial Variation in Contraceptive Practice Across the Districts of India, 1998-2016.

India is currently one of the most demographically diverse regions of the world. Fertility and mortality rates are known to show considerable variation at the level of regions, states and districts. Little is known however, about the spatial variations of the contraceptive usage-a critical variable that is relevant to fertility as well as health policy. This paper uses data from four national population-based household surveys conducted between 1998 and 2016 to explore district-level variations in the contraceptive prevalence rate. We find no clear evidence of convergence. The gap between the best and worst performing districts is more than 70 percent across the four rounds and does not diminish over time. We also find considerable evidence of spatial clustering across districts. Districts with high prevalence concentrate in Southern states and more recently, in the Northeast of the country. Our analysis suggests that female literacy and health care infrastructure are important correlates of spatial clusters. This suggests that investments in women's human capital and health-care infrastructure play a role in expanding women's opportunities to time their births.

Poised for a dividend? Changes in the life trajectories of India's young women over the past two decades.

This paper examines recent changes in the life trajectories of Indian women. We use data from four major national population surveys that span the years 1998-2016. We look at several cohorts of women across the states and regions. We compare decisions related to education, marriage, childbearing and participation in the labor force. Though there is considerable diversity across states and regions, as well as religious groups, we find some consistent patterns that emerge everywhere. First, educational attainment and the age at marriage have been steadily increasing. Women who do not complete secondary school are more likely to marry early. Second, caste and religion (rather than education) play a significant role in decisions after marriage, such as the timing of births, the use of contraception and labor force participation. Third, women from disadvantaged communities continue to have very different life trajectories than other social groups. They are more likely to use contraception and participate in the labor force. Lower levels of schooling also appear to exacerbate the disadvantages of social identity. The pace of these changes varies sharply across states as well as regions of the country.

STATE-LEVEL DIETARY DIVERSITY AS A CONTEXTUAL DETERMINANT OF NUTRITIONAL STATUS OF CHILDREN IN INDIA: A MULTILEVEL APPROACH.

This study aimed to identify the determinants of nutritional status of children in India with a special focus on dietary diversity at the state level. Household-level consumption data from three rounds of the Consumer Expenditure Survey of the National Sample Survey Organization (1993-2012) were used. Information on the nutritional status of children was taken from the National Family Health Survey (2005-06). Dietary diversity indices were constructed at the state level to examine diversity in quantity of food consumed and food expenditure. Multilevel regression analysis was applied to examine the association of state-level dietary diversity and other socioeconomic factors with the nutritional status of children. It was observed that significant variation in childhood stunting, wasting and underweight could be explained by community- and state-level factors. The results indicate that dietary diversity has increased in India over time, and that dietary diversity at the state level is significantly associated with the nutritional status of children. Moreover, percentage of households with a regular salaried income in a state, percentage of educated mothers and mothers receiving antenatal care in a community are important factors for improving the nutritional status of children. Diversity in complementary child feeding is another significant determinant of nutritional status of children. The study thus concludes that increasing dietary diversity at the state level is an effective measure to reduce childhood malnutrition in India.

Exploring the multidimensional nature of anthropometric indicators for under-five children in India.

This study examined the multidimensional nature of the association of stunting, wasting, and underweight for children below 5 years of age in India using data from the National Family Health Survey (NFHS)-3 (2005-2006). Multiple correspondence analysis (MCA) was applied to examine the association of the indicators. Additionally, log-linear model was used to find out the model of best fit to examine the nutritional status of children. It was found that underweight is associated with both stunting and wasting, whereas there was no consistent pattern of association between stunting and wasting. The results also confirmed that children suffered from multiple anthropometric failures. The results showed that height-for-age, weight-for-height, and weight-for-age taken together give the model of best fit for analysis of nutritional status. The study concluded that the three indicators of nutritional status should be considered simultaneously to determine the percentage of undernourished children.

FEMALE EDUCATION AND ITS ASSOCIATION WITH CHANGES IN SOCIO-DEMOGRAPHIC BEHAVIOUR: EVIDENCE FROM INDIA.

Education is a crucial factor in influencing the pattern and timing of marriage for women, and the changes in levels of female literacy will also change the dynamics of family formation. India has experienced consistent improvement in levels of female literacy; therefore, this study examined the association of women's education with the changes in their demographic behaviour in the Indian context. The central idea of the paper is to examine the differences in age at marriage and first birth, choice of marriage partner and the number of children ever born based on educational attainment of women. In addition, the study examined incongruence in years of schooling and discontinuation from school, for children based on education of the mother. The study utilized data from the third round of District Level Household and Facility Survey. The sample constituted 344,164 ever-married women aged 35 years and above with surviving children aged 5-20 years. The results imply that women with higher education are more likely to marry late and have fewer children compared with less educated women. Accordingly, increase in education of women also increases the probability of marrying men with better education than themselves. The study further observed that education of wife has a greater association with the number of children ever born than the education of husband. At the same time, incongruence in years of schooling and drop-out from school are both high for children of uneducated women. The study also found that the children from urban areas are more likely to drop out than their rural counterparts. In addition to education of the mother, number and composition of children in the family and economic condition of the household are some other factors that influence the educational attainment of children.

Indicators to examine quality of large scale survey data: an example through district level household and facility survey.

BACKGROUND: Large scale surveys are the main source of data pertaining to all the social and demographic indicators, hence its quality is also of great concern. In this paper, we discuss the indicators used to examine the quality of data. We focus on age misreporting, incompleteness and inconsistency of information; and skipping of questions on reproductive and sexual health related issues. In order to observe the practical consequences of errors in a survey; the District Level Household and Facility Survey (DLHS-3) is used as an example dataset. METHODS: Whipple's and Myer's indices are used to identify age misreporting. Age displacements are identified by estimating downward and upward transfers for women from bordering age groups of the eligible age range. Skipping pattern is examined by recording the responses to the questions which precede the sections on birth history, immunization, and reproductive and sexual health. RESULTS: The study observed errors in age reporting, in all the states, but the extent of misreporting differs by state and individual characteristics. Illiteracy, rural residence and poor economic condition are the major factors that lead to age misreporting. Female were excluded from the eligible age group, to reduce the duration of interview. The study further observed that respondents tend to skip questions on HIV/RTI and other questions which follow a set of questions. CONCLUSION: The study concludes that age misreporting, inconsistency and incomplete response are three sources of error that need to be considered carefully before drawing conclusions from any survey. DLHS-3 also suffers from age misreporting, particularly for female in the reproductive ages. In view of the coverage of the survey, it may not be possible to control age misreporting completely, but some extra effort to probe a better answer may help in improving the quality of data in the survey.