Dynamics of caste and early childbearing in India: a perspective of three decades.

BACKGROUND: Early childbearing disrupts girls' otherwise healthy growth into adulthood and adversely affects their education, livelihood, and health. Individual, sociocultural, economic, environmental, and health service-related factors contribute to childbearing among young females. In India, caste affects health outcomes despite several affirmative policies aimed at improving the health and welfare of the backward castes/tribes. However, there is a dearth of empirical evidence about the impact of caste on early childbearing, more specifically, regarding the trajectory of inter-caste disparities in early childbearing. METHOD: This study used data from all five rounds of the National Family Health Survey (NFHS) in India to assess the association between caste and early childbearing over the last three decades. All women aged 20-24 [NFHS-1 (n = 17,218), NFHS-2 (n = 15,973), NFHS-3 (n = 22,807), NFHS-4 (n = 122,955) and NFHS-5 (n = 118,700)] were considered to create a pooled data set (n = 297,653) for analysis. Bivariate analysis and binary logistic regression were conducted using Stata (v17). ArcMap (v10.8) presented the caste-wise prevalence of early childbearing among the states and Union Territories (UTs). RESULTS: Many women continue to have early childbearing despite a considerable reduction over the last three decades from 47% in 1992-93 to 15% in 2019-21. Compared to NFHS-1, the odds of early childbearing increased by 15% in NFHS-2 and, after that, declined by 42% in NFHS-3 and 64% in NFHS-4 and NFHS-5. The inter-caste disparity in early childbearing persists, albeit with a narrowing gap, with the Scheduled castes (SC) remaining the most vulnerable group. Adjusting the effects of socio-demographic and economic characteristics, SC women had significantly higher odds of early childbearing (OR = 1.07, CI = 1.04-1.11) than those from the General caste. CONCLUSION: To decrease early childbirth, a focus on adolescent marriage prevention and increasing contraceptive use among young SC women is necessary. Strengthening ongoing programs and policies targeting educational and economic empowerment of the socially weaker castes/tribes will help in reducing early childbearing. Efforts to prevent early childbearing will accelerate the achievement of the Sustainable Development Goals (SDGs)-especially those related to health, poverty, nutrition, education, and general wellbeing, in addition to protecting women's reproductive rights.

Prevalence and predictors of minimum acceptable diet (MAD) feeding among tribal children aged 6-23 months in India.

Minimum acceptable diet (MAD) that combines minimum dietary diversity (MDD) and minimum meal frequency (MMF) is one of the eight core indicators for assessing infant and young child feeding (IYCF) practices for children aged 6-23 months. With low MAD, young children and infants are more susceptible to undernutrition. The study assesses the prevalence and predictors of MAD among tribal children aged 6-23 months in India. Descriptive, bivariate, and multivariate analyzes were performed on data from 6326 tribal children of the National Family Health Survey (2019-21). Stata was used for the analyzes, with a 5% significance level. Only 12% of tribal children were fed with a MAD, while 24% had MDD and 34% MMF. Children aged 18-23 months had a three times higher chance of MAD than their 6-8 months counterparts. Children receiving Integrated Child Development Services (ICDS), children of mothers with ten or more years of schooling, children whose mothers were exposed to mass media, and whose mothers had 4+ antenatal care visits in their last pregnancy had a higher likelihood of MAD. The study concludes that MAD among tribal children aged 6-23 months is unsatisfactory and varies significantly by socio-demographic characteristics, suggesting targeted intervention.

Why do women abort their pregnancies? Evidence from the National Family Health Survey (2019-21) of India.

Induced abortion is closely associated with maternal morbidity, mortality, and reproductive rights of women and thus continues to draw research interest. This study assesses the reasons for abortion and their predictors using India's National Family Health Survey-5 (2019-21) data. The sample of women aged 15-49 who had terminated their last pregnancy by induced abortion in the five years preceding the survey (n=5835) was considered for analysis. Multinomial logistic regression was used to check the adjusted effects of the socioeconomic predictors on the reasons for abortion. Stata (v16.0) was used for the data analysis. Women were more likely to abort their pregnancy at home/other than in the public health sector if unintended pregnancies (RR: 2.79; CI: 2.15-3.61) and sex-selective abortions (RR: 2.43; CI: 1.67-3.55) rather than life risk. The study found unintended pregnancy as the primary contributor to induced abortion. However, some women undergo the procedure due to medical reasons and the undesired gender of the unborn child. Unintended pregnancies that end in abortion are strongly correlated with gestational age, method of abortion, place of abortion, number of surviving children, religion, place of residence, and region. Again, there is a strong association between the sex-selective reason for abortion and the gestational age, method of abortion, place of abortion, number of surviving children, proper knowledge of the ovulatory cycle, religion, wealth quintile, and region. Women had abortions mainly due to unintended pregnancies, and there was socioeconomic, demographic, and geographic variation in the reasons for abortion in India. Sex-selective abortions continue to exist, especially among women of higher parity, poorest households and from the central, eastern, and north-eastern regions. The key to reducing unintended pregnancies and abortions is raising the understanding of contraception and empowering women in reproductive decisions. Reducing unintended pregnancies will contribute to lower induced abortion and thus improve women's health.

Patterns and correlates of post-abortion complications in India.

BACKGROUND: Abortion complications can range from minor and treatable to severe but rare complications that can result in morbidity or even death. There is limited evidence on the socioeconomic and demographic correlates of post-abortion complications, though abortion is associated with pregnancy and birth-related complications and contributes to maternal mortality in India. This study thus assesses the patterns and correlates of post-abortion complications in India. METHODS: This study gathered data from the cross-sectional National Family Health Survey(2019-21) on women aged 15-49 who had their last pregnancy terminated by induced abortion in the five years preceding the survey (n = 5,835). Multivariate logistic regression was used to check the adjusted association of socioeconomic and demographic characteristics with abortion complications. The data were analysed using Stata with a 5% significance threshold. RESULTS: Post-abortion complications affected 16% of the women. Women who had an abortion with a gestational age of 9-20 weeks (AOR:1.48, CI: 1.24-1.75) and those who had an abortion due to life risk/medical reasons (AOR:1.37, CI:1.13-1.65) had higher odds of abortion complications than their respective counterparts. Women in the North-Eastern (AOR:0.67, CI:0.51-0.88) and the Southern (AOR:0.60, CI:0.44, 0.81) regions were less likely to have abortion complications than those in the Northern region. CONCLUSION: Many Indian women suffer from post-abortion complications, with the primary causes being increased gestational age and abortions performed due to life-threatening or medical conditions. Efforts to educate women about early abortion decision-making and improve abortion care will reduce post-abortion complications.