Nandita Saikia

Does type of household affect maternal health? Evidence from India.

The present paper examines the association between the type of household and maternal health in India using data from the National Family Health Survey 1998-99. The indicators of maternal health used in the analysis are contraceptive use, visit to obtain antenatal care in the first trimester, safe delivery and nutritional status of women measured in terms of body mass index (BMI). Binary and multinomial logistic regressions are used to establish associations. The type of household is coded into three categories, viz. nuclear household, joint household with in-laws and joint household without in-laws. The other independent variables used in the analysis are age, children ever born, work status, education of women, religion, caste, standard of living, exposure to mass media, womens autonomy and presence of others at the time of interview. The findings clearly suggest that type of household is significantly associated with the utilization of the above-mentioned services that positively affect maternal health. Women in nuclear households are more likely to utilize these services compared with women in joint households. However, an association between type of household and BMI was not found.

Trends and geographic differentials in mortality under age 60 in India

The study examines overall and region-specific mortality changes and regional mortality variation in India since the 1970s, using data from the Sample Registration System (SRS). An evaluation of the quality of SRS data confirms their reliability for children and adults under age 60. The results suggest the convergence of mortality across the regions of India with important inter-state differences in the pace of health improvements over time. After spectacular progress during the 1970s and the 1980s, many Indian states have witnessed slower mortality improvements in both young and adult age groups. India faces difficulties in making further reductions in infant mortality and in the burden of chronic and man-made diseases at adult ages.

Gender Differentials in Self-Rated Health and Self-Reported Disability among Adults in India

Background The extant literature on gender differentials in health in developed countries suggests that women outlive men at all ages, but women report poorer health than men. It is well established that Indian women live longer than men, but few studies have been conducted to understand the gender dimension in self-rated health and self-reported disability. The present study investigates gender differentials in self-rated health (SRH) and self-reported disability (SRD) among adults in India, using a nationally representative data. Methods Using data on 10,736 respondents aged 18 and older in the 2007 WHO Study on Global Ageing and Adult Health in India, prevalence estimates of SRH are calculated separately for men and women by socio-economic and demographic characteristics. The association of SRH with gender is tested using a multinomial logistic regression method. SRD is assessed using 20 activities of daily living (ADL). Further, gender differences in total life expectancy (TLE), disability life expectancy (DLE) and the proportion of life spent with a disability at various adult ages are measured. Results The relative risk of reporting poor health by women was significantly higher than men (relative risk ratio: 1.660; 95% confidence Interval (CI): 1.430–1.927) after adjusting for socio-economic and demographic characteristics. Women reported higher prevalence of severe and extreme disability than men in 14 measures out of a total20 ADL measures. Women aged less than 60 years reported two times more than men in SRD ≥ 5 ADLs. Finally, both DLE and proportion of life spent with a disability were substantially higher for women irrespective of their ages. Conclusion Indian women live longer but report poorer health than men. A substantial gender differential is found in self-reported disability. This makes for an urgent call to health researchers and policy makers for gender-sensitive programs.

Gender Difference in Health-Care Expenditure: Evidence from India Human Development Survey

Background While the gender disparity in health and mortality in various stages of life in India is well documented, there is limited evidence on female disadvantage in health-care expenditure (HCE). Aims Examine the gender difference in HCE in short-term and major morbidity in India, and understand the role of factors underlying the difference. Data and Methods Using two rounds of nationally representative panel data—the India Human Development Survey (IHDS) 2004–2005 and 2011–2012 (IHDS I & II)—we calculate morbidity prevalence rate and mean HCE by gender, and examine the adjusted effect of gender on major morbidity-related HCE by using a two-part regression model. Further, we performed Oaxaca-Blinder decomposition of the gender gap in HCE in major morbidity to understand the contribution of demographic and socio-economic factors. Results Health-care expenditure on females was systematically lower than on males across all demographic and socio-economic groups. Multivariate analysis confirms that female HCE is significantly lower than male HCE even after controlling demographic and socio-economic factors (β = -0.148, p = 0.000, CI:-0.206–0.091). For both short-term and major morbidity, a female disadvantage on HCE increased from IHDS I to IHDS II. For instance, the male–female gap in major morbidity related expenditure increased from INR 1298 to INR 4172. A decomposition analysis of gender gap in HCE demonstrates that about 48% of the gap is attributable to differences in demographic and socio-economic factors (endowment effect), whereas 50% of the gap is due to the differential effect of the determinants (coefficient effect). Interpretation Indians spend less on female health care than on male health care. Most of the gender gap in HCE is not due to differential distribution of factors affecting HCE.

DETERMINANTS OF ADULT MORTALITY IN INDIA

This study attempts to evaluate the factors affecting adult mortality with special emphasis on the lifestyle factors using the 1998–1999 National Family Health Survey (NFHS). The sample size, N, in this analysis is 330,267. It includes those aged 15–59 of which 2.6 per cent died during adulthood. In the Poisson regression model, the independent variables used are age, sex, place of residence, lifestyle factors of other members of the family, standard of living, literacy composition, caste, religion, mass media exposure, household type, fuel for cooking and region of residence. This analysis has been adjusted for the clustering of deaths at the family level. The findings suggest that there is a strong positive relationship between lifestyle factors and premature mortality, even after controlling for other background characteristics of the deceased person. Further, age, standard of living index (SLI), literacy composition, religion, household type and region of residence are some important determinants of adult mortality in India.

Trends and Sub-National Disparities in Neonatal Mortality in India from 1981 to 2011

ABSTRACT Despite progress made in recent decades, infant and neonatal mortality rates (NMRs) in India have remained high compared to neighbouring developing countries. This study aims at establishing quantitative links between the relatively slow progress in fight against neonatal death at national level and strikingly varying mortality patterns at sub-national level. It appears that the tempo and quantum of reductions in neonatal mortality have been inconsistent across time, states, and urban and rural sub-populations. Decompositions have shown that the total NMR decrease in India, since the early 1980s has been largely driven by mortality changes in poorer states and rural areas, whereas compositional changes had negligible impact. The disparity in NMRs across the sub-populations which had been declining earlier stabilised in the 2000s. These disparities produce a heavy burden of avoidable death. While the mortality excess in poorer states and rural areas constitutes the core of bulk of excess deaths, some richer states, and urban areas, also show unexpected slower mortality decreases. However, the experience of the two states of Kerala and Tamil Nadu highlights the potential for declines in NMRs in low-income settings with sensible health and social policies.

Adult Male Mortality in India: An application of the widowhood method

This paper presents levels and trends of adult male mortality in India and its major states during the post-independence period applying the widowhood method on census data. It also estimates adult male mortality for all the districts from major states of India. We adjusted widowhood estimates for possible bias due to remarriages and examined the sensitivity of adjusted estimates to different scenarios of remarriage rates. Comparison of widowhood estimates with direct estimates from official sources supports the credibility of widowhood estimates. Information obtained from widows aged 40–44 and 45–49 provided the most convincing patterns of adult mortality. Trends in adult mortality suggest that maximum gain in 45q15 for India and its states occurred during 1949–1960. Adult male mortality varied substantially across the states of India. Although adult life expectancy has been rising in India, the rate of mortality reduction has been decreasing over the last few decades.

Excess under-5 female mortality across India: a spatial analysis using 2011 census data

BACKGROUND Excess female mortality causes half of the missing women (estimated deficit of women in countries with suspiciously low proportion of females in their population) today. Globally, most of these avoidable deaths of women occur during childhood in China and India. We aimed to estimate excess female under-5 mortality rate (U5MR) for Indias 35 states and union territories and 640 districts. METHODS Using the summary birth history method (or Brass method), we derived district-level estimates of U5MR by sex from 2011 census data. We used data from 46 countries with no evidence of gender bias for mortality to estimate the effects and intensity of excess female mortality at district level. We used a detailed spatial and statistical analysis to highlight the correlates of excess mortality at district level. FINDINGS Excess female U5MR was 18·5 per 1000 livebirths (95% CI 13·1-22·6) in India 2000-2005, which corresponds to an estimated 239 000 excess deaths (169 000-293 000) per year. More than 90% of districts had excess female mortality, but the four largest states in northern India (Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh) accounted for two-thirds of Indias total number. Low economic development, gender inequity, and high fertility were the main predictors of excess female mortality. Spatial analysis confirmed the strong spatial clustering of postnatal discrimination against girls in India. INTERPRETATION The considerable effect of gender bias on mortality in India highlights the need for more proactive engagement with the issue of postnatal sex discrimination and a focus on the northern districts. Notably, these regions are not the same as those most affected by skewed sex ratio at birth. FUNDING None.

Neonatal and under-five mortality rate in Indian districts with reference to Sustainable Development Goal 3: An analysis of the National Family Health Survey of India (NFHS), 2015–2016

Background and objective India contributes the highest global share of deaths among the under-fives. Continuous monitoring of the reduction in the under-five mortality rate (U5MR) at local level is thus essential to set priorities for policy-makers and health professionals. In this study, we aimed to provide an update on district-level disparities in the neonatal mortality rate (NMR) and the U5MR with special reference to Sustainable Development Goal 3 (SDG3) on preventable deaths among new-borns and children under five. Data and methods We used recently released population-based cross-sectional data from the National Family Health Survey (NFHS) conducted in 2015–2016. We used the synthetic cohort probability approach to analyze the full birth history information of women aged 15–49 to estimate the NMR and U5MR for the ten years preceding the survey. Results Both the NMR and U5MR vary enormously across Indian districts. With respect to the SDG3 target for 2030 for the NMR and the U5MR, the estimated NMR for India for the period studied is about 2.4 times higher, while the estimated U5MR is about double. At district level, while 9% of the districts have already reached the NMR targeted in SDG3, nearly half (315 districts) are not likely to achieve the 2030 target even if they realize the NMR reductions achieved by their own states between the last two rounds of National Family Health Survey of India. Similarly, less than one-third of the districts (177) of India are unlikely to achieve the SDG3 target on the U5MR by 2030. While the majority of high-risk districts for the NMR and U5MR are located in the poorer states of north-central and eastern India, a few high-risk districts for NMR also fall in the rich and advanced states. About 97% of districts from Chhattisgarh and Uttar Pradesh, for example, are unlikely to meet the SDG3 target for preventable deaths among new-borns and children under age five, irrespective of gender. Conclusions To achieve the SDG3 target on preventable deaths by 2030, the majority of Indian districts clearly need to make a giant leap to reduce their NMR and U5MR.

Correction: Disability Divides in India: Evidence from the 2011 Census

[This corrects the article DOI: 10.1371/journal.pone.0159809.].