Saswata Ghosh

Is health status of elderly worsening in india? A comparison of successive Rounds of national Sample survey data

The increasing greying of Indias population raises concerns about the welfare and health status of the aged. One important source of information of health status of the elderly is the National Sample Survey Rounds on Morbidity and Health Care Expenditure. Using unit-level data for 1995-96 and 2004, this paper examines changes in reported health status of the elderly in India and analyses their relationship with living arrangements and extent of economic dependency. It appears that even after controlling for factors like caste, education, age, economic status and place of residence, there has been a deterioration in self-perceived current health status of the elderly. The paper argues that, although there have been changes in the economic condition and traditional living arrangements--with a decline in co-residential arrangements--this is not enough to explain the decline in reported health status and calls for a closer look at narratives of neglect being voiced in developing countries.

Health & Demographic Surveillance System Profile: The Birbhum population project (Birbhum HDSS)

The Birbhum HDSS was established in 2008 and covers 351 villages in four administrative blocks in rural areas of Birbhum district of West Bengal, India. The project currently follows 54 585 individuals living in 12557 households. The population being followed up is economically underprivileged and socially marginalized. The HDSS, a prospective longitudinal cohort study, has been designed to study changes in population demographic, health and healthcare utilization. In addition to collecting data on vital statistics and antenatal and postnatal tracking, verbal autopsies are being performed. Moreover, periodic surveys capturing socio-demographic and economic conditions have been conducted twice. Data on nutritional status (children as well as adults), non-communicable diseases, smoking etc. have also been collected in special surveys. Currently, intervention studies on anaemia, undernutrition and common preschool childhood morbidities through behavioural changes are under way. For access to the data, a researcher needs to send a request to the Data Manager [suri.shds@gmail.com]. Data are shared in common formats like comma-separated files (csv) or Microsoft Excel (xlsx) or Microsoft Access Database (mdb).The HDSS will soon upgrade its data management system to a more integrated platform, coordinated and guided by INDEPTH data sharing policy.

‘Ultramodern Contraception’ Re-Examined

The family planning literature considers behavioural family planning methods ‘ineffective’ because their users are not motivated to control their fertility. While this is true for the initial stages of fertility transition, studies report that urban, educated, and affluent women—propelled by a reaction against the medicalisation of the female body by Western technology—mainly use behavioural family planning methods. This elite group has the skill and knowledge to use such methods effectively. The term ‘ultramodern contraception’ has been coined to describe this phenomenon. This paper critically re-examines the ‘ultramodern contraception’ theory, and argues that it has certain limitations. Analysing three rounds of National Family Health Survey data for India, we argue that reliance on such methods may be a transient phase in the reproductive cycle of women, specifically before the desired gender parity of children is attained. Moreover, it may also be a manifestation of son preference.

EXPLORING SOCIOECONOMIC VULNERABILITY OF ANAEMIA AMONG WOMEN IN EASTERN INDIAN STATES

The present study investigates the socioeconomic risk factors of anaemia among women belonging to eastern Indian states. An attempt has been made to find out differences in anaemia related to social class and place of residence, and age and marital status. It was hypothesized that rural women would have a higher prevalence of anaemia compared with their urban counterparts, particularly among the poorest social strata, and that ever-married women would be at elevated risk of anaemia compared with never-married women, particularly in the adolescent age group. Using data from National Family Health Survey-3, 2005-6, a nationally representative cross-sectional survey that provided information on anaemia level among 19,695 women of this region, the present study found that the prevalence of anaemia was high among all women cutting across social class, location and other attributes. In all 47.9% were mildly anaemic (10.0-11.9.9 g/dl), 16.1% were moderately anaemic (7.0-9.9 g/dl) and 1.6% were severely anaemic (<7.0 g/dl). Protective factors include frequent consumption of pulses, milk and milk products, fruits and fish, educational attainment, mass media exposure and high socioeconomic status. Urban poor women and adolescent ever-married women had very high odds of being anaemic. New programme strategies are needed, particularly those that improve iron storage and enhance the overall nutritional status of women throughout the life-cycle.

Sex differences in the risk profile of hypertension: a cross-sectional study

Objective To assess the socioeconomic and behavioural risk factors associated with hypertension among a sample male and female population in India. Setting Cross-sectional survey data from a Health and Demographic Surveillance System (HDSS) of rural West Bengal, India was used. Participants 27 589 adult individuals (13 994 males and 13 595 females), aged ≥18 years, were included in the study. Primary and secondary outcome measures Hypertension was defined as mean systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg, or if the subject was undergoing regular antihypertensive therapy. Prehypertension was defined as SBP 120–139 mm Hg and DBP 80–89 mm Hg. Individuals were categorised as non-normotensives, which includes both the prehypertensives and hypertensives. Generalised ordered logit model (GOLM) was deployed to fulfil the study objective. Results Over 39% of the men and 25% of the women were prehypertensives. Almost 12.5% of the men and 11.3% of the women were diagnosed as hypertensives. Women were less likely to be non-normotensive compared to males. Odds ratios estimated from GOLM indicate that women were less likely to be hypertensive or prehypertensive, and age (OR 1.04, 95% CI 1.03 to 1.05; and OR 1.08, 95% CI 1.07 to 1.09 for males and females, respectively) and body mass index (OR 1.64, 95% CI 1.38 to 1.97 for males; and OR 1.32, 95% CI 1.08 to 1.60 for females) are associated with hypertension. Conclusions An elevated level of hypertension exists among a select group of the rural Indian population. Focusing on men, an intervention could be designed for lifestyle modification to curb the prevalence of hypertension.

Influence of Son Preference on Contraceptive Method Mix: Some Evidences from ‘Two Bengals’

Although the people of Bangladesh and the state of West Bengal in India share common cultural practices, they differ in contraceptive adoption and practice. The use of modern contraceptive methods among women and couples of the two Bengals differ from each other. The use of natural method is significantly higher among women and couples in West Bengal compared to that of their counterparts in Bangladesh. The study analyses data from Demographic and Health Survey (DHS) using sequential logit models. Results show that greater reliance on natural methods among women of West Bengal is related to higher preference for sons compared to that in Bangladesh.

ROLE OF COMMUNITY AND CONTEXT IN CONTRACEPTIVE BEHAVIOUR IN RURAL WEST BENGAL, INDIA: A MULTILEVEL MULTINOMIAL APPROACH

Studies examining the influence of community-level interactions and contextual/supply-side factors in determining contraceptive choices have yielded mixed results in the context of rural India. Using small-scale survey data of 1348 women from rural West Bengal and by employing multilevel multinomial logit models, this study tested the influence of these factors after controlling for various socio-demographic and individual-level socioeconomic factors. The study reveals that supply-side intervention strategies, i.e. addressing outreach and advocacy activities and socio-religious needs at the community level, are essential prerequisites to breaking away from the predominance of sterilization in the contraceptive method-mix and enhancing the adoption of modern reversible contraceptives for improved spacing of births - a crucial factor in maternal and child health outcomes.

Second demographic transition or aspirations in transition: an exploratory analysis of lowest-low fertility in Kolkata, India

ABSTRACT Fertility transition occurred during the 1970s in Kolkata (erstwhile Calcutta), capital of the state of West Bengal, India, and has remained persistently at the low fertility level. Fertility rate in Kolkata attained its lowest-low level in the beginning of the present century. It currently has the lowest fertility rate (TFR 1.2) in India. This could be a case of second demographic transition (SDT) or pertains to changing dynamics in childbearing, childrearing, and/or aspirations for children. Using primary data of 600 couples (1200 individuals) and employing quantitative and qualitative methods, this study found that constraints in childbearing and childrearing; and aspirations for children have a strong negative and significant effect on second and higher order childbearing among couples, particularly among women. In our study there was no strong evidence of voluntary childlessness as well as decline in the importance of marriage, family and children as posited by SDT. Thus we argue that SDT might have to be redefined for a developing country context.

Exploring Vulnerability of Undernutrition among Wives Do Husbands’ Attributes Matter?

Generally, at household level, cultural norms and practices regarding intra-household food allocation and distribution, and other demographic and socio-economic factors determine the extent of nutritional status among women. Arguably, husbands’ background attributes such as educational attainment, employment, nutritional status and health habits such as smoking and drinking could also contribute in determining their wives’ nutritional status. It was hypothesized that risk of undernourishment is higher among wives whose husbands are less educated, engaged in low-paid jobs, undernourished and possessing unhealthy lifestyle. Using data from the third round of National Family Health Survey, 2005–06, a nationally representative cross-sectional survey that provided information on BMI level of 34,062 couples, the present study found that the prevalence of undernutrition among wives was high cutting across husbands’ differential attributes as well as other social, economic and cultural covariates. Protective factors include husbands’ tertiary employment, husbands’ well nourishment and healthy lifestyle, high social and economic status and living in urban areas. Programmes and policies should focus on the issues related to household nutritional status instead of focusing only women and children of a household.

Health Communication and Behavioural Change: An Exploratory Study among Marginalized Communities in Rural West Bengal, India:

A small-scale research/intervention project that aimed to develop and test an integrated package of communication campaign on health awareness among women belonging to the marginalized community was implemented in an underdeveloped setting of West Bengal, India during 2010–11. A quasi-experimental research design, with cross-sectional surveys conducted in six intervention and control villages at the baseline and endline, was used to evaluate the outcome of intervention among 1,196 respondents. This article examines the impact of behaviour change communication intervention on knowledge, reporting of illnesses and treatment-seeking of symptoms of general and gynaecological morbidity. Analyses included multiple, binary logistic and multinomial logistic regressions using a Difference-in-Difference estimator. Results of the evaluation suggest that the net effect of exposure to the intervention had a positive and significant impact on most of the indicators reflecting an increased level of awareness about signs and symptoms of general and reproductive complications. However, the net effect of exposure was mixed for the indicators of reporting of illnesses, pattern and sources of seeking treatment. The experience of implementing the project demonstrates that it is possible to improve women’s general and reproductive health awareness and practices which could have resulted in positive health outcomes in the long run.