Srinivas Goli

Birth Preparedness and Its Effect on Place of Delivery and Post-Natal Check-Ups in Nepal

Introduction and Rationale Number of demographically laggard countries will forego MDGs 4 and 5, and Nepal is not an exception to it. International reports reveal that, lack of adequate birth preparedness is one of the greatest hurdles in achievement of MDG 4 and 5. However, lack of comprehensive evidence at country level in developing countries like Nepal is a hindrance for policy making. In this context, this study estimated birth preparedness among Nepali women and its association with institutional delivery and postnatal care in Nepal. Methodology/Principal Fining Secondary data such as latest round of Nepal Demographic and Health Survey Data (NDHS, 2011) has been used in the study. Bivariate and multivariate models are applied as the methods of data analyses. Results reveals that only 32 per cent of women in Nepal have birth preparedness. The women who are well prepared belong to higher age group (45%), higher education (36%) and with higher women autonomy (86%). Women, who are well prepared for child birth (OR = 3.137, p<0.01) have a greater likelihood of going for institutional deliveries that women with no preparation (OR = 1). However, irrespective of level of birth preparedness, women in Nepal preferred to deliver the baby in public health facility that private health Facility. Conclusion and Implications Findings reveal that birth preparedness is one of the critical factors in determining the likelihood of having institutional delivery and checkups after delivery. At policy perspective, this study fosters that developing countries like Nepal have to ensure adequate and universal birth preparedness in order to achieve goal 4 and 5 of MDGs.

Trends in health and health inequalities among major states of India: assessing progress through convergence models.

Convergence in health and health inequalities reflects not only a sense of equity, but also provides a critical assessment tool for monitoring the health progress of differently placed individuals. This study examines convergence hypothesis for health and health inequalities across major Indian states, using both standard and cutting-edge convergence metrics. The findings lend support to the convergence in average health status among the states and the socioeconomic group of India, examined through select health indicators. However, results also suggest a setback in convergence in decline of health inequalities in recent times, particularly in life expectancy at birth, child immunization and underweight. Evidence signals that from the late 1990s, convergence in decline of health inequalities are replaced by emerging divergence. This paper contributes to health policy and planning by identifying areas where, India needs to work to achieve efficiency with equity in health status across geographical divisions and social groups.

Consanguineous Marriages and Their Effects on Pregnancy Outcomes in India

Purpose – The purpose of this study is to investigate the association between the marriage among blood relatives and resulting adverse pregnancy outcomes.Design/methodology/approach – This study uses data from India Human Development Survey in 2005. The methods of analyses include bivariate, trivariate estimates and Cox proportional hazard regression model.Findings – The results reveal that the occurrence of consanguineous marriages is more predominant in southern India and among socioeconomically disadvantageous groups. Moreover, women inconsanguineous unions are more likely to have adverse pregnancy outcomes including stillbirths (RR=1.59, p-value Practical implications – In order to avoid loss of pregnancy and related reproductive health problems in India, it is imperative to create awareness regarding the adverse effects of consanguineous marriages, focusing on the regions with high prevalence.Originality/value – This unique study comprehensively examines the occurrence of consanguineous marriages and their association with adverse pregnancy outcomes by using advanced statistical analyses and nationally representative data.

Maternal and child mortality indicators across 187 countries of the world: Converging or diverging

This study reassessed the progress achieved since 1990 in maternal and child mortality indicators to test whether the progress is converging or diverging across countries worldwide. The convergence process is examined using standard parametric and non-parametric econometric models of convergence. The results of absolute convergence estimates reveal that progress in maternal and child mortality indicators is diverging for the entire period of 1990–2010 [maternal mortality ratio (MMR) − β = .00033, p < .574; neonatal mortality rate (NNMR) − β = .04367, p < .000; post-neonatal mortality rate (PNMR) − β = .02677, p < .000; under-five mortality rate (U5MR) − β = .00828, p < .000)]. In the recent period, such divergence is replaced with convergence for MMR but diverged for all the child mortality indicators. The results of Kernel density estimate reveal considerable reduction in divergence of MMR for the recent period; however, the Kernel density distribution plots show more than one ‘peak’ which indicates the emergence of convergence clubs based on their mortality levels. For child mortality indicators, the Kernel estimates suggest that divergence is in progress across the countries worldwide but tended to converge for countries with low mortality levels. A mere progress in global averages of maternal and child mortality indicators among a global cross-section of countries does not warranty convergence unless there is a considerable reduction in variance, skewness and range of change.

High Spending on Maternity Care in India: What Are the Factors Explaining It?

Background and Objectives High maternity-related health care spending is often cited as an important barrier in utilizing quality health care during pregnancy and childbirth. This study has two objectives: (i) to measure the levels of expenditure on total maternity care in disaggregated components such as ANCs, PNCs, and Natal care expenditure; (ii) to quantify the extent of catastrophic maternity expenditure (CME) incurred by households and identify the factors responsible for it. Methods and Findings Data from the 71st round of the National Sample Survey (2014) was used to estimate maternity expenditure and its predictors. CME was measured as a share of consumption expenditure by different cut-offs. The two-part model was used to identify the factors associated with maternity spending and CME. The findings show that household spending on maternity care (US

Relevance of Health Knowledge in Reporting Maternal Health Complications and Use of Maternal Health Care in India

149 in constant price) is much higher than previous estimates (US

Burden of Multiple Disabilities Among the Older Population in India: An Assessment of Socioeconomic Differentials

50 in constant price). A significant proportion of households in India (51%) are incurring CME. Along with economic and educational status, type of health care and place of residence emerged as significant factors in explaining CME. Conclusion Findings from this study assume importance in the context of an emerging demand for higher maternity entitlements and government spending on public health care in India. To reduce CME, India needs to improve the availability and accessibility of better-quality public health services and increase maternity entitlements in line with maternity expenditure identified in this study.

Provisional results of the 2011 Census of India: Slowdown in growth, ascent in literacy, but more missing girls

We measured levels of womens health knowledge and their association with the reporting of maternal health complications and related health care use. We found that women with higher levels of health knowledge reported more pregnancy and postnatal complications, and used more maternal health care services. Education has a positive impact on health, but education alone is not enough to ensure recognizing and reporting of health complications and increasing the demand for maternal health care services. We conclude that the provision of health education for women will help them to identify maternal health complications and improve their reporting and related health care use.

Epidemiological Transition in Urban Population of Maharashtra

Purpose – The aim of this study is twofold, first, to estimate the prevalence of multiple disabilities among the older population in India; second, to examine the socio economic determinants of multiple disabilities among the older population. Design/methodology/approach – This study used the India Human Development Survey Data (IHDS) for the analysis. Bivariate, multinomial logit regression and multiple classification analysis are used as methods for the study. Disability score is constructed for measuring the multiple disabilities among the older population. Findings – The results of disability prevalence show, a high prevalence of multiple disabilities among the older population in India. Further, disability prevalence varies considerably by age and socio-economic characteristics of the older population. Among all the socioeconomic factors, economic factor emerged as a dominant predictor of prevalence of disabilities among the older population in India. The findings of the dimension specific assessment reveal that the disability in walking is the highest among all the disabilities. The distribution of disabled older population by living arrangement and the social network indicates that a large proportion of disabled older population lives with their children. In addition, only a few of the disabled older people have social networks. The distribution of disabled older people by employment and financial source reveal that there is a meager government support to the disabled older population in India. This study evidently suggests that a significant number of older populations in India are suffering from multiple disabilities. The number of multiple disabilities increases with the decrease in the socioeconomic status. The living arrangement and financial security assessment suggest that there is an increasing need of children and government support to the disabled older population. Originality/value – The distinctiveness of this study can be primarily found in the type of the data used, the assessment of additional disability dimensions, and the inclusion of differentials such as living arrangement, social network and work status as part of the analysis. Overall, the study with its robust statistical assessment provides a number of key insights into the social, economic security, and health care needs of the disabled older population in India.

Explaining Sex Differentials in Child Mortality in India: Trends and Determinants

Purpose - The purpose of this paper is to compare the new Census 2011 results with the results of the previous Censuses and assess the progress in trends of population growth, literacy rate, and sex ratio imbalance and also to highlight the critical socioeconomic issues based on short-term trends and patterns. Design/methodology/approach - The paper is structured in a “commentary and perspective” format. The paper assesses key demographic and socioeconomic features of Indias population using 2011 Census data, and compares progress in population and social trends with the results of previous Censuses. The paper also uses data from the National Family Health Survey (2005-2006) and the United Nations World Population Prospects (2008) to complement Census results and understand the underlying reasons for the progress or deterioration in critical demographic and socioeconomic indicators. Findings - The provisional results of the 2011 Census data reveal a mixed bag of insights. On the positive side, there has been steady progress in population stabilization and a swift ascent in female literacy since 1991. These encouraging trends, among others, represent major driving forces of demographic and economic returns for India in the coming decades. However, on the negative side, the 2011 Census reveals a deplorable deterioration in the female-male ratio of the child population aged 0-6 years, despite Indias enforcement of targeted policy measures following the 2001 Census. The country needs to take careful stock of this issue, as its advancing demographic transition and changing socioeconomic circumstances are rapidly translating into an adverse trend of girl child discrimination. Originality/value - This study compares Indias most recent two Censuses and provides original analytical insights into Indias progress in population stabilization and development, and the setbacks it faces in terms of gender inequalities. Region and state-wise analyses are additional contributions based on disaggregated state level data from the recent two Censuses.