Background Since 2005, India has experienced an impressive 77% reduction in maternal mortality compared to the global average of 43%. What explains this impressive performance in terms of reduction in maternal mortality and improvement in maternal health outcomes? This paper evaluates the effect of household wealth status on maternal mortality in India, and also separates out the performance of the Empowered Action Group (EAG) states and the Southern states of India. The results are discussed in the light of various pro-poor programmes and policies designed to reduce maternal mortality and the existing supply side gaps in the healthcare system of India. Using multiple sources of data, this study aims to understand the trends in maternal mortality (1997–2017) between EAG and non EAG states in India and explore various household, economic and policy factors that may explain reduction in maternal mortality and improvement in maternal health outcomes in India. Methods This study triangulates data from different rounds of Sample Registration Systems to assess the trend in maternal mortality in India. It further analysed the National Family Health Surveys (NFHS). NFHS-4, 2015–16 has gathered information on maternal mortality and pregnancy-related deaths from 601,509 households. Using logistic regression, we estimate the association of various socio-economic variables on maternal deaths in the various states of India. Results On an average, wealth status of the households did not have a statistically significant association with maternal mortality in India. However, our disaggregate analysis reveals, the gains in terms of maternal mortality have been unevenly distributed. Although the rich-poor gap in maternal mortality has reduced in EAG states such as Bihar, Odisha, Assam, Rajasthan, the maternal mortality has remained above the national average for many of these states. The EAG states also experience supply side shortfalls in terms of availability of PHC and PHC doctors; and availability of specialist doctors. Conclusions The novel contribution of the present paper is that the association of household wealth status and place of residence with maternal mortality is statistically not significant implying financial barriers to access maternal health services have been minimised. This result, and India’s impressive performance with respect to maternal health outcomes, can be attributed to the various pro-poor policies and cash incentive schemes successfully launched in recent years. Community-level involvement with pivotal role played by community health workers has been one of the major reasons for the success of many ongoing policies. Policy makers need to prioritise the underperforming states and socio-economic groups within the states by addressing both demand-side and supply-side measures simultaneously mediated by contextual factors.

In India, sterilisation is the most frequent method of modern contraception, and is primarily used by women. The contemporaneous assessment of sterilisation literature focuses only on trends and patterns that are limited to socioeconomic considerations, ignoring the cohort and period issues. No study has employed Age Period Cohort (APC) analysis to highlight the effect of APC on a particular outcome to yet. We have used maximum entropy method modelling to analyse the individual influence of APC on female sterilisation in India using the four rounds of the National Family Health Survey (NFHS). While the older group had higher sterilisation rates than the younger cohort, the age effects were found to have a standard inverted U-shaped curve, with women sterilising in their mid-30s as the might have completed their desire family size. The analysis found high rural-urban differentials in utilising female sterilisation, highlighting the relevance of education and empowerment in contraceptive decision-making among the educated one. Female sterilisation has become less common among Muslims in India over time, and among uneducated women, and it has shifted to later ages with each succeeding period. This was determined to be concerning in terms of India's future fertility. Since 1947, the government has implemented numerous policies to provide women with a variety of contraceptive options; however, the dominance of female sterilisation throughout all periods demonstrates that the government's efforts to provide temporary methods were futile.

Background According to United Nations, 19% of females in the world relied only on the permanent method of family planning, with 37% in India according to NFHS-4. Limited studies tried to measure the sterilization regret, and its correlated factors. The study tried to explore the trend of sterilization regret in India from 1992 to 2015 and to elicit the determining effects of various factors on sterilization regret, especially in context to perceived quality of care in the sterilization operations and type of providers. Data and methods The pooled data from NFHS-1, NFHS-3 and NFHS-4 was used to explore the regret by creating interaction between time and all the predictors. Predicted probabilities were calculated to show the trend of sterilization regret amounting to quality of care, type of health provider at the three time periods. Results The sterilization regret was increased from 5 % in NFHS-1 to 7 % in NFHS-4. According to NFHS-4, for those whose sterilization was performed in private health facility the regret was found to be less (OR-0.937; 95% CI- (0.882–0.996)) compared to public health facility. Also, the results show a two-fold increase in regret when women reported bad quality of care. The results from predicted probabilities provide enough evidence that the regret due to bad quality of care in sterilization operation had increased with each subsequent round of NFHS. Conclusion Many socio-economic and demographic factors have influenced the regret, but the poor quality of care contributed maximum to the regret from 1992 to 2015. The health facilities have seriously strayed from improving the health and well-being of women in providing the family planning methods. In addition, to public facilities, the regret amounting to private facilities have also increased from NFHS-1 to 4. The quality of care provided in the family planning operation should be standardized in every hospital to strengthen the health systems in the country. The couple should be motivated to adopt more of spacing methods.

Background Food Insecurity (FI) is a crucial social determinant of health, independent of other socioeconomic factors, as inadequate food resources create a threat to physical and mental health especially among older person. The present study explores the associations between FI and cognitive ability among the aged population in India. Methods To measure the cognitive functioning we have used two proxies, word recall and computational problem. Descriptive analysis and multivariable logistic regression was used to understand the prevalence of word recall and computational problem by food security and some selected sociodemographic parameters. All the results were reported at 95% confidence interval. Results We have used the data from the first wave of longitudinal ageing study of India (LASI), with a sample of 31,464 older persons 60 years and above. The study identified that 17 and 5% of the older population in India experiencing computational and word recall problem, respectively. It was found that respondents from food secure households were 14% less likely to have word recall problems [AOR:0.86, 95% CI:0.31–0.98], and 55% likely to have computational problems [AOR:0.45, 95% CI:0.29–0.70]. We also found poor cognitive functioning among those experiencing disability, severe ADL, and IADL. Further, factors such as age, education, marital status, working status, health related factors were the major contributors to the cognitive functioning in older adults. Conclusion This study suggest that food insecurity is associated with a lower level of cognition among the elderly in India, which highlight the need of food policy and interventional strategies to address food insecurity, especially among the individuals belonging to lower wealth quintiles. Furthermore, increasing the coverage of food distribution may also help to decrease the burden of disease for the at most risk population. Also, there is a need for specific programs and policies that improve the availability of nutritious food among elderly.

Background According to the latest round of National Family Health Survey—4 (NFHS (2015–16)) maternal and child health care (MCH) services improved drastically compared to NFHS-3. Previous studies have established that the uptake of MCH services increases the likelihood of early adoption of contraceptives among women. So, our study aims to examine if the early initiation of contraceptive has proportionately improved with the recent increase in MCH services. Methods This study used the reproductive calendar of NFHS-4, 2015–16, to evaluate contraceptive initiation within 12 months after the last birth among 1,36,962 currently married women in India. A complementary log-log regression model was created to examine the link between the time of initiation of contraception and MCH care at the national level. Results It was found that only a quarter of women within 12 months from last birth have adopted the modern contraceptive method. Among those majority of the females adopted sterilization mostly at the time of birth. The multivariable model identified, that the period of initiation of contraceptive depends on the gender composition of children and access to MCH services. It was found that the odds of early initiation of contraceptive use was higher when a women have only son (AOR = 1.15,95% CI– 1.22, 1.18) compared to women with only daughter. Also, it was found that women who have availed MCH services were more likely to adopt contraceptives earlier. Conclusion The number of women availing MCH services has increased in India, but it did not result in a proportional increase in initiation of contraception after childbirth. Facilitating family planning services alongside MCH services will be beneficial in low-resource settings. It is a golden opportunity to educate and encourage women for early adoption of contraceptive.