Background Cesarean section (CS) delivery rate has increased significantly both globally and in India, thereby posing a burden on overstretched health systems. Objective This study plans to understand the factors associated with CS rate with an objective to (1) analyze the trends of CS delivery from 1998-99 to 2019-21 and (2) understand the proximate determinants of CS deliveries in India. Methods Analysis of secondary data (National Family Health Survey) of a nationally representative sample of 230,870 women (year 2019-21) was undertaken to explore the trends, distribution, and determinants of CS deliveries in India and within states. Multivariable analyses were performed to determine the proximate variables associated with CS and elective CS. The relative interaction effect of confounding factors, such as number of antenatal care (ANC) visits, place of residence, and wealth status, on cesarean delivery was assessed. A composite index was generated using trust, support, and intimate partner violence variables (termed the partner human capital index [PHI]) to study its influence on CS deliveries, with a low PHI indicating abusive partner and a high PHI indicating supportive partner. Statewise spatial distribution of the most significantly associated factors, namely, wealth quintile and ANC checkups, were also analyzed. Results The overall prevalence of CS was 21.50% (49,634/230,870) which had risen from 16.72% (2312/13,829) in 1998-99. The adjusted odds of CS deliveries were significantly higher among women who were highly educated (odds ratio [OR] 7.30, 95% CI 7.02-7.60; P<.001), had 4 or more ANC visits (OR 2.28, 95% CI 2.15-2.42; P<.001), belonging to the high-wealth quintile (OR 7.87, 95% CI 7.57-8.18; P<.001), and from urban regions. Increasing educational level of the head of the household (OR 3.05, 95% CI 2.94-3.16; P<.001) was also found to be a significant determinant of CS deliveries. The odds of selection of elective and emergency CS were also significantly higher among women from richer families (OR 1.66, 95% CI 1.25-2.21; P<.001) and those belonging to Christian religion (OR 1.67, 95% CI 1.14-2.43; P=.008). Adjusting the cesarean delivery by PHI, the odds of outcome were significantly higher among women with moderate and high PHI compared with those with low PHI (OR 1.46, 95% CI 1.36-1.56 and OR 1.61, 95% CI 1.49-1.74, respectively; P<.001 for both). The interaction effect result reiterates that women with more than 4 ANC checkups, high PHI, and belonging to the richer wealth quintile were more likely to undergo cesarean delivery (OR 22.22, 95% CI 14.99-32.93; P<.001) compared with those with no ANC visit, low PHI, and poorest women. Conclusions The increasing trend of CS deliveries across India is raising concerns. Better education, wealth, and good support from the partner have been incriminated as the contributory factors. There is a need to institute proper monitoring mechanisms to assess the need for CS, especially when performed electively.

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This study is on caste inequality in child health outcomes: mortality, malnutrition and anaemia for the year 1998/99 to year 2019/21 and examines the association of socio-economic factors with outcomes. Disparity ratio (DR) and Concentration Index (CI) are computed to examine inequality in outcomes. The association of socio-economic factors was modelled using logit regression. The study finds marginalised group were more likely to have poor health outcomes. The disparity ratio found increased among SC and ST compared to Others during 1998-99 and 2019-21. The value of the concentration index was found high on U5MR among SC and ST. Among SC and ST, the child health outcome greatly varies for poorest and richest. Odds ratio is 40-60 per cent higher for SC and ST compared to children belonging to Others. On socio-economic factors; land ownership and wealth status contribute significantly but house ownership not so. Caste-based inequality is still impacting health and nutrition of children in the country. The more focused inclusive policy and clustering of marginalised groups at regional level can be helpful in improving health and nutrition of marginalised children concentrated in different regions with equity lens to push the SDG Goals.

Maternal morbidity and mortality during pregnancy and childbirth is a serious concern in developing countries. The failure of women to discuss their reproductive health problems leads to less attention being given to healthcare for gynaecological and reproductive morbidities (GARMs). Intra-familial relations and empowerment specifically on GARMs may contribute to identifying determinants of healthcare in rural areas. Data from Primary Field Survey (N= 660) conducted during Feb-June, 2015 in 12 villages of Nalanda, Bihar, was accessed in order to identify the underlying determinants motivating women to seek advice or treatment for GARMs. The bivariate, logistic regression, and simultaneous equation modelling were used to achieve the objectives of the study. The GARMs related to female genital organs and menstrual cycle (56%) followed by menstrual disorder (53%), and prolapse (48%) was found to be the most common among rural women in Bihar. By drawing attention to intra-familial relations and promoting women to interact on GARMs may reduce maternal morbidity or death, particularly in rural India.Keywords Gynecological and reproductive morbidities; Empowerment; intra-familial relations; rural India IntroductionChildbirth can lead to gynaecological and reproductive morbidities (GARMs) if not managed properly. The World Health Organization International Classification of Diseases (ICD-10) confirms morbidities such as female genital prolapse, menstruation disorder, pain and other conditions associated with female genital organs and menstrual cycle, pregnancy with abortive outcome, pregnancy and childbirth puerperium, maternal hypotension syndrome, complication of labour and delivery disorder venous puerperium disorder, infections of breast associated with childbirth, perinatal period disorder are common among women at disadvantaged sites. Earlier studies confirm that fewer morbidities have been studies but majority of them have wider scope of research especially in rural settings. The menstrual disorder, and pre-eclampsia are among those which has been studied. Studies on eclampsia indicate there are 2-3 cases per 10000 births in Europe while cases in developing countries tend to be 10-30 times more common than in high income countries. (Duley, 2009). Other studies showed that nutrition and body mass index (Fujiwara & Nakata, 2010;Vyver, Steinegger, & Katzman, 2008) show that complications such as polycystic ovary syndrome and infertility (Lambert-Messerlian et al., 2011) & Steege, 1996), and limitations on attendance from regular day to day life and missed activities (Houston et al., 2006;Kadir, Edlund, & Von Mackensen, 2010). The studies on healthcare for GARMs include the medication of such disorders (Ganzevoort et al., 2005;Visser & Wallenburg, 1995;Walker, Greer, & Calder, 1983;Walraven et al., 2002) but mostly from developed region. The case in rural India is slightly exceptional and it becomes even more complicated in patriarchal society where despite the role of health care at home women cannot decide to ...