Investment in family planning (FP) provides returns through a lifetime. Global evidence shows that FP is the second-best buy in terms of return on investment after liberalizing trade. In this study, we estimate the cumulative benefits of FP investments for India from 1991 to 2016 and project them up to 2061 with four scenarios of fertility levels. The findings suggest that India will have greater elasticity of FP investments to lifetime economic returns compared to the world average (cost–revenue ratio of 1:120). We have taken four scenarios for the goalpost, viz., 2.1, 1.8, 1.6, and 1.4. Although different scenarios of total fertility rate (TFR) levels at the goalpost (i.e., the year 2061) offer varied lifetime returns from FP, scenario TFR < 1.8 will be counterproductive and will reduce the potential benefits. With a comprehensive approach, if the country focuses more on improving the quality of FP services and on reducing the unmet need for FP to enhance reproductive health care and expand maximum opportunities for education and employment for both women and men, it can improve its potential to reap more benefits.

Introduction The continuum of care (CoC) throughout pregnancy, delivery and post-delivery has recently been highlighted as an integrated intervention programme for maternal, new-born, and child health. Existing literature suggests the importance of continuum of care (CoC) for improved maternal and child health outcomes. However due to unavailability of data at the lowest administrative levels, literature on spatial pattern of uptake of full CoC is lacking. The present study attempts to focus on the spatial analysis of CoC in maternal health care in India. Data and methods The study is based on the fourth round of National Family Health Survey data conducted in 2015–16 in India. The outcome variable used is maternal health continuum of care which includes- at least 4 ANC visits, delivery through skilled birth attendant and postnatal check-up within 48 hours of delivery. Univariate and bivariate Local Indicator of Spatial Association (LISA) maps have been generated to show the spatial pattern of CoC across 640 districts in India. We also employed spatial regression techniques to explore the determinants of CoC. Findings Percentage of women who followed full CoC was observed to be least for East Kameng (0.0%) district of Arunachal Pradesh and highest in North Goa district (90.4%). Majority of districts where uptake of full CoC was more than 80 percent were found concentrated in southern region on India. Equivalently, findings indicated a strong spatial clustering of full CoC with high-high clusters mostly concentrated in southern districts. Low-low district clusters are concentrated in the states of Uttar Pradesh, Bihar and Madhya Pradesh. For complete CoC the global Moran’s I is 0.73 indicating the spatial dependence. The spatial regression analysis suggested that modern contraceptive use, meeting with health worker, urbanization and secondary or above education for women have positive impact on the utilisation of CoC. Conclusion The spatial pattern indicates district level clustering in uptake of CoC among women. The study suggests policymakers and stakeholders to implement comprehensive interventions at sub-regional levels for ensuring the completion of CoC for women which acts as a preventive measure for adverse outcomes such as-maternal and child mortality.

The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among female sex workers (FSWs) are not well known in low prevalence states showing rising trends within the HIV epidemic. This paper studies these attributes among FSWs in three north (Punjab, Rajasthan and Uttar Pradesh) and one east Indian states (Jharkhand). Integrated Biological and Behavioural Surveillance (IBBS) data, collected from 4491 FSWs in the study states, were analysed, with HIV status as the dependent variable and several socio-demographic, sex work, knowledge and agency characteristics as independent variables. Multivariate analysis found a number of factors such as age above 25 years (adjusted odds ratio [AOR] 5.0, 95% confidence interval [CI] 1.4–18.1), client solicitation in rented rooms (AOR 2.8, 95% CI 1.2–6.4) and the use of mobile phones for client solicitation (AOR 5.1, 95% CI 1.6–16.0) to be significantly associated with HIV risk. The study found low levels of HIV programme services uptake and HIV/AIDS knowledge among FSWs in the study states. There is an urgent need to focus on these risk factors for improving the effectiveness of the ongoing HIV prevention efforts and attaining the ‘Sustainable Development Goals’ goal of ‘Ending the AIDS epidemic’ by 2030.

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