Effects of short birth spacing on birth-order differences in child stunting: Evidence from India

Prevalence of short inter-birth intervals and associated factors among women of reproductive age: evidence from a nationally representative survey in Tanzania

INTRODUCTION

Short inter-birth intervals negatively impact maternal and child health; however, data on their prevalence and associated factors in Tanzania are limited. This study investigates the prevalence of short inter-birth intervals and the associated factors among women of reproductive age in Tanzania.

METHODS

This was a cross-sectional study utilizing the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey dataset. The study population included women aged 15-49 years with at least two births within five years preceding the survey. A short inter-birth interval was defined as a birth occurring < 33 months after the preceding birth. A generalized linear model with Poisson as a link and robust standard errors was used to examine factors associated with short inter-birth intervals. A p-value < 0.05 was considered statistically significant.

RESULTS

A total of 8,350 births from 6,034 women were included in this analysis. The mean (± SD) age of the women was 31.6 ± 6.8 years. The overall prevalence of short inter-birth intervals was 42.6%. Younger age (aPR 3.12, 95% CI 2.88-3.52 for age 15-24 years, and aPR 1.74, 95% CI 1.62-1.1.86 for age 25-34 years), being married (aPR 1.27, 95% CI 1.03-1.57), late age at first childbirth (aPR 1.24, 95% CI 1.17-1.32) for a 20-24 years and aPR 1.55, 95% CI 1.39-1.73 for ≥ 25 years), and higher birth order (aPR 1.02, 95% CI 1.03-1.19; aPR 1.24, 95% CI 1.14-1.34; aPR 1.72, 95% CI 1.58-1.86 for 3rd, 4th, and 5th or more birth orders, respectively, compared to 2nd birth order) were independently associated with short inter-birth intervals. Additionally, there was significant variation in the prevalence of short inter-birth intervals across different zones and levels of household wealth. Women from richer (aPR 0.87, 95% CI: 0.80-0.95) and richest (aPR 0.84, 95% CI: 0.74-0.94) households exhibited a lower prevalence of short inter-birth intervals.

CONCLUSION

This study highlights the significant prevalence of short inter-birth intervals among women of reproductive age in Tanzania. The associated factors include younger age, marital status, delayed first childbirth, higher birth order, geographical disparities, and lower household wealth. These findings highlight the need for targeted interventions to promote birth spacing and improve maternal and child health outcomes.

Who actualizes postpartum contraceptive intentions? A trajectory cluster analysis

Contraceptive intention is an important woman-centered indicator for family planning. Yet, few studies have examined the determinants of women or couples actualizing their contraceptive intentions. We leverage panel data from the Performance Monitoring for Action (PMA) survey in Ethiopia to examine these dynamics among a pregnancy cohort, over the first year postpartum. Using cluster analysis on intent-to-use trajectories, we find distinct patterns across wealth categories, education levels, and regions. Additionally, we find that receiving family planning counseling in both antenatal and postnatal care visits led to a higher likelihood of intending to use. However, counseling did not increase the odds of actualization. We argue that examining actualization through model-based approaches like cluster analysis generates better insight into woman-centered contraceptive demand and provides stronger evidence for strengthening postpartum family planning interventions, than quantifying contraceptive use alone. Modeling postpartum actualization trajectories can shed light on the barriers to women's and couple's reproductive autonomy and inform future investments in both upstream development of better contraceptive methods and downstream implementation.

Baby bump? Birth month, family income, and early childhood development

Federal and state laws in the U.S. provide families with babies born just before the end of the year with thousands of dollars in tax savings. Because this income windfall is realized during the first few months of a newborn's life, we assess whether babies born in December experience developmental advantages in early childhood compared to those born right after the New Year. Using data from the Child Development Supplement of the Panel Study of Income Dynamics and the Children of the National Longitudinal Survey of Youth, we implement a regression discontinuity design that exploits variation in birth timing. We first illustrate that the tax savings received by families with end of year babies are substantial. We then show that while children born in December have a weight disadvantage at birth compared to those born in January, they have an average weight-gain advantage of between 0.7 and 1.5 pounds (0.08-0.17 standard deviations) during subsequent follow-up interviews. We also find that end-of-year babies reach early developmental milestones faster, but exhibit no advantage in memory, word recognition, or applied problem solving. This end-of-year birth developmental advantage is consistent with the identified tax savings from end-of-year births.

Maternal Complications during Pregnancy and Risk Factors for Stunting

Background

Stunting can be prevented by early detection when the mother is pregnant. Early detection can be carried out by looking for risk factors of stunting during pregnancy so that interventions can be early detected. This study aims to assess complications during pregnancy (disease and infection) and risk factors associated with stunting.

Materials and Methods

The type of research was observational analytic with a case-control design on 450 mothers who were selected with simple random sampling (150 mothers who have stunting babies aged 0-2 months and 300 mothers who have not stunting babies aged 0-2 months in Malang Regency, Indonesia. This study used secondary data by looking at medical records, namely, laboratory examinations in the mother's book and cohort records at the public health center. This study was conducted from December 2021 to August 2022. Bivariate analysis with Chi-square and multivariate logistic regression was carried out to determine the variables that most influenced the incidence of stunting.

Results

The results of multivariate analysis with logistic regression of maternal complications during pregnancy, which are a risk as a factor causing stunting, are Sexually Transmitted Infections (STIs) (Odds Ratio [OR]: 6.36; 95% Confidence Interval [CI]: 2.97-13.62), coronavirus disease 2019 (COVID-19) accompanied by pneumonia (OR: 5.12; 95% CI: 1.87-14.052), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (OR: 4.63; 95% CI: 1.10-19.59), hepatitis B (OR: 3.97; 95% CI: 1.253-12.565), pre-eclampsia (OR: 3.88; 95% CI: 1.81-8.30), and heart disease (OR: 3.373; 95% CI: 0.99-11.40).

Conclusions

After recognizing the maternal factors that cause stunting, intervention should immediately be carried out on pregnant women with diseases (pre-eclampsia and heart disease) and infections (STI, COVID-19 + pneumonia, HIV/AIDS, and hepatitis B) to prevent stunting early.

Geographical altitude and stunting among children aged under 5 years in India

Introduction

Previous studies have found positive associations between higher geographical altitude and increased risk of stunting in children under 5 years old, but little evidence exists on this relationship in the Indian context specifically. Chronic exposure to high altitudes can impair food security, healthcare access, oxygen delivery and nutrient absorption, potentially increasing malnutrition.

Objective

To investigate the association between geographical altitude and stunting among children aged under 5 years in India.

Methods

Using data from the 2015-2016 National Family Health Survey, logistic regression was conducted to estimate the relationship between altitude and stunting, adjusting for child, maternal and household characteristics. The analysis included over 167 555 children under 5 years old.

Results

Children at higher altitudes had a significantly greater risk of stunting. Those at >2000+ metres had 40% higher adjusted odds of stunting than children below 1000 metres. The altitude-stunting association was stronger among rural children.

Conclusions

This study provides robust evidence that higher geographical altitude is an important risk factor for stunting among young children in India, especially those in rural areas. Targeted interventions to improve food security, healthcare access and nutrition in high-altitude regions could help to mitigate the higher burden of stunting in these areas.

Birth order and children's health and learning outcomes in India

India has a high prevalence of stunting among children under five years of age, despite marginal improvement over the years. In 2019-21, 35.5 per cent of children below five years were stunted (National Family Health Survey (NFHS), 2019-21). This has been attributed to several factors including open defecation, poor maternal nutrition and food insecurity. This paper examines if the birth order of children is associated with variation in height among them, using nationally representative data from the India Human Development Survey (IHDS 2005 & 2011). The objectives of this paper are to: (i) assess the association of a child's birth order with height (ii) test if the association of birth order with height changes with the degree of son preference (iii) analyse the relationship between birth order and educational outcomes of children. Our results suggest that (i) the height-for-age z score is negatively associated with the birth order of the child (ii) the negative association of birth order with height is stronger for mothers who have a moderate or high degree of son preference, especially when children have an older brother (iii) maternal characteristics such as education could mitigate the negative relationship between birth order and height when son preference is low but not when son preference is high (iv) birth order has a negative association with the reading, writing and mathematical ability of children, especially if the child was stunted in childhood. This indicates that the fertility behaviour of families has both a direct and an indirect impact, which could influence both long term nutrition and education of children.

Predictors of height in Romanian infants 6-23 months old: findings from a national representative sample

BACKGROUND

The research explored the association between infants' height and various demographic factors in Romania, a country where such critical information has been lacking.

METHODS

This study was conducted on a nationally representative sample and used a family physicians database to determine a sample of 1532 children (713 girls and 819 boys) 6-23 months of age (M = 14.26; SD = 5.15). Infants' height-for-age z-scores (HAZ) were calculated using the World Health Organization's computing algorithm. A multiple regression analysis was conducted to investigate whether certain risk factors, such as infant mother's age, location, marital status, socioeconomic status (SES), as well as infant's term status at birth, age, anemia, minimum dietary diversity (MDD) and birth order, could significantly predict the HAZ.

RESULTS

The study identified several significant predictors of height. Specifically, lower HAZ was associated with rural living, preterm birth, age 18-23 months, unmarried mothers, anemia, lack of MDD and being third or later born in the family. In contrast, higher HAZ was associated with medium or high maternal SES and older maternal age.

CONCLUSIONS

The study underscores the importance of addressing these significant risk factors through distinct interventions to improve height outcomes in at-risk Romanian populations.

Exploring the paradox of Muslim advantage in undernutrition among under-5 children in India: a decomposition analysis

BACKGROUND

While there is a substantial body of research on inequalities in child nutrition along the axes of gender and socioeconomic gradient, the socio-religious differences in health and nutrition outcomes remain grossly understudied. The handful of studies on the socio-religious differential in child health outcomes has found a Muslim advantage in chances of survival and nutritional status over Hindus despite their comparatively lower socioeconomic status, which undeniably warrants investigating the pathways through which this paradoxical Muslim advantage manifests.

METHODS

Using data from the National Family Health Survey, 2015-16, we quantify the inter-group differentials in child undernutrition (stunting, wasting, and underweight) between Muslims and caste-disaggregated Hindus. We further decompose the gap to delineate its major contributory factors by employing Fairlie's decomposition method.

RESULTS

The analysis revealed that, compared to the Hindus as an aggregated group, Muslims have a higher rate of stunting and lower rates of wasting and being underweight. However, the differences get altered when we disaggregate the Hindus into high and low castes. Muslims have a lower prevalence of all three measures of undernutrition than the low-caste Hindus and a higher prevalence of stunting and underweight than the high-caste Hindus, consistent with their levels of socioeconomic status. However, the prevalence of wasting among Muslim children is lower than among high-caste Hindus. This nutritional advantage is paradoxical because Muslims' relatively poorer socioeconomic status compared to high-caste Hindus should have disadvantaged them. In the decomposition analysis, the Muslim advantage over the low-caste Hindus could only be partially attributed to the former's better economic status and access to sanitation. Moreover, the poor performance of Muslim children compared to the high-caste Hindus in stunting and underweight could mainly be explained by the religious differentials in birth order, mother's education, and wealth index. However, Muslim children's comparatively better performance in wasting than the high-caste Hindus remained a puzzle.

CONCLUSION

The Muslim advantage over high-caste Hindus in wasting and low-caste Hindus in all the indicators of undernutrition may have been rendered by certain 'unobserved' behavioural and cultural differences. However, further exploration is needed to make a definitive claim in this respect.

Early-childhood linear growth faltering in low- and middle-income countries

Globally, 149 million children under 5 years of age are estimated to be stunted (length more than 2 standard deviations below international growth standards)1,2. Stunting, a form of linear growth faltering, increases the risk of illness, impaired cognitive development and mortality. Global stunting estimates rely on cross-sectional surveys, which cannot provide direct information about the timing of onset or persistence of growth faltering-a key consideration for defining critical windows to deliver preventive interventions. Here we completed a pooled analysis of longitudinal studies in low- and middle-income countries (n = 32 cohorts, 52,640 children, ages 0-24 months), allowing us to identify the typical age of onset of linear growth faltering and to investigate recurrent faltering in early life. The highest incidence of stunting onset occurred from birth to the age of 3 months, with substantially higher stunting at birth in South Asia. From 0 to 15 months, stunting reversal was rare; children who reversed their stunting status frequently relapsed, and relapse rates were substantially higher among children born stunted. Early onset and low reversal rates suggest that improving children's linear growth will require life course interventions for women of childbearing age and a greater emphasis on interventions for children under 6 months of age.

Cultural and Contextual Drivers of Triple Burden of Malnutrition among Children in India

This study examines malnutrition's triple burden, including anaemia, overweight, and stunting, among children aged 6-59 months. Using data from the National Family Health Survey-5 (2019-2021), the study identifies risk factors and assesses their contribution at different levels to existing malnutrition burden. A random intercept multilevel logistic regression model and spatial analysis are employed to identify child, maternal, and household level risk factors for stunting, overweight, and anaemia. The study finds that 34% of children were stunted, 4% were overweight, and 66% were anaemic. Stunting and anaemia prevalence were higher in central and eastern regions, while overweight was more prevalent in the north-eastern and northern regions. At the macro-level, the coexistence of stunting, overweight, and anaemia circumstantiates the triple burden of childhood malnutrition with substantial spatial variation (Moran's I: stunting-0.53, overweight-0.41, and anaemia-0.53). Multilevel analysis reveals that child, maternal, and household variables play a substantial role in determining malnutrition burden in India. The nutritional health is significantly influenced by a wide range of determinants, necessitating multilevel treatments targeting households to address this diverse group of coexisting factors. Given the intra-country spatial heterogeneity, the treatment also needs to be tailor-made for various disaggregated levels.

Analyzing determinants from both compositional and contextual level impeding desired linear growth of children in Indian context

Childhood stunting is recognized as significant public health concern in India. It is a form of malnutrition with impaired linear growth and creates a range of adversaries among children, including under-5 mortality, morbidity, and physical and cognitive growth. The purpose of the present study was to recognize the various leading determinants causing childhood stunting from both individual and contextual level in Indian context. Data were obtained from the India's Demography and Health Survey (DHS) conducted in 2019-2021. A total of 1, 46,521 children aged 0-59 months were included in this present study. The study applied a multilevel mixed-effect logistic regression model in which individual factors nested within community based contextual-level factors estimating the likelihood of childhood stunting phenomena among Indian children. The variance explained in full model accounted for about 35.8% of the odds of stunting across the communities. The present study elucidates that the recognized factors from individual level characteristics have really increased the odds of childhood stunting: gender of child, multiple births, low birth weight, low BMI among mothers, less educational attainment by mothers, maternal anemic status, breast feeding duration longer than usual, < 4 antenatal care (ANC) visits during gestation period. Similarly, contextual-level factors like rural places of residence, western Indian children, and communities with high poverty rates, lower literacy rates, improper sanitation, and unsafe drinking water were also found to have a significant positive association with childhood stunting. The study finally concludes that cross level interaction between individual and contextual-level factors are identified as significant determinants of linear growth retardation among child in India. In order to reduce this type of malnutrition among the child one should more concentrate on both individual and contextual-level factors as a notable reasons.

Estimating the impact of birth interval on under-five mortality in east african countries: a propensity score matching analysis

BACKGROUND

Under-five mortality remains a global public health concern, particularly in East African countries. Short birth interval is highly associated with under-five mortality, and birth spacing has a significant effect on a child's likelihood of survival. The association between short birth intervals and under-five mortality was demonstrated by numerous observational studies. However, the effect of short birth intervals on under-five mortality has not been investigated yet. Therefore, this study aimed to investigate the impact of short birth intervals on under-five mortality in East Africa using Propensity Matched Analysis.

METHODS

A secondary data analysis was conducted based on the most recent Demographic and Health Survey (DHS) data of 12 East African countries. A total weighted sample of 105,662 live births was considered for this study. A PSM analysis was carried out to evaluate the effect of short birth intervals on under-five mortality. Under-five mortality was the outcome variable, while the short birth interval was considered a treatment variable. To determine the Average Treatment Effect on the population (ATE), Average Treatment Effect on the treated (ATT), and Average Treatment Effect on the untreated (ATU), we performed PSM analysis with a logit-based model using the psmatch2 ate STATA function. The quality of matching was assessed statistically and graphically. The common support assumption was checked and fulfilled. We have employed Mantel-Haenszel bounds to examine whether the result would be free from hidden bias or not.

RESULTS

The prevalence of short birth intervals in East Africa was 44%. The under-five mortality rate among mothers who had optimal birth intervals was 39.9 (95% CI: 38.3, 41.5) per 1000 live births while it was 60.6 (95% CI: 58.5, 62.8) per 1000 live births among mothers who had a short birth intervals. Propensity score matching split births from mothers into treatment and control groups based on the preceding birth interval. In the PSM analysis, the ATT values in the treated and control groups were 6.09% and 3.97%, respectively, showed under-five mortality among births to mothers with short birth intervals was 2.17% higher than births to mothers who had an optimal birth interval. The ATU values in the intervention and control groups were 3.90% and 6.06%, respectively, indicating that for births from women who had an optimal birth interval, the chance of dying within five years would increase by 2.17% if they were born to mother with short birth interval. The final ATE estimate was 2.14% among the population. After matching, there was no significant difference in baseline characteristics between the treated and control groups (p-value > 0.05), which indicates the quality of matching was good.

CONCLUSIONS

We conclude that enhancing mothers to have optimal birth spacing is likely to be an effective approach to reducing the incidence of under-five mortality. Our findings suggest that births to mothers with short birth intervals have an increased risk of death in the first five years of life than births to mothers who had an optimal birth interval. Therefore, public health programs should enhance interventions targeting improving birth spacing to reduce the incidence of under-five mortality in low-and middle-income countries like East African countries. Moreover, to achieve a significant reduction in the under-five mortality rate, interventions that encourage birth spacing should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets in East African countries.

Assessing the effects of duration of birth interval on adverse pregnancy outcomes in sub-Saharan Africa: a propensity score-matched analysis

OBJECTIVES

Unlike high-income countries, sub-Saharan African countries have the highest burden of adverse pregnancy outcomes such as abortion, stillbirth, low birth weight and preterm births. The WHO set optimal birth spacing as a key strategy to improve pregnancy outcomes. Estimating the impact of short and long birth intervals on adverse pregnancy outcomes based on an observational study like the Demographic and Health Survey (DHS) is prone to selection bias. Therefore, we used the propensity score-matched (PSM) analysis to estimate the actual impact of short and long birth intervals on adverse pregnancy outcomes.

DESIGN

A community-based cross-sectional study was conducted based on the DHS data.

SETTING

We used the recent DHS data of 36 sub-Saharan African countries.

PARTICIPANTS

A total of 302 580 pregnant women for stillbirth and abortion, 153 431 for birth weight and 115 556 births for preterm births were considered.

PRIMARY OUTCOME MEASURES

To estimate the impact of duration of birth interval (short/long) on adverse pregnancy outcomes, we used PSM analysis with logit model using psmatch2 ate STATA command to find average treatment effect on the population (ATE), treated and untreated. The quality of matching was assessed statistically and graphically. Sensitivity analysis was conducted to test the robustness of the PSM estimates using the Mantel-Haenszel test statistic.

RESULTS

The prevalence of short and long birth intervals in sub-Saharan Africa was 46.85% and 13.61%, respectively. The prevalence rates of abortion, stillbirth, low birth weight, macrosomia, and preterm births were 6.11%, 0.84%, 9.63%, 9.04%, and 4.87%, respectively. In the PSM analysis, the differences in ATE of short birth intervals on abortion, stillbirth, low birth weight, and preterm births were 0.5%, 0.1%, 0.2%, and 0.4%, respectively, and -2.6% for macrosomia. The difference in ATE among the treated group was 1%, 1%, and 1.1% increased risk of abortion, low birth weight, and preterm births, respectively, while there was no difference in risk of stillbirth between the treated and control groups. The ATEs of long birth intervals on abortion, stillbirth, low birth weight, macrosomia and preterm births were 1.3%, 0.4%, 1.0%, 3.4%, and 0.2%, respectively. The ATE on the treated group had 0.9%, 0.4%, 2.4%, 2.8%, and 0.2% increased risk of abortion, stillbirth, low birth weight, macrosomia, and preterm births, respectively. The estimates were insensitive to hidden bias and had a good quality of matching.

CONCLUSION

Short and long birth intervals had a significant positive impact on stillbirth, abortion, low birth weight, macrosomia and preterm births after matching treated and control groups by observed variables. These findings highlighted maternal and newborn healthcare programmes and policies to empower reproductive-aged women to exercise optimal birth spacing to reduce the incidence of stillbirth, abortion, low birth weight, macrosomia and preterm births.

Relationship between Birth Order and Postnatal Growth until 4 Years of Age: The Japan Environment and Children’s Study

Later-borns tend to be shorter than first-borns in childhood and adulthood. However, large-scale prospective studies examining growth during infancy according to birth order are limited. We aimed to investigate the relationship between birth order and growth during the first 4 years of life in a Japanese prospective birth cohort study. A total of 26,249 full-term singleton births were targeted. General linear and multivariable logistic regression models were performed and adjusted for birth weight, parents’ heights, maternal age at delivery, gestational weight gain, maternal smoking and alcohol drinking status during pregnancy, household income, breastfeeding status, and Study Areas. The multivariate adjusted mean length Z-scores in “first-borns having no sibling”, “first-borns having siblings”, “second-borns”, and “third-borns or more” were −0.026, −0.013, 0.136, and 0.120 at birth and −0.324, −0.330, −0.466, and −0.569 at 10 months, respectively. Results similar to those at 10 months were observed at 1.5, 3, and 4 years. The adjusted odds ratios (95% confidence intervals) of short stature at 4 years in “first-borns having siblings”, “second-borns”, and “third-borns or more” were 1.08 (0.84–1.39), 1.36 (1.13–1.62), and 1.50 (1.20–1.88), respectively, versus “first-borns having no sibling”. Birth order was significantly associated with postnatal growth and may be a factor predisposing to short stature in early childhood.

Interpregnancy Interval and Child Health Outcomes in India: Evidence from Three Recent Rounds of National Family Health Survey

INTRODUCTION

Short interpregnancy interval (IPI) is a well-known risk factor for preterm births and low birth weights. However, research on the association between interpregnancy interval (IPI) and health outcomes in children under age 5 is limited in India. We examined the associations between IPI and five child health outcomes in India.

METHODS

We used nationally representative cross-sectional data from three rounds of National Family Health Survey (NFHS) conducted in India during 2005-06, 2015-16 and 2019-21 to examine the associations between IPI [categorized as < 12 months, 12-17 months, 18-23 months (ref), 24-35 months, and 36-59 months] and five child health outcomes - neonatal mortality, postneonatal mortality, diarrhea and/or acute respiratory infections (ARI), stunting, and underweight, for the total sample and, secondarily, using sex-stratified analyses. We used multivariable and mother fixed-effects binary logistic regressions to examine the associations.

RESULTS

3% and 2% of infants died during the neonatal and postneonatal period, respectively. Thirteen, 40, and 37% of children had diarrhea and/or ARI, were stunted, and were underweight, respectively. IPI < 12 months was associated with higher odds of diarrhea and/or ARI (OR: 1.11; 95% CI: 1.05-1.18), stunting (OR: 1.13; 95% CI: 1.08-1.18) and underweight (OR: 1.06; 95% CI: 1.01-1.11). Mother fixed-effects adjustments confirmed these associations and also found that births with IPI of 12-17 months and 36-59 months had higher odds of stunting, and IPI of 12-17 months was also associated with higher odds of underweight.

DISCUSSION

Our findings indicate that IPIs shorter than 12 months are a risk factor for diarrhea and/or ARI, and IPIs shorter than 12 months and 12-17 months are risk factors for stunting and underweight among children under 5 in India. Mother fixed-effects models allowed us to adjust our estimates for unobserved heterogeneity; this has rarely been done before. Increases in birth spacing may improve child health outcomes in India.

Role of maternal and child health services on the uptake of contraceptive use in India: A reproductive calendar approach

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.

Emerging Concepts in Innate Lymphoid Cells, Memory, and Reproduction

Members of the innate immune system, innate lymphoid cells (ILCs), encompass five major populations (Natural Killer (NK) cells, ILC1s, ILC2s, ILC3s, and lymphoid tissue inducer cells) whose functions include defense against pathogens, surveillance of tumorigenesis, and regulation of tissue homeostasis and remodeling. ILCs are present in the uterine environment of humans and mice and are dynamically regulated during the reproductive cycle and pregnancy. These cells have been repurposed to support pregnancy promoting maternal immune tolerance and placental development. To accomplish their tasks, immune cells employ several cellular and molecular mechanisms. They have the capacity to remember a previously encountered antigen and mount a more effective response to succeeding events. Memory responses are not an exclusive feature of the adaptive immune system, but also occur in innate immune cells. Innate immune memory has already been demonstrated in monocytes/macrophages, neutrophils, dendritic cells, and ILCs. A population of decidual NK cells characterized by elevated expression of NKG2C and LILRB1 as well as a distinctive transcriptional and epigenetic profile was found to expand during subsequent pregnancies in humans. These cells secrete high amounts of interferon-γ and vascular endothelial growth factor likely favoring placentation. Similarly, uterine ILC1s in mice upregulate CXCR6 and expand in second pregnancies. These data provide evidence on the development of immunological memory of pregnancy. In this article, the characteristics, functions, and localization of ILCs are reviewed, emphasizing available data on the uterine environment. Following, the concept of innate immune memory and its mechanisms, which include epigenetic changes and metabolic rewiring, are presented. Finally, the emerging role of innate immune memory on reproduction is discussed. Advances in the comprehension of ILC functions and innate immune memory may contribute to uncovering the immunological mechanisms underlying female fertility/infertility, placental development, and distinct outcomes in second pregnancies related to higher birth weight and lower incidence of complications.

Siblings and Early Childhood Development: Evidence from a Population-Based Cohort in Preschoolers from Shanghai

(1) Background: The current study aims to investigate the association between the presence of a sibling and early childhood development (ECD). (2) Methods: Data were obtained from a large-scale population-based cohort in Shanghai. Children were followed from three to six years old. Based on birth order, the sample was divided into four groups: single child, younger child, elder child, and single-elder transfer (transfer from single-child to elder-child). Psychosocial well-being and school readiness were assessed with the total difficulties score from the Strengths and Difficulties Questionnaire (SDQ) and the overall development score from the early Human Capability Index (eHCI), respectively. A multilevel model was conducted to evaluate the main effect of each sibling group and the group × age interaction effect on psychosocial well-being and school readiness. (3) Results: Across all measures, children in the younger child group presented with lower psychosocial problems (β = −0.96, 95% CI: −1.44, −0.48, p < 0.001) and higher school readiness scores (β = 1.56, 95% CI: 0.61, 2.51, p = 0.001). No significant difference, or marginally significant difference, was found between the elder group and the single-child group. Compared to the single-child group, the single-elder transfer group presented with slower development on both psychosocial well-being (Age × Group: β = 0.37, 95% CI: 0.18, 0.56, p < 0.001) and school readiness (Age × Group: β = −0.75, 95% CI: −1.10, −0.40, p < 0.001). The sibling-ECD effects did not differ between children from families of low versus high socioeconomic status. (4) Conclusion: The current study suggested the presence of a sibling was not associated with worse development outcomes in general. Rather, children with an elder sibling are more likely to present with better ECD.

Maternal Time Use Drives Suboptimal Complementary Feeding Practices in the El Niño-Affected Eastern Ethiopia Community

Ethiopia is affected by recurrent drought and food-insecurity crises, including El Niño. El Niño started in mid-2014, worsened in 2015, and continued in 2016, leading to a widespread food-insecurity emergency resulting in a surge in the rate of acute malnutrition in infants due to suboptimal feeding practices. This study explored how El Niño influenced complementary feeding practices in the eastern Ethiopia community from March to September 2016. It was an exploratory qualitative study with a basic interpretative qualitative approach. A general inductive approach was used for the analysis. The study involved 11 focus group discussions (FGD) with a total of 76 people, including three with mothers, three with Health Development Army (HDA) leaders, two with fathers, two with traditional birth attendants, and one with religious leaders. El Niño resulted in failed crops and loss of livestock, resulting in reduced dietary diversity and meal frequency. El Niño resulted in suboptimal complementary feeding practices by reducing food access and altering livelihood and coping strategies, reducing the time mothers allocated to child feeding, keeping them away from home, and stressing community health services. The maternal suboptimal time allocation is central to the poor complementary feeding practices. Thus, the women should be supported with climate-resilient livelihood options in their villages, allowing them to feed their children and attend education sessions with HDA leaders.

Understanding the Change in the Prevalence and Factors Influencing the Childhood Stunting Using District-Level Data from NFHS-4 and NFHS-5 in India

To compare the district level prevalence of childhood stunting between NFHS-4 and NFHS-5 and to explore the correlates of it at the district level. Although malnutrition rates in India have decreased over a period, country is still a home for the highest number of stunted and wasted children in the world. Among the South Asian countries, India has the second highest number of stunted children. An ecological study conducted by using the data from fourth and fifth round of National Family Health Survey. Study concentrated on percentage of children who were stunted across 692 Indian districts during 2 survey periods and its correlates from NFHS-5. District level change in childhood stunting was calculated by differencing the NFHS-5 estimates from NFHS-4. Descriptive statistics were used to understand the nature of the variables and Moran's I statistic was calculated to check for the spatial autocorrelation in the childhood stunting. Spatial error regression model was used to identify the correlates of childhood stunting. Among the Indian districts considered, 243 districts showed the increase in childhood stunting between the time periods considered. Currently, about 33.56% of children in India are stunted and there is high spatial disparity in the prevalence of childhood stunting among the districts of it. Major hotspots of childhood stunting were found in the parts of UP, Bihar, Jharkhand, and West Bengal. Households access to improved sanitation facility, iodized salt, clean fuel, women 10 plus years of schooling, post-natal care of mother were found to be the significant protective factors. Closed spacing of births, teenage pregnancy, low BMI of women, childhood diarrhea, and anemia were found to be the significant risk factors of childhood stunting. Stunting depends on several other factors apart from poverty, working on these factors will help in reducing childhood stunting in India.

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005-06 and 2015-16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.