23 Apr Childbirth and it’s seasonal variation
Childbirth and it’s seasonal variation – Today Current Affairs
Births are invariably preceded by conception, which itself is a consequence of cohabitation. For the human population, there is no biological interregnum across the seasons towards any of the three steps. Yet, births do show seasonal patterns, and it is of interest to see what these patterns are and what they could imply.
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Such an analysis is constrained by the absence of large-scale data for an entire population and usually the literature reports analysis based on a sample or survey data. Very few data have the reach that the Health Management Information System (HMIS) data offers for India at a granular level of subdistrict and on a monthly basis. We use this data for a 36-month period, from April 2017 to March 2020, just before the onset of the current COVID-19 pandemic.
The interest in birth seasonality has not been new. Conception does have its own natural variation across seasons, though it varies in different populations. Documentation of such seasonal variation in conception followed by childbirth was started in the mid-19th century in Europe and India. The very first publication on birth statistics seasonality in India reported maximum birth occurring in September and the minimum in June, corresponding to maximum conceptions in December and minimum in September when the monthly average rates of birth per thousand per annum were computed for the years 1878–87. The Hindu Analysis
Climatic comfortability, lesser incidence of morbidity, and every cause of death along with food and economic abundancy post the reaping of cereals in November were found to favour conception in December; the dip in conception during September was found to be influenced by low energy levels among people due to the long summer, high disease prevalence like malaria, and the exhaustion of resources such as food, money, and savings. A hospital-based study, in Calcutta during 1850–1901, also reported similar observation, that is, the maximum birth rate in October and the minimum in monsoon months, June corresponding to the optimum condition of conception in December–January, the post-harvest month in Bengal.
Thus, conception, followed by the childbirth rate in rural areas, is governed by the harvesting and monsoon seasons, cultivation, and labour. But the variation in urban areas is primarily due to the changes in the temperature of weather in terms of pleasantness or comfortability for coitus as the employment status remains comparatively stable in the cities throughout the year. Regional variation in conception is also found to be affected by the variation in the time of marriage in the cities. But in recent times, the peak of the two curves, of a “lagged” marriage (marriage plus nine months) and the first child born, was not found to coincide. The seasonality curve in Faridabad district of Haryana, with the maximum number of deliveries in August–September and the least in April, was not found to vary between couples using vs non-using spacing method. Certain biological issues like irregularities in menstruation during the hot weather and suppression of spermatogenesis by higher external temperature of 29°C–38°C may also be significant players determining the variations in childbirth. Today Current Affairs
In India, there are different climatic zones along with varied agro-economic patterns and sociocultural diversities. Thus, understanding birth seasonality across the country based on these indicators is definitely worth investigating. The use of large-scale databases in this regard will definitely be of special help. In India, there are various nationwide demographic databases such as the National Family Health Survey (NFHS), Census of India, District Level Household and Facility Survey (DLHS), and the HMIS.
Responsible factors : The Hindu Analysis
We look at two parameters—the locus of seasonal variation and its extent, that is, the standard deviation in the data.
Seasonality: A distinct seasonal variation in childbirth exists in India. If there were no seasonal variation in the births, every month would have accounted for 8.33% of the total annual births, but that is not the case.
In the northern states, a dominant pattern is seen where births peak in the months of August–September and dip during the February–April period. The regularity of this pronounced peak is observed in both the urban and rural areas. Interestingly, Delhi and Chandigarh, which are more urban, exhibit similar patterns as well. The standard deviation is higher in the rural domain than in urban. As against these pronounced seasonal patterns, such a “peak” effect is quite small and giving birth does appear to go on more evenly with a very low standard deviation in Karnataka, Kerala, and Goa. There are no sharp October peaks, but there is a clear declining trend from November to February. Kerala shows a faint but clear trend of the number of births coming down steadily in both rural and urban areas. One interesting trend discernible in rural Kerala is the bimodal nature of the peaks—one in May and the other in October. Tamil Nadu is another interesting case where births in urban areas are more than that in the rural, but the similarity of the pattern in the rural and the urban is unusually striking. The February dip is apparent in Tamil Nadu along with a mild peak in May that goes with a rising trend continuing up to October and then dips till February. The Hindu Analysis
Andhra Pradesh and Telangana also confirm the “southern” pattern of low standard deviation, a peak in and around September and October, and a dip till February–March. In Andhra Pradesh, births in urban areas are more compared to that in the rural as in the case of Tamil Nadu and a discernible, though mild, trend of a decreasing number of births in rural Andhra Pradesh.
In Maharashtra, regular dips during February–March and peaks during September–November are observed. Similar peaks and dips are observed for urban–rural live births. In Goa, a mild October peak is apparent, which is more pronounced in rural Goa. Gujarat shares a trend of high birth peaks in August–October and sharp dips in February–March. Similar peaks and dips are observed for urban–rural live births. The standard deviation between urban and rural births in Gujarat is low as compared with Punjab. Today Current Affairs
Bihar follows the Punjab pattern, although in Bihar, the “dip” prolongs from October till June with a sharp peak again in August. There are no sharp October peaks in Odisha, but a clear declining trend from November to February is seen as similar to Kerala and West Bengal. Contrastingly, the September–October peak is visible in West Bengal.
The regularity of the pattern in MP is striking, with a rising trend from April to August and a dip from August till April; urban MP also seems to follow a similar pattern (standard deviation = 0.93). An upward “kink” is observed in UP and Rajasthan during March. Rajasthan also shows a similar pattern as MP, barring the irregular march spurt similar to UP.
Discussions and Conclusions : The Hindu Analysis
This study reveals a very distinct and uniform seasonal pattern of childbirth in most regions of the country based on monthly birth record data at a large canvas and a granular level provided by the HMIS. Regional variations can be seen between the northern and southern parts of India as well as the western and eastern parts. A dominant peak during August–September and a dip during February–April were prominent in North India, whereas a more evenly distributed pattern with low standard deviation was visible in the southern region. Within the southern states also, seasonal variation is displayed. The amplitude of the peaks gets attenuated as we move from the north-western direction to the south-eastern direction. In the north-eastern states, a pattern of birth peaks shifting towards the later part of the year by a month or two is noted.
The steady and significant seasonal pattern having a birth peak during August–September and a steady dip towards February and March can be characterized as the northern agrarian pattern. This pattern is widely visible in the northern and central zones of the country, covering a contiguous belt comprising Punjab, Haryana, UP, MP, and Rajasthan. The four BIMARU states, that is, Bihar, MP, Rajasthan, and UP, also conform to the Punjab pattern, although, in Bihar, the dip prolongs from October to June, with a sharp peak again in August. The upward kink observed in UP and Rajasthan during March may have more to do with the administrative reporting formalities than an actual increase in birth. This will merit a closer scrutiny though. A previous cohort in Haryana with 35,244 childbirths recorded for 19 years (1972–90) also reported the maximum number of childbirths during August–September and the least in April.
Future Scope : The Hindu Analysis
It is interesting to note the strong similarity in the urban and rural patterns. Whether the urban peaks are influenced due to rural clients availing of the urban health facilities is a matter of separate inquiry, and for this, we may need to look at the urban data more carefully and granularly.
It may also be worthwhile to see the variation in the patterns across natural regions. The 88 natural regions of the National Sample Survey provide a more homogeneous aggregation than the administrative boundaries of the states (MoHFW 2019). It stands to reason that the pattern in Konkan and Vidarbha is likely to differ, just as that between western and eastern UP. This will be a separate follow-up exercise to this analysis. Another interesting dimension could be those of the coastal districts. We prima facie expect the fluctuations to become less pronounced compared to those in the northern agrarian pattern.
A similar analysis of a state-level pattern with districts as a unit will be taken up to study the childbirth seasonal variation at the district level for more effective management at the local level. However, we are aware that the statistical fluctuations in the number of births reported at the district levels are likely to be higher as the number of births reduce.
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Conclusions
The interest in seasonal variations in births and deaths has been a matter of academic and policy inquiry for quite a while now. We notice distinct seasonal childbirth patterns in India through different dips, peaks, and magnitude that differ in different parts of the country. We see a shift in the patterns from those revealed in the earlier literature. This is understandable as the patterns of agriculture, migration, and shift from farm sector to other sectors have taken place. Nevertheless, there is a dominant pattern that we may term as the northern agricultural pattern. As we move from the north-western region towards the southern and eastern regions, the August–September birth peak shifts towards October–November. These are, incidentally, regions of more moderate climate and also have different cropping patterns. The steady decline from the winter peak to the dip until February–March seems, however, to be a common feature across most regions. Identification of peak and lean months of childbirth in different states will help the local administration to improve and prioritize the delivery of maternal and child services and family planning facilities.
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plutus ias daily current affairs 23 April 2022
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