Chronic diseases have emerged as a significant global health challenge, substantially impacting both developed and developing nations. According to the World Health Organization (WHO), chronic diseases account for approximately 74% of all global deaths, with 77% occurring in low- and middle-income countries like India [1]. These diseases, also known as non-communicable diseases (NCDs), encompass various […]

National Family Health Survey (NFHS) has played a pivotal role in formulating policies and programs by providing nationally representative data on a wide range of monitoring and impact evaluation indicators in population, health and nutrition. However, due to measurement errors resulting in misreporting, the collection of accurate data on sensitive issues in sample surveys has always been a matter of concern. This study examines the fieldworker effect on the reporting of physical, sexual, and emotional Intimate Partner Violence (IPV) using fifth round of NFHS (2019-21) data in India. The cross-classified multi-level model was used to examine the fieldworker's effect on the reporting of IPV. The fieldworker effect accounted for around 32% of total variation in the reporting of intimate partner violence. The fieldworker's effect varied from 26% to 41 % for physical violence, 29% to 33% for emotional IPV and 30%–36% for sexual IPV. It was observed that variation due to fieldworker for non-sensitive outcomes was negligible.Of total variation, only 1.6% for information related to ever attending school, 4.8% for ever given birth, 5% for currently pregnant and 8.5% for information on ever terminated pregnancy was being explained by the fieldworker. Our results indicate a significant fieldworker influence on the likelihood of reporting intimate partner violence, underlining the need for an increased understanding of the impact of fieldworkers on data outputs, especially—but not exclusively—when queries contain delicate or stigmatized themes. This study highlights the importance of providing extra guidance and special training to the fieldworkers when collecting sensitive information related to IPV.

The inclusion of adolescent fertility in the Sustainable Development Goals demonstrates the widespread recognition of the possible health hazards as well as social and economic disadvantages encountered by young women and their infants. Moreover, adolescents are in a precarious situation due to their socioeconomic vulnerability coupled with the responsibility of motherhood at an early age. The present study has been conducted to examine factors associated with adolescent fertility in India and to understand the socioeconomic inequality in teenage pregnancy utilizing data from the National Family Health Survey-5 (NFHS-5). Binary logistic regression and marginal effects are applied to determine the association between teenage childbearing and other independent variables. The socioeconomic inequality in teenage pregnancy is assessed by Errygers decomposition. Around one-fifth of the respondents aged 19 years reported being pregnant in their teenage (21%). The risk of teen pregnancy was negatively associated with increasing educational attainment, improving wealth index, and working status. The risk of teenage pregnancy was 46% lower among individuals with family planning mass media exposure (OR: 0.54***0.4–0.75). Marginal effects showed that with secondary and higher educational attainment, the probability of having teenage pregnancy reduced by three and eight percent points in comparison to women without education. Results from Erregyers decomposition indicated that variables such as rural place of residence (47%), attempt to delay pregnancy (25%), no exposure to mass media related to family planning (13%), incorrect knowledge of ovulatory cycle (4%) were positive contributors to inequality attributable to wealth quintile in teenage pregnancy. Promoting formal, institutional sources of knowledge regarding sexual and reproductive health, availability of contraception and their effective usage can enable adolescents to understand the negative repercussions of adolescent pregnancy. Moreover, work participation, higher schooling and access to family planning can also positively contribute to the reduction of teenage pregnancies.

Generating unbiased and accurate assessments of sexual behavior among unmarried individuals is a major challenge, as it is governed by many social, moral, legal conventions and restrictions. These estimates are particularly susceptible to Fieldworker-induced social desirability bias. Accurate estimation of pre-marital sexual behavior is crucial for evaluating many aspects of sexual and reproductive health. The National Family Health Survey (NFHS) is the only reliable source of information on pre-marital sexual behavior in India, especially in the absence of any other comparative large-scale survey. This study provides us with an opportunity to understand the Fieldworker-level bias in the reporting of pre-marital sex among unmarried men and women. This study uses nationally representative data from the fifth round of the National Family Health Survey (NFHS-5). The analysis included 2950 female and 2073 male fieldworkers, as well as all unmarried women and men of reproductive age. Bayesian cross-classified multilevel modelling was performed to examine the Fieldworker’s effect on the reporting of premarital sex among unmarried respondents. Additionally, Multivariate decomposition analysis was used to quantify the effect of various fieldworker characteristics in reporting pre-marital sex. The fieldworker effect accounted for around 31.7% of total variation in the reporting of intimate partner violence for females and 24.6% for IPV reporting among males. Results from the decomposition analysis indicated that age and residence of fieldworker were associated with a 2.4% increase and 1.3% decrease in the likelihood of reporting pre-marital sexual activity, respectively. After adjusting fieldworker and individual-level characteristics, an association between an age difference of greater than ten years and higher reporting of ever having had sexual intercourse was observed for both sexes. Although we believe that NFHS surveys are a potentially valuable source of information on pre-marital sexual behavior, especially in the absence of proven alternatives, the evidence from this study suggests that fieldworker effects may bias reporting of ever-had sexual intercourse. Therefore, estimates from these surveys should be evaluated carefully and interpreted in the context of other available information, given their wide use in policy formulation and monitoring in India.