Analyzing the Spatial Contours of Child Health in India: Evidence from NFHS4 to NFHS5

## **Seasonal Variations of Childbirth in India: A Policy and Program Planning Perspective**

#### **Apoorva Nambiar1, Dripta Roy Choudhury2, and Satish B. Agnihotri3**

<sup>1</sup> IITB-Monash Research Academy, Mumbai, India

<sup>2</sup> Indian Institute of Technology Bombay, Mumbai, India

<sup>3</sup> Indian Institute of Technology Bombay

For the human population, there is no biological interregnum across the seasons in terms of birth. Nevertheless, births do show seasonal patterns, and in India, given the different climatic zones along with varied agro-economical patterns and socio-cultural diversities, it is crucial to study its patterns and their probable causes. Analyses done so far have been based on small samples and limited geographical locations. The present study examines, for the first time, the seasonality of childbirth across all states of India using the Health Management Information System (HMIS) data on all reported live births over a 36-month period. We used the HMIS monthly data for three years, 2017–2018, 2018–2019, and 2019–2020. 'Total children born' was the primary outcome variable of this study, examined as a percent of total annual births and absolute counts. Rural–urban variations were also analyzed for each state of India. Time-series analyses were conducted to analyze seasonality. The extent of birth variations has been studied by actual numbers and by calculating and mapping standard deviations for each state. If there were no seasonal birth variations, births every month would have accounted for 8.33% of total annual births. However, this study indicated the existence of distinct seasonal variation across states, and the extent of variation around the mean was found to be close to 10% in India. The state-wise variability ranged between 4% and 18%. Consistent birth peaks in the August–October window and dips in the February–March window, as well as some equally interesting departures from these dominant trends, have emerged at the regional level. Such seasonality could be attributed to the agricultural patterns, climatic conditions, the farming cycle, and coinciding with less abundance of food and money, or simply because of administrative reporting formalities than an actual increase in birth. These findings are of interest to both academic research and the policy domain. Identification of peak and lean months will help health service functionaries to prioritize the delivery of maternal and child services and family planning facilities, leading to more targeted and focused preventive steps for better maternal and child health outcomes.

Apoorva Nambiar1, Dripta Roy Choudhury2, and Satish B Agnihotri3

1 ITB-Monash Research Academy 2 Indian Institute of Technology Bombay 3 Indian Institute of Technology Bombay

> Results Percentage of births per month by total annual births, state-wise, HMIS 2017-2020

*Figure 4. Birth seasonality in Gujarat, a western state of India. Figure 5. Birth seasonality in Gujarat, a western state of India. Figure 6. Birth seasonality in Tamil Nadu, a southern state of India.*

*Figure 7. Standard deviation maps of seasonal variation in births.*

#### Findings

If there was no seasonal variation, births every month would account for 8.33% of the total annual births. But this study indicated the existence of distinct seasonal variation across states, and the extent of variation around the mean was found to be close to 10% in India.


#### Conclusion

The study has considerable implications for policy as well as programme implementation.


#### Data and Methods


#### Background

There is no biological interregnum across the seasons in terms of birth. Yet, births do show seasonal patterns, and in India, given the different climatic zones along with varied agro-economical patterns and socio cultural diversities. It's crucial to study its patterns and their probable causes. Till now, not much research has been conducted.

#### Objective

The present study examined the seasonality of childbirth and corresponding conception throughout the states of India based on the agro-climatic variation present in the country.
