Determinants of zinc intake in low-Income black and white pregnant women

A prospective study was conducted to evaluate and compare the determinants of dietary zinc intake in black and white low-income pregnant women. The study population consisted of 1298 low-income women (70% Black, 30% White) who received prenatal care at University Hospital at the University of Alabama in Birmingham from 1985 to 1989. Various maternal characteristics were evaluated at the first prenatal visit. Two 24 h recalls were obtained at 18 and 30 wk of gestation to calculate the intakes of dietary zinc and other nutrients. Student’st test, ξ², Pearson correlation coefficients, and multiple regression analyses were used to compare and evaluate the determinants of zinc and other nutrient intakes in Black and White subjects. The mean prepregnancy body mass index and the mean intake of zinc, energy, and all the other nutrients except calcium were significantly higher in Black than in White subjects. There was a significant correlation between zinc and energy intake (r- 0.69,p = 0.001). Age, marital status, parity, socioeconomic status, smoking, and alcohol intake were not significant predictors of zinc or other nutrient intakes. After adjusting for energy intake, race was the only significant predictor of dietary zinc intake. Race and energy intake explained 24% of the variation in zinc intake. Results of this study indicate that after adjusting for other covariates, race and energy intakes are the only predictors of zinc intake in low-income pregnant women.     

Modeling the effects of maternal nutritional status and socioeconomic variables on the anthropometric and psychological indicators of Kenyan infants from age 0-6 months

This paper presents a comprehensive empirical analysis of the factors affecting growth and psychological development of over 100 infants from birth to age 6 months in the Embu region of Kenya. The analysis was divided into four parts. First, infants' birth weight, and length and head circumference as measured few days after birth, were modeled using multiple regression models. Maternal prepregnancy body mass index (BMI), gestation period, and parity were associated with infants' anthropometric measurements (P < 0.05). Second, the scores on seven clusters of the Brazelton Neonatal Behavioral Assessment Scale were explained by health and socioeconomic indicators. While the models had poor predictive power, the scores were comparable to those reported in the literature for Puerto Rican and African American infants. The third part of the analysis modeled infant growth between 1-6 months by analyzing longitudinal data on length, head circumference, and weight. Dynamic models were postulated for the effects of nutritional, socioeconomic, and environmental factors and morbidity on anthropometric variables. The results showed that infants' calcium intakes were positively associated with length (P < 0.05). Maternal BMI and hemoglobin concentration were positively associated with infant weight (P < 0. 05); infant morbidity was negatively associated with weight (P < 0. 05). Lastly, the infants' scores at 6 months on the Bayley Motor Scale and on eight items from the Bayley Infant Behavior Record were explained using anthropometric, socioeconomic, and psychological variables. The infants' arm circumference and intake of protein were significant predictors of scores on the Bayley Motor Scale. In addition, time spent by the mother talking to the infant was positively associated with the scores on the Bayley Infant Behavior Record. The empirical results have implications for identifying vulnerable children in developing countries.     

Does Severe Maternal Morbidity Affect Female Sexual Activity and Function? Evidence from a Brazilian Cohort Study

Objective

to assess Female Sexual Function Index (FSFI) scores and delay to resume sexual activity associated with a previous severe maternal morbidity.

Method

This was a multidimensional retrospective cohort study. Women who gave birth at a Brazilian tertiary maternity between 2008 and 2012 were included, with data extraction from the hospital information system. Those with potentially life-threatening conditions and maternal near miss episodes (severe maternal morbidity) were considered the exposed group. The control group was a random sample of women who had had uncomplicated pregnancy. Female sexual function was evaluated through FSFI questionnaire, and general and reproductive aspects were addressed through specific questions. Statistical analyses were performed using Mann-Whitney and Pearson´s Chi-square for bivariate analyses. Logistic regression was used to identify variables independently associated with lower FSFI scores.

Results

638 women were included (315 at exposed and 323 at not exposed groups). The majority of women were under 30 years-old in the control group and between 30 and 46 years-old in the exposed group (p = 0.003). Women who experienced severe maternal morbidity (SMM) had statistically significant differences regarding cesarean section (82.4% versus 47.1% among deliveries without complications, p<0.001), and some previous pathological conditions. FSFI mean scores were similar among groups ranging from 24.39 to 24.42. It took longer for exposed women to resume sexual activity after index pregnancy (mean 84 days after SMM and 65 days for control group, p = 0.01). Multiple analyses showed no significant association of FSFI below cut-off value with any predictor.

Conclusion

FSFI scores were not different in both groups. However, they were lower than expected. SMM delayed resumption of sexual activity after delivery, beyond postpartum period. However, the proportion of women in both groups having sex at 3 months after delivery was similar. Altered sexual response may be evaluated as one of possible long-term consequences after SMM episodes. Further studies on the growing population of women surviving severe maternal conditions might be worth for improvement of care for women.     

Age at menarche in urban Argentinian girls: association with biological and socioeconomic factors

Age at menarche is regarded as a sensitive indicator of physical, biological, and psychosocial environment. The aim of this study was to determine the age at menarche and its association with biological and socioeconomic factors in girls from Santa Rosa (La Pampa, Argentina). An observational cross-sectional study was carried out on 1,221 schoolgirls aged 9-15 years. Menarche data were obtained by the status-quo method. Height, sitting height, weight, arm circumference, tricipital and subscapular skinfolds were measured. We also calculated body mass index, measures of body composition and proportions, and fat distribution. To assess socioeconomic factors, parents completed a self-administered questionnaire about their occupation and education, family size, household, and other family characteristics. The median age at menarche - estimated by the logit method--was 12.84 years (95% CI: 12.71, 12.97). Compared with their premenarcheal age peers, postmenarcheal girls had greater anthropometric dimensions through age 12. After this age, only height was higher in the latter group. Data were processed by fitting two logistic regressions, both including age. The first model included anthropometric variables and birth weight, while the second model included the socioeconomic variables. The significant variables derived from each model were incorporated into a new regression: height, sitting height ratio (first model), and maternal education (second model). These three variables remained significantly associated with menarche. The results suggest a relationship between linear growth and menarche and agree with those found in other populations where the advancement of menarche is associated with improved living conditions. In relatively uniform urban contexts, maternal education may be a good proxy for the standard of living.     

The Complex Interaction between Home Environment,Socioeconomic Status,Maternal IQ and Early Child Neurocognitive Development: A Multivariate Analysis of Data Collected in a Newborn Cohort Study

BackgroundThe relative role of socioeconomic status (SES), home environment and maternal intelligence, as factors affecting child cognitive development in early childhood is still unclear. The aim of this study is to analyze the association of SES, home environment and maternal IQ with child neurodevelopment at 18 months.MethodsThe data were collected prospectively in the PHIME study, a newborn cohort study carried out in Italy between 2007 and 2010. Maternal nonverbal abilities (IQ) were evaluated using the Standard Progressive Matrices, a version of the Raven’s Progressive Matrices; a direct evaluation of the home environment was carried out with the AIRE instrument, designed using the HOME (Home Observation for Measurement of the Environment) model; the socioeconomic characteristics were evaluated using the SES index which takes into account parents occupation, type of employment, educational level, homeownership. The study outcome was child neurodevelopment evaluated at 18 months, with the Bayley Scales of Infant and Toddler Development Third Edition (BSID III). Linear regression analyses and mediation analyses were carried out to evaluate the association between the three exposures, and the scaled scores of the three main scales of BSID III (cognitive, language and motor scale), with adjustment for a wide range of potential explanatory variables.ResultsData from 502 mother-child pairs were analyzed. Mediation analysis showed a relationship between SES and maternal IQ, with a complete mediation effect of home environment in affecting cognitive and language domains. A direct significant effect of maternal IQ on the BSID III motor development scale and the mediation effect of home environment were found.ConclusionsOur results show that home environment was the variable with greater influence on neurodevelopment at 18 months. The observation of how parents and children interact in the home context is crucial to adequately evaluate early child development.     

Early second trimester maternal plasma choline and betaine are related to measures of early cognitive development in term infants

Background

The importance of maternal dietary choline for fetal neural development and later cognitive function has been well-documented in experimental studies. Although choline is an essential dietary nutrient for humans, evidence that low maternal choline in pregnancy impacts neurodevelopment in human infants is lacking. We determined potential associations between maternal plasma free choline and its metabolites betaine and dimethylglycine in pregnancy and infant neurodevelopment at 18 months of age.

Methodology

This was a prospective study of healthy pregnant women and their full-term, single birth infants. Maternal blood was collected at 16 and 36 weeks of gestation and infant neurodevelopment was assessed at 18 months of age for 154 mother-infant pairs. Maternal plasma choline, betaine, dimethylglycine, methionine, homocysteine, cysteine, total B12, holotranscobalamin and folate were quantified. Infant neurodevelopment was evaluated using the Bayley Scales of Infant Development–III. Multivariate regression, adjusting for covariates that impact development, was used to determine the associations between maternal plasma choline, betaine and dimethylglycine and infant neurodevelopment.

Results

The maternal plasma free choline at 16 and 36 weeks gestation was median (interquartile range) 6.70 (5.78–8.03) and 9.40 (8.10–11.3) µmol/L, respectively. Estimated choline intakes were (mean ±SD) 383±98.6 mg/day, and lower than the recommended 450 mg/day. Betaine intakes were 142±70.2 mg/day. Significant positive associations were found between infant cognitive test scores and maternal plasma free choline (B = 6.054, SE = 2.283, p = 0.009) and betaine (B = 7.350, SE = 1.933, p = 0.0002) at 16 weeks of gestation. Maternal folate, total B12, or holotranscobalamin were not related to infant development.

Conclusion

We show that choline status in the first half of pregnancy is associated with cognitive development among healthy term gestation infants. More work is needed on the potential limitation of choline or betaine in the diets of pregnant women.     

Changing determinants of infant and child mortality: on the basis of the Korean experience, 1955-73

Data from the 1974 Korean National Fertility Survey were analyzed to learn more about the main determinants of infant and child mortality in the course of mortality decline and how they change. In the Korean survey, about 5000 eligible women were selected for the individual survey and the sample design aimed at a self-weighting nationally representative and probability sample. Preliminary analysis showed clear mortality differentials between different socioeconomic levels and between demographic subgroups in infant and child mortality during the period 1955-73 in Korea. To examine the net effect of each variable on mortality, the logit-linear model was used. A table shows the probability level of 4 variables -- maternal age, birth order, mother's education, and number of rooms used by household -- in Korea, when the effects of others were controlled. In the urban areas, only the socioeconomic factors were the main determinants of infant mortality on all the birth cohorts. Mother's education and number of rooms used strongly affected infant mortality in the 1955-59 and 1960-64 birth cohorts, but the effects became weaker in the 1965-69 and 1970-73 birth cohorts, and their statistical significance was reduced. In the rural areas, the effects of 3 variables -- the exception being number of rooms used -- on infant mortality were statistically significant. It is concluded that the main determinants of infant mortality in urban areas were socioeconomic factors. The main determinants of infant mortality in the rural areas were demographic in the earlier birth cohorts, but in the recent birth cohorts mother's education, a socioeconomic factor, became the main determinant while the effects of demographic variables became weaker and finally disappeared. The change in the determinants of child mortality appears to be the reverse of that for infant mortality. Prior to the introduction of the national development program, in the rural areas mother's education was the main determinant of child mortality (rural 1955-59 cohort), but with the socioeconomic development the determinants changed to give dominance to demographic factors (urban 1955-59) cohort and, in the recent period, even the effects of demographic factors on child mortality became weaker (urban 1960-69 cohort). When the differences in living status by maternal age were weaker and the competition among siblings less because of small family size, only the socioeconomic variables remained as main determinants affecting child mortality.     

Whole-body protein metabolism in lactating and nonlactating women

The adaptive responses of body protein metabolism to lactation were characterized in women at 1, 5, and 12 mo postpartum and in nulliparous controls during a controlled diet of measured protein and energy intakes by nitrogen balance, a constant infusion of [13C]bicarbonate, and a primed constant infusion of [1-13C]leucine and [alpha-15N]-lysine. Dietary energy intakes in the lactating women were 27% greater than those in the nulliparous controls. Despite these differences, lactating women had significantly lower nitrogen balances compared with the nonlactating women (-4.0 +/- 37.8 vs. +44.7 +/- 30.8 mg.kg-1.day-1). No significant differences in amino acid flux, oxidation, or incorporation into protein were detected during fasting conditions in the two groups of women. However, significantly positive associations were noted between dietary intakes and the variables of protein metabolism in the lactating women. A more complete understanding of the mechanisms that regulate the disposition of dietary nutrients into maternal body stores or milk production will enhance the determination of nutrient requirements in lactating women.     

Sedentism, seasonality, and economic status: A multivariate analysis of maternal dietary and health statuses between pastoral and agricultural Ariaal and Rendille communities in northern Kenya

This paper examines longitudinal data to assess the effects of the recent transition from pastoralism to sedentary agriculture for Ariaal and Rendille mothers in northern Kenya. Dietary, morbidity, and anthropometric data resulting from bimonthly repeated surveys of the pastoral community of Lewogoso and the sedentary agricultural community of Songa, covering the period from September 1994-July 1995, were used to test two hypotheses: 1) that sedentism is associated with changes in diet, seasonality, morbidity, and socioeconomic differentiation, and 2) that these changes affect maternal body composition. The first hypothesis is partly supported, with starch replacing milk in the sedentary diet. Repeated-measures multivariate analysis of variance revealed no seasonal effects for diet in the agricultural sample, while starch consumption was significantly affected by seasonality for the pastoral sample. The agricultural community also featured economic dietary disparities favoring wealthier mothers, while no such effect was found in the pastoral community. However, no seasonal or economic effects were found for morbidity patterns in either sample. The second hypothesis is also partially supported, as a generalized estimating equations analysis revealed differences in the way diet and economic strata influence maternal anthropometric values. Economic status was significantly associated with maternal arm-fat area in Lewogoso. Milk was a significant factor associated with maternal weight and arm-muscle area in Songa. These findings are discussed in light of development policy implications.     

Socioeconomic Predictors of Cognition in Ugandan Children: Implications for Community Interventions

Background

Several interventions to improve cognition in at risk children have been suggested. Identification of key variables predicting cognition is necessary to guide these interventions. This study was conducted to identify these variables in Ugandan children and guide such interventions.

Methods

A cohort of 89 healthy children (45 females) aged 5 to 12 years old were followed over 24 months and had cognitive tests measuring visual spatial processing, memory, attention and spatial learning administered at baseline, 6 months and 24 months. Nutritional status, child''s educational level, maternal education, socioeconomic status and quality of the home environment were also measured at baseline. A multivariate, longitudinal model was then used to identify predictors of cognition over the 24 months.

Results

A higher child''s education level was associated with better memory (p = 0.03), attention (p = 0.005) and spatial learning scores over the 24 months (p = 0.05); higher nutrition scores predicted better visual spatial processing (p = 0.002) and spatial learning scores (p = 0.008); and a higher home environment score predicted a better memory score (p = 0.03).

Conclusion

Cognition in Ugandan children is predicted by child''s education, nutritional status and the home environment. Community interventions to improve cognition may be effective if they target multiple socioeconomic variables.     

The associations between socioeconomic status, allostatic load and measures of health in older Taiwanese persons: Taiwan social environment and biomarkers of aging study

Data from a national representative sample of 1023 elderly and near-elderly Taiwanese were used to explore whether allostatic load is associated with health outcomes and mediates the association between socioeconomic status and health in a non-Western population. The information collected included: demographic characteristics; allostatic load scores; socioeconomic status, measured by education and income; health behaviours; health-related variables, including self-rated health, basic activities of daily living difficulties, instrumental activities of daily living difficulties, and physical activity difficulties. The adjusted prevalent odds ratios of higher allostatic load level were 1.25 (95% CI: 1.00, 1.56) for reporting one level worse in self-rated health and 1.43 (95% CI: 1.14, 1.82) for reporting one more physical activity difficulty. There were significant associations of lower education or less income with worse self-rated health and more difficulties with physical functioning. The associations between education, income and health status are not mediated by the conventional ten-point measure of allostatic load in older Taiwanese adults.     

Paternal Age in Relation to Offspring Intelligence in the West of Scotland Twenty-07 Prospective Cohort Study

Background

The adverse effects of advancing maternal age on offspring''s health and development are well understood. Much less is known about the impact of paternal age.

Methods

We explored paternal age-offspring cognition associations in 772 participants from the West of Scotland Twenty-07 study. Offspring cognitive ability was assessed using Part 1 of the Alice Heim 4 (AH4) test of General Intelligence and by reaction time (RT).

Results

There was no evidence of a parental age association with offspring RT. However, we observed an inverse U-shaped association between paternal age and offspring AH4 score with the lowest scores observed for the youngest and oldest fathers. Adjustment for parental education and socioeconomic status somewhat attenuated this association. Adjustment for number of, particularly older, siblings further reduced the scores of children of younger fathers and appeared to account for the lower offspring scores in the oldest paternal age group.

Conclusion

We observed a paternal age association with AH4 but not RT, a measure of cognition largely independent of social and educational experiences. Factors such as parental education, socioeconomic status and number of, particularly older, siblings may play an important role in accounting for paternal age-AH4 associations. Future studies should include parental intelligence.     

Examining the relationships between early childhood experiences and adolescent and young adult health status in a resource-limited population: A cohort study

BackgroundAdolescence is a critical point in the realization of human capital, as health and educational decisions with long-term impacts are made. We examined the role of early childhood experiences on health, cognitive abilities, and educational outcomes of adolescents followed up from a longitudinal cohort study in Pakistan, hypothesizing that early childhood experiences reflecting poverty would manifest in reduced health and development in adolescence.Methods and findingsAdolescents/young adults previously followed as children aged under 5 years were interviewed. Childhood data were available on diarrhea, pneumonia, and parental/household characteristics. New data were collected on health, anthropometry, education, employment, and languages spoken; nonverbal reasoning was assessed. A multivariable Bayesian network was constructed to explore structural relationships between variables. Of 1,868 children originally enrolled, 1,463 (78.3%) were interviewed as adolescents (range 16.0–29.3 years, mean age 22.6 years); 945 (65%) lived in Oshikhandass. While 1,031 (70.5%) of their mothers and 440 (30.1%) of their fathers had received no formal education, adolescents reported a mean of 11.1 years of education. Childhood diarrhea (calculated as episodes/child-year) had no association with nonverbal reasoning score (an arc was supported in just 4.6% of bootstrap samples), health measures (with BMI, 1% of bootstrap samples; systolic and diastolic blood pressure, 0.1% and 1.6% of bootstrap samples, respectively), education (0.7% of bootstrap samples), or employment (0% of bootstrap samples). Relationships were found between nonverbal reasoning and adolescent height (arc supported in 63% of bootstrap samples), age (84%), educational attainment (100%), and speaking English (100%); speaking English was linked to the childhood home environment, mediated through maternal education and primary language. Speaking English (n = 390, 26.7% of adolescents) was associated with education (100% of bootstrap samples), self-reported child health (82%), current location (85%) and variables describing childhood socioeconomic status. The main limitations of this study were the lack of parental data to characterize the home setting (including parental mental and physical health, and female empowerment) and reliance on self-reporting of health status.ConclusionsIn this population, investments in education, especially for females, are associated with an increase in human capital. Against the backdrop of substantial societal change, with the exception of a small and indirect association between childhood malnutrition and cognitive scores, educational opportunities and cultural language groups have stronger associations with aspects of human capital than childhood morbidity.

In a cohort study, Zeba A Rasmussen and colleagues examine the relationship between early childhood experiences on health, cognitive abilities and education, and health outcomes in adolescents and young adults in Pakistan.     

Correlation Between Dietary Zinc Intakes and Its Serum Levels with Depression Scales in Young Female Students

It has been suggested that mood disorders and depressive status may be accompanied by lowered zinc status in the body, and adequate consumption of zinc increases a general perceived well-being. The main objective of this study was to assess the correlation between serum zinc concentrations and dietary zinc intakes with depression scores in university female students. In the first phase, Beck's depression questionnaire was applied in a random sampling of 308 selected 20–25-year-old female students (one third of total students in Ahvaz Jondi-Shapour University of Medical Sciences Golestan dormitories) to assess the major depressive disorder (MDD) scales. Then, in the second phase, 23 students who identified as having moderate and severe depression were selected as the case group, and 23 healthy age matched were chosen as the controls. Each of them completed a 12-item semiquantitative food frequency questionnaire containing the main food sources of zinc in the usual dietary patterns and also a 24-h food recall questionnaire to assure the daily zinc intakes. Daily zinc intakes were obtained by multiplying each portion size by its zinc content using food tables. A 5-ml blood sample was taken for further serum zinc status using flame atomic absorption spectrophotometry technique. Pearson's r was used to show the correlation between quantitative variables. Both daily zinc intake and serum zinc concentrations of MDD group were about two thirds of healthy index (p < 0.01). Depressed individuals used to eat lower servings of red meats and chicken as the main food sources of zinc in students' usual diets (p < 0.001). Consumption of other foods as the sources of zinc was not significantly different in two groups. A linear significant correlation between dietary zinc intakes and its serum levels was seen in samples (r = 0.62; p < 0.001) and MDD students (r = 0.55; p < 0.001). There was a linear inverse correlation between Beck questionnaire scores and serum zinc concentrations in all of the investigated students(r = -0.65; p < 0.001) and MDD girls (r = −0.71; p < 0.001). Beck questionnaire scores and diatary zinc intakes were also inversly correlated (r = −0.58; p < 0.001). However, no statistical correlation was seen between these two variables in MDD cases. In depressed female students, dietary zinc intake is correlated to its serum concentrations; however, the serum zinc levels are inversely correlated to depression scales. Consumption of the main dietary sources of zinc such as red meats and chicken should be encouraged in young depressed girls.     

Docosahexaenoic acid and lactation

Docosahexaenoic acid (DHA) is an important component of membrane phospholipids in the retina and brain and accumulates rapidly in these tissues during early infancy. DHA is present in human milk, but the amount varies considerably and is largely dependent on maternal diet. This article reviews data addressing the impact of different DHA intakes by lactating women on infant and maternal outcomes to determine if available data are sufficient to estimate optimal breast milk DHA content and estimate dietary reference intakes (DRIs) for DHA by breast-feeding mothers. Results of published observational studies and interventional trials assessing the impact of maternal DHA intake (or breast milk DHA content) on infant visual function, neurodevelopment, and immunologic status were reviewed. Studies related to the potential impact of DHA intake on depression or cognitive function of lactating women also were reviewed. Although only a limited number of studies are available in the current medical literature, and study results have not been consistent, better infant neurodevelopment and/or visual function have been reported with higher vs. lower levels of breast milk DHA. The effect of DHA intake on the incidence or severity of depression in lactating women is not clear. Increasing breast milk DHA content above that typically found in the US, by increasing maternal DHA intake, may confer neurodevelopmental benefits to the recipient breast-fed infant. However, current data are insufficient to permit determination of specific DRIs during this period.     

Covariates of child mortality in Mali: does the health-seeking behaviour of the mother matter?

This paper uses data from the 1995/96 Mali DHS survey to examine the importance of a wide range of socioeconomic, behavioural and biodemographic factors in the determination of child mortality in Mali, with a special focus on maternal education and behaviour. The central hypothesis of the study is that advances in maternal education would contribute little to child survival in settings such as Mali's urban and rural communities where progress in educational attainment is not matched with improvements in other aspects of socioeconomic development such as economic growth, job creation, financial security and public health and medical resources. Units of analysis are children born in the past 5 years to DHS respondents (women aged 15-45) who were married at the time of the survey. The Cox proportional hazards regression technique has been used to estimate the net effects of variables included as covariates. The findings indicate that the health-seeking behaviour of the mother matters more than maternal education in explaining the observed differences in infant and child mortality in Mali's urban and rural areas.     

Determinants of maternity care services utilization among married adolescents in rural India

Background

Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed.

Methodology/Principal Findings

Using the data from third wave of National Family Health Survey (2005–06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15–19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions.

Conclusions

The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to poor and specific sub-groups of the population in rural areas to address the unmet need for maternal healthcare service utilization.