{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:02:12Z","timestamp":1790996532402,"version":"4.1.0"},"reference-count":48,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"unspecified","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,1,16]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the prevalence of anaemia among currently married women with high-risk fertility behaviour (HRFB) based on age, parity and birth spacing indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings and participants<\/jats:title>\n                    <jats:p>Fifth round of the National Family Health Survey (NFHS) was conducted in India (2019\u20132021) and included a nationally representative sample of 724,\u2009115\u2009women in the reproductive age group (15\u201349). Our analysis focused exclusively on married women who had given birth in the preceding 5 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The prevalence of anaemia with HRFB was the primary outcome, and the likelihood of having anaemia due to HRFB was the secondary outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data and methods<\/jats:title>\n                    <jats:p>\n                      Secondary data analysis of the NFHS-5 (2019\u20132021) datasets was done using a weighted analysis to determine anaemia prevalence in different HRFB categories. Bivariate analysis was done using the \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      test, and multiple binary logistic regression analyses were done to estimate the odds of having anaemia due to HRFB after adjusting for known confounders. A p value &lt;0.05 was reported as statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final analysis comprised 145,468\u2009women, of whom 59.1% had anaemia. About 53.1% of women depicted \u2018No risk\u2019 fertility behaviour, and 34.6% and 12.3% had single and multiple HRFB. Women with \u2018no-risk,\u2019 single and multiple HRFB had anaemia prevalence rates of 58.1%, 59.4% and 63.1%, respectively. Women with \u2018Single risk\u2019 had an 18% higher likelihood (1.18; 1.13\u20131.22) of having anaemia after controlling for confounding variables, compared with the HRFB category with \u2018No risk.\u2019 Women with \u2018Multiple risks\u2019 showed a 6% higher likelihood (adjusted OR 1.06; 95%\u2009CI 1.03 to 1.08).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Anaemia remains a prevalent issue in India, and HRFB is observed as a significant contributing factor. This vulnerable group can be targeted through multiple interventions and further our efforts to realise our anaemia-related goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-073395","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T12:35:15Z","timestamp":1706704515000},"page":"e073395","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Prevalence of anaemia among married women with recent birth history and high-risk fertility behaviour: secondary data analysis of the National Family Health Survey-India (2019\u201321)"],"prefix":"10.1136","volume":"14","author":[{"given":"Milan","family":"Das","sequence":"first","affiliation":[{"name":"International Institute for Population Sciences, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1787-8392","authenticated-orcid":false,"given":"Madhur","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Papai","family":"Barman","sequence":"additional","affiliation":[{"name":"International Institute for Population Sciences, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak Kumar","family":"Behera","sequence":"additional","affiliation":[{"name":"Economics and Finance Department, The Business School, RMIT International University of Vietnam, Ho Chi Minh, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"2025121220484813000_14.1.e073395.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0208485","article-title":"The relationship between iron deficiency anemia and sexual function and satisfaction among reproductive-aged Iranian women","volume":"13","author":"Nikzad","year":"2018","journal-title":"PLoS One"},{"key":"2025121220484813000_14.1.e073395.2","doi-asserted-by":"crossref","first-page":"e702","DOI":"10.1016\/S2352-3026(23)00168-0","article-title":"The challenge of defining the global burden of iron deficiency anaemia","volume":"10","author":"Young","year":"2023","journal-title":"Lancet Haematol"},{"key":"2025121220484813000_14.1.e073395.3","doi-asserted-by":"publisher","DOI":"10.1016\/s2352-3026(23)00160-6"},{"key":"2025121220484813000_14.1.e073395.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2015.11.002"},{"key":"2025121220484813000_14.1.e073395.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0236449","article-title":"Prevalence and factors associated with anemia among women of reproductive age in seven South and Southeast Asian countries: evidence from nationally representative surveys","volume":"15","author":"Sunuwar","year":"2020","journal-title":"PLoS One"},{"key":"2025121220484813000_14.1.e073395.6","unstructured":"International Institute for Population Sciences . National Family Health Survey (NFHS-4), 2015\u201316 (India Report). 2017: 791\u2013846. Available: https:\/\/dhsprogram.com\/pubs\/pdf\/fr339\/fr339.pdf"},{"key":"2025121220484813000_14.1.e073395.7","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(13)70001-9"},{"key":"2025121220484813000_14.1.e073395.8","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1007\/s10995-015-1700-7","article-title":"The effect of early marriages and early childbearing on Women\u2019s Nutritional Status in India","volume":"19","author":"Goli","year":"2015","journal-title":"Matern Child Health J"},{"key":"2025121220484813000_14.1.e073395.9","unstructured":"Ministry of Health and Family Welfare . Intensified National Iron Plus Initiative (I-NIPI). Anemia Mukt Bharat 2018. Available: https:\/\/www.fitterfly.com\/site\/pdf\/anemia-mukt-bharat.pdf"},{"key":"2025121220484813000_14.1.e073395.10","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.4103\/jfmpc.jfmpc_140_19","article-title":"Prevalence of anemia among adolescent girls in a rural area of Tamil Nadu, India","volume":"8","author":"Chandrakumari","year":"2019","journal-title":"J Family Med Prim Care"},{"key":"2025121220484813000_14.1.e073395.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-022-01333-w","article-title":"Determinants associated with high-risk fertility behaviours among reproductive aged women in Bangladesh: a cross-sectional study","volume":"19","author":"Howlader","year":"2022","journal-title":"Reprod Health"},{"key":"2025121220484813000_14.1.e073395.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-020-00912-z","article-title":"Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling","volume":"17","author":"Dadi","year":"2020","journal-title":"Reprod Health"},{"key":"2025121220484813000_14.1.e073395.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0281015","article-title":"Prevalence of anemia among reproductive women in different social group in India: cross-sectional study using nationally representative data","volume":"18","author":"Sharif","year":"2023","journal-title":"PLoS One"},{"key":"2025121220484813000_14.1.e073395.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-11569-z","article-title":"Preceding child survival status and its effect on infant and child mortality in India: an evidence from National Family Health Survey 2015-16","volume":"21","author":"Srivastava","year":"2021","journal-title":"BMC Public Health"},{"key":"2025121220484813000_14.1.e073395.15","doi-asserted-by":"crossref","DOI":"10.1186\/s40795-017-0173-z","article-title":"Folate, vitamin B12, ferritin and haemoglobin levels among women of childbearing age from a rural district in South India","volume":"3","author":"Singh","year":"2017","journal-title":"BMC Nutr"},{"key":"2025121220484813000_14.1.e073395.16","doi-asserted-by":"crossref","DOI":"10.1111\/mcn.12478","article-title":"Determinants of anemia among women and children in Nepal and Pakistan: an analysis of recent national survey data","volume":"14 Suppl 4","author":"Harding","year":"2018","journal-title":"Matern Child Nutr"},{"key":"2025121220484813000_14.1.e073395.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62304-5"},{"key":"2025121220484813000_14.1.e073395.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0253736","article-title":"Determinants of maternal high-risk fertility behaviors and its correlation with child stunting and anemia in the East Africa region: a pooled analysis of nine East African countries","volume":"16","author":"Tamirat","year":"2021","journal-title":"PLoS ONE"},{"key":"2025121220484813000_14.1.e073395.19","doi-asserted-by":"crossref","first-page":"100739","DOI":"10.1016\/j.cegh.2021.100739","article-title":"Examining the role of high-risk fertility behaviour in chronic undernutrition among Indian married women age 15-49","volume":"11","author":"Pal","year":"2021","journal-title":"Clinical Epidemiology and Global Health"},{"key":"2025121220484813000_14.1.e073395.20","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-021-01498-0"},{"key":"2025121220484813000_14.1.e073395.21","unstructured":"International Institute of Population Sciences (IIPS) . Data quality assurance and quality control mechanisms. National family health survey 2019-20. n.d. Available: https:\/\/rchiips.org\/NFHS\/NFHS5\/pdf\/NFHSdata\/quality\/assurance.pdf"},{"key":"2025121220484813000_14.1.e073395.22","unstructured":"International Institute for Population Sciences . National family health survey(NFHS-5) India 2019-21. Demographic and health surveys. 2021: 1\u2013714. Available: https:\/\/dhsprogram.com\/methodology\/survey\/survey-display-541.cfm"},{"key":"2025121220484813000_14.1.e073395.23","unstructured":"Kariyeva GK , Magtymova A , Sharman A . Anemia prevalence among pregnant women. 2000: 141\u20137."},{"key":"2025121220484813000_14.1.e073395.24","unstructured":"Demographic Health Survey . High-risk fertility behavior [Internet]. guide to DHS Statistics DHS-7. n.d. Available: https:\/\/dhsprogram.com\/data\/Guide-to-DHS-Statistics\/High-Risk_Fertility_Behavior.htm"},{"key":"2025121220484813000_14.1.e073395.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12963-017-0128-2","article-title":"Prevalence and risk factors for anemia severity and type in Malawian men and women: urban and rural differences","volume":"15","author":"Adamu","year":"2017","journal-title":"Popul Health Metr"},{"key":"2025121220484813000_14.1.e073395.26","unstructured":"United States Agency for International Development . The DHS program. 2023."},{"key":"2025121220484813000_14.1.e073395.27","doi-asserted-by":"publisher","DOI":"10.1079\/BJN20051493"},{"key":"2025121220484813000_14.1.e073395.28","unstructured":"Indian Council of Medical Research (ICMR) . Iron absorption and its implications on strategies to control iron deficiency anaemia. ICMR Bull 2000;30."},{"key":"2025121220484813000_14.1.e073395.29","doi-asserted-by":"crossref","first-page":"928","DOI":"10.4103\/njcp.njcp_423_19","article-title":"Effects of short inter-pregnancy interval on maternal and perinatal outcomes: a cohort study of pregnant women in A low-income country","volume":"23","author":"Onwuka","year":"2020","journal-title":"Niger J Clin Pract"},{"key":"2025121220484813000_14.1.e073395.30","first-page":"139","article-title":"Prevalence of anemia and correlated factors in the reproductive age women in rural areas of tabas","volume":"7","author":"Sadeghian","year":"2013","journal-title":"J Family Reprod Health"},{"key":"2025121220484813000_14.1.e073395.31","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0208413","article-title":"Prevalence and risk factors of preconception anemia: a community based cross sectional study of rural women of reproductive age in northeastern Tanzania","volume":"13","author":"Msemo","year":"2018","journal-title":"PLoS One"},{"key":"2025121220484813000_14.1.e073395.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0218288","article-title":"Determining factors for the prevalence of anemia in women of reproductive age in Nepal: evidence from recent national survey data","volume":"14","author":"Gautam","year":"2019","journal-title":"PLoS ONE"},{"key":"2025121220484813000_14.1.e073395.33","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1111\/bjh.16430","article-title":"Blood counts in adult and elderly individuals: defining the norms over eight decades of life","volume":"189","author":"Zierk","year":"2020","journal-title":"Br J Haematol"},{"key":"2025121220484813000_14.1.e073395.34","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1111\/ijlh.13615","article-title":"Erythropoiesis changes with increasing age in the elderly Chinese","volume":"43","author":"Chen","year":"2021","journal-title":"Int J Lab Hematol"},{"key":"2025121220484813000_14.1.e073395.35","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-8331-7","article-title":"Human fertility in relation to education, economy, religion, contraception, and family planning programs","volume":"20","author":"G\u00f6tmark","year":"2020","journal-title":"BMC Public Health"},{"key":"2025121220484813000_14.1.e073395.36","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1177\/1010539512442567","article-title":"Temporal trend of anemia among reproductive-aged women in India","volume":"27","author":"Bharati","year":"2015","journal-title":"Asia Pac J Public Health"},{"key":"2025121220484813000_14.1.e073395.37","doi-asserted-by":"publisher","DOI":"10.1177\/1010539508322762"},{"key":"2025121220484813000_14.1.e073395.38","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-015-0211-4","article-title":"Differentials in the prevalence of anemia among non-pregnant, ever-married women in Bangladesh: multilevel logistic regression analysis of data from the 2011 Bangladesh Demographic and Health Survey","volume":"15","author":"Kamruzzaman","year":"2015","journal-title":"BMC Womens Health"},{"key":"2025121220484813000_14.1.e073395.39","doi-asserted-by":"crossref","unstructured":"Casey G , Galor O . Is faster economic growth compatible with reductions in carbon emissions? The role of diminished population growth. Environ Res Lett 2017;12. doi:10.1088\/1748-9326\/12\/1\/014003","DOI":"10.1088\/1748-9326\/12\/1\/014003"},{"key":"2025121220484813000_14.1.e073395.40","first-page":"32","article-title":"Anaemia \u2018a silent killer\u2019among women in India: Present scenario","volume":"3","author":"Kaur","year":"2014","journal-title":"Eur J Zool Res"},{"key":"2025121220484813000_14.1.e073395.41","doi-asserted-by":"crossref","DOI":"10.1093\/tropej\/fmac030","article-title":"Regional water availability and WASH indicators as predictors of malnutrition in under-5 children: analysis of the National Family Health Survey, India (2015-16)","volume":"68","author":"Das","year":"2022","journal-title":"J Trop Pediatr"},{"key":"2025121220484813000_14.1.e073395.42","doi-asserted-by":"crossref","DOI":"10.1186\/s13104-019-4408-8","article-title":"Low dietary diversity and its influencing factors among a San group in Namibia","volume":"12","author":"Heim","year":"2019","journal-title":"BMC Res Notes"},{"key":"2025121220484813000_14.1.e073395.43","first-page":"625","article-title":"Dietary diversity and its association with anemia among pregnant women attending Public Health Facilities in South Ethiopia","volume":"28","author":"Delil","year":"2018","journal-title":"Ethiop J Health Sci"},{"key":"2025121220484813000_14.1.e073395.44","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2018-200178"},{"key":"2025121220484813000_14.1.e073395.45","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.ijgo.2015.06.040","article-title":"Association between oral contraceptive use and markers of iron deficiency in a cross-sectional study of Tanzanian women","volume":"132","author":"Haile","year":"2016","journal-title":"Int J Gynaecol Obstet"},{"key":"2025121220484813000_14.1.e073395.46","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.contraception.2017.11.001","article-title":"Effect of oral contraception on anemia in 12 low- and middle-income countries","volume":"97","author":"Bellizzi","year":"2018","journal-title":"Contraception"},{"key":"2025121220484813000_14.1.e073395.47","doi-asserted-by":"publisher","DOI":"10.1111\/trf.13252"},{"key":"2025121220484813000_14.1.e073395.48","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0188903","article-title":"A history of repetitive cesarean section is a risk factor of anemia in healthy perimenopausal women: The Korea National Health and Nutrition Examination Survey 2010-2012","volume":"12","author":"Park","year":"2017","journal-title":"PLoS ONE"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-073395","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T04:49:08Z","timestamp":1765601348000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-073395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,31]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/bmjopen-2023-073395"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-073395","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}