Gynaecological health requires a health systems approach through the life course to address the interlinked nature of common gynaecological conditions or symptoms. This narrative review, following the READ approach, examined how the public health system in India addresses gynaecological health, as reflected in policies, services and data. A multi-disciplinary team searched government policies, service guidelines and standards across relevant Ministries and national institutions, Parliamentary Questions, government surveys and administrative data sources between 2005 and 2025. The extraction of 34 documents examined whether a condition/symptom was covered in policy and included in guidelines for community awareness/outreach and facility-based treatment. The analysis assessed the extent of policy guidelines and data available for different gynaecological conditions and across the life course, along with an in-depth analysis of heavy menstrual bleeding across five health system building blocks. India's health policies cover most gynaecological conditions, to varying degrees. Cancers and reproductive tract infections have comprehensive policies and guidelines for community-based outreach and services, while outreach and services for menstrual disorders, sexual health, infertility and menopause remain limited. Injuries from gender-based violence are a priority policy area. Heavy menstrual bleeding has comprehensive service guidelines, but gaps remain in community-based outreach and access to conservative treatment options. Nationally representative surveys currently collect data on some gynaecological conditions, but there are limited population-level data on the prevalence of and treatment for menstrual disorders, infertility and sexual health. Advacing women's health will will require policy and service guidelines that address the range of gynaecological conditions in an integrated approach, including community outreach, facility-based management and national, routine data colleciton.

Background and objectives The utilisation of hysterectomy has emerged as a public health concern in India. The Ministry of Health’s National Guidelines aim to reduce unnecessary hysterectomies by promoting adherence to recommended indications, age, and extent of surgery. Although audits are routinely conducted in tertiary hospitals, their findings have not been synthesised. We present a synthesis of medical audits of hysterectomy practices in India to identify patterns, gaps, and opportunities to improve the quality of care. Methods This systematic review included medical audits of hysterectomies in India published between 2010 and 2024 across PubMed, Scopus, and EMBASE. Using PRISMA guidelines, a systematic search and narrative synthesis were conducted to examine clinical indications, surgical route, complications, and histopathological correlations. Study selection and quality assessment were carried out independently by two reviewers using the Joanna Briggs Institute critical appraisal tool. Results The review included 89 medical audits, mostly of moderate quality. Hysterectomies were predominantly performed in premenopausal women, with one-fourth in women under 40 years. The leading indications were abnormal uterine bleeding and fibroids, commonly managed by abdominal surgery. Oophorectomy was frequently performed without documented ovarian pathology. Reported complications included haemorrhage, postoperative fever, and urinary tract infections. Interpretation and conclusions This review identified benign gynaecological conditions, particularly fibroids, as the predominant indication for hysterectomy. It also revealed substantial gaps in standardised reporting, clinicopathological documentation, and sociodemographic data. Strengthening audit systems, ensuring adherence to evidence-based guidelines, and expanding access to conservative and minimally invasive treatments are essential to support rational surgical decision-making and improve the quality of gynaecological care.

Pregnant and postpartum women living with Human Immunodeficiency Virus (HIV) are at high risk for perinatal depression, which can significantly undermine HIV care engagement and treatment outcomes. Despite this, depression often remains unidentified and untreated. This pilot study evaluated the feasibility, fidelity, acceptability and preliminary effects of a mobile phone counselling intervention among perinatal women living with HIV and depression in India. Forty women in their third trimester (≥28 weeks of gestation) and screening positive for depressive symptoms (Edinburgh Postnatal Depression Scale ≥13) were recruited from three government-run treatment centres in Delhi. Participants were randomized to: (a) the intervention condition, 'BEST-ma-CARE' mobile phone counselling, or (b) an attention control condition, time- and phone-matched perinatal wellness counselling. All counselling was delivered via basic mobile phones. Data were collected at baseline and follow-up at 36-40 weeks pregnancy, within 7 days of delivery and at 6 and 12 weeks postpartum. Overall, 82% of the participants completed the study, with higher retention in the intervention arm (90%). Engagement was also higher in the intervention group with 78% of antenatal and 95% of postnatal calls attended, compared to 70% and 80% in the control group. The intervention was highly acceptable; 76% reported it 'helped them a lot', compared to 69% in the control group. All participants (100%) appreciated scheduled counsellor calls. Both groups showed reductions in depressive symptoms and perceived illness severity, while internalized stigma increased only in the control group. Improvements in antiretroviral adherence, viral load and CD4 counts were stronger in the intervention group. Results indicate that integration of mobile phone counselling into maternal HIV care shows promise.

Women face numerous gender-based barriers that hinder their access to resources, nutritious foods, nutrition services, and maternity entitlements. Evidence shows that certain types of women’s groups can improve women’s access to resources and social capital and in some approaches also improve health and nutrition outcomes. Women’s rights-based organizations in South Asia have a longstanding tradition of collective action toward gender equality. Women’s rights-based organizations work in areas such as microfinance, livelihoods, women’s rights, health, and combating violence against women. In this perspective article, we explore how women’s groups and rights-based organizations can leverage their collective strength to advance nutrition outcomes for women and children. We identify seven pathways implemented through women’s groups toward improving nutrition outcomes. These pathways include (i) income generation, (ii) agriculture, (iii) health and nutrition behavior change communication and participatory learning and action, (iv) advocating for rights to better health and social services, (v) food access, (vi) cash transfers, and (vii) strengthening service delivery and fostering convergence with health systems. We also note that women’s groups have the potential to implement integrated interventions through combined food-systems-rights pathways. Investing in this area can support transforming nutrition policy from a service delivery model to a rights-based approach.

Background: Interventions with women’s groups are increasingly seen as an important strategy for advancing women’s empowerment, health, and economic outcomes in low- and middle-income countries, with the potential to increase the resiliency of members and their communities during widespread covariate shocks, such as coronavirus disease 2019 (COVID-19). Methods: This evidence synthesis compiles evidence from past shocks on women’s group activities and the extent to which women’s groups mitigate the effects of shocks on members and communities. We reviewed 90 documents from academic databases, organizational reports, and additional gray literature, and included literature diverse in geography, type of women’s group, and shock. Results: The literature suggests that covariate shocks tend to disrupt group activities and reduce group resources, but linkages to formal institutions can mitigate this impact by extending credit beyond the shock-affected resource pool. Evidence was largely supportive of women’s groups providing resilience to members and communities, though findings varied according to shock severity, group purpose and structure, and outcome measures. Further, actions to support individual resilience during a shock, such as increased payment flexibility, may run counter to group resilience. The findings of the evidence synthesis are largely consistent with emerging evidence about women’s groups and COVID-19 in South Asia and sub-Saharan Africa. Conclusions: We finalize the paper with a discussion on policy implications, including the importance of sustainable access to financial resources for women’s group members; equity considerations surrounding the distribution of group benefits and burdens; and the potential for meaningful partnerships between women’s groups and local governments and/or non-governmental organizations (NGOs) to enhance community response amidst crises.

Background: Interventions with women’s groups are increasingly seen as an important strategy for advancing women’s empowerment, health, and economic outcomes in low- and middle-income countries, with the potential to increase the resiliency of members and their communities during widespread covariate shocks, such as coronavirus disease 2019 (COVID-19). Methods: This evidence synthesis compiles evidence from past shocks on women’s group activities and the extent to which women’s groups mitigate the effects of shocks on members and communities. We reviewed 90 documents from academic databases, organizational reports, and additional gray literature, and included literature diverse in geography, type of women’s group, and shock. Results: The literature suggests that covariate shocks tend to disrupt group activities and reduce group resources, but linkages to formal institutions can mitigate this impact by extending credit beyond the shock-affected resource pool. Evidence was largely supportive of women’s groups providing resilience to members and communities, though findings varied according to shock severity, group purpose and structure, and outcome measures. Further, actions to support individual resilience during a shock, such as increased payment flexibility, may run counter to group resilience. The findings of the evidence synthesis are largely consistent with emerging evidence about women’s groups and COVID-19 in South Asia and sub-Saharan Africa. Conclusions: We finalize the paper with a discussion on policy implications, including the importance of sustainable access to financial resources for women’s group members; equity considerations surrounding the distribution of group benefits and burdens; and the potential for meaningful partnerships between women’s groups and local governments and/or non-governmental organizations (NGOs) to enhance community response amidst crises.

Background Hysterectomy, particularly when conducted in women younger than 45 years, has been associated with increased risk of non-communicable diseases. In India, research indicates that hysterectomy is a common procedure for women, but there have been no studies on its long-term effects. We examined patterns of hysterectomy amongst women in India and associations with their health and well-being in later life. Methods This analysis utilised the first wave of the Longitudinal Study on Aging in India, a nationally representative study of adults that included a module on health and well-being. We analysed data on 35,083 women ≥45 years in India. We estimated prevalence of hysterectomy and performed multivariable logistic regression to identify associated risk factors and to examine the association between hysterectomy status and eight self-reported chronic conditions, hospitalisation and mobility. Results The prevalence of hysterectomy among women >=45 years was 11.4 (95% CI: 10.3, 12.6), with higher odds among urban women (aOR: 1.39; 1.17,1.64) and higher economic status (highest compared to lowest quintile: aOR: 1.95; 1.44, 2.63). Hysterectomy history was associated with four chronic conditions: hypertension (aOR: 1.51; 95% CI: 1.28, 1.79), high cholesterol (aOR: 1.43; 1.04, 1.97), diabetes (aOR: 1.69; 1.28, 2.24), and bone/joint disease (aOR: 1.54; 1.20, 1.97) and higher odds of any hospitalisation in the past year (aOR: 1.69; 1.36, 2.09). Conclusions In India, evidence suggests that hysterectomy is associated with major chronic conditions. The assessment for hysterectomy as a treatment option for gynaecological morbidity should consider potential health consequences in later life.

This study examined the hypothesis that HIV-related stigma mediates the effect of alcohol use on health-related quality of life (HRQoL) among alcohol consuming Indian men living with HIV (PLWH). The study used baseline data from a randomized controlled clinical trial entitled ‘Alcohol and ART adherence: Assessment, Intervention, and Modeling in India. Participants completed surveys assessing demographic characteristics, alcohol use, HIV-related stigma, HRQoL. Mediation analysis was conducted to establish the mediation effect of HIV-related stigma on the relationship between alcohol use and HRQoL. The final mediation model showed that the effect of alcohol use on HRQoL were partially mediated by overall HIV-related stigma. Specially, 27.1% of the effects of alcohol use on HRQoL was mediated through overall HIV stigma. In the HIV stigma subdomain analyses, negative self-image mediated 14% and concerns with public attitudes (anticipated stigma) mediated 17.3% of the effect of alcohol use on HRQoL respectively. The findings suggest that efforts to reduce the negative impact of alcohol use on HRQoL and improve HRQoL among PLWH should include interventions addressing both alcohol use and specific forms of HIV-related stigma.

Introduction Economic groups, such as microfinance or self-help groups are widely implemented in low-income and middle-income countries (LMICs). Women’s groups are voluntary groups, which aim to improve the well-being of members through activities, such as joint savings, credit, livelihoods development and/or health activities. Health interventions are increasingly added on to existing women’s economic groups as a public health intervention for women and their families. Here, we present the protocol for a mixed-methods systematic review we will conduct of the evidence on integrated economic and health interventions on women’s groups to assess whether and how they improve health-related knowledge, behaviour and outcomes in LMICs. Methods and analysis We will search seven electronic databases for published literature, along with manual searches and consultation. The review will include (1) randomised trials and non-randomised quasiexperimental studies of intervention effects of integrated economic and health interventions delivered through women’s groups in LMICs, and (2) sibling studies that examine factors related to intervention content, context, implementation processes and costs. We will appraise risk of bias and study quality using standard tools. High and moderate quality studies will be grouped by health domain and synthesised without meta-analysis. Qualitative evidence will be thematically synthesised and integrated into the quantitative synthesis using a matrix approach. Ethics and dissemination This protocol was reviewed and deemed exempt by the institutional review board at the American Institutes for Research. Findings will be shared through peer-reviewed publication and disseminated with programme implementers and policymakers engaged with women’s groups. PROSPERO registration number CRD42020199998.

Context: India's adolescent health policy aims to improve sexual and reproductive health, especially amongst the most vulnerable. There is limited evidence on how gender influences treatment-seeking patterns amongst unmarried adolescents. Methods: We analyzed data from a cross-sectional survey of 11,651 unmarried adolescent boys and girls aged 1519 in two large states of India. We conducted sex-disaggregated analyses to estimate the prevalence of symptoms of genital infections and compare treatment-seeking patterns. We identified correlates through multivariable regression and used a conceptual framework to explore structural, household, social and individual factors that influence gender inequities in adolescent sexual and reproductive health. Results: One in five unmarried adolescents reported symptoms of genital infections, such as burning or discharge, in the past three months. Factors associated with reporting symptoms varied between boys and girls, except for a common correlation with symptoms of depression. At least two-thirds of boys sought treatment, compared to approximately one in four girls (rural: 66.2% boys, 23.1% girls; urban: 69.4% boys, 30.7% girls). Boys primarily sought care from medical shops or private facilities, while girls used both private and government services. Amongst boys, having friends and being in school was associated with seeking treatment (aOR: 11.47; 95% CI: 2.75, 47.87; aOR: 1.95; 95% CI: 1.24, 3.07, respectively). Odds of seeking treatment were higher amongst girls with exposure to any mass media (aOR: 1.93; 95% CI: 1.25, 2.99) and who had discussed puberty with a parent (aOR: 1.98; 95% CI: 1.32, 2.98). Conclusion: Stark sex differentials in factors associated with symptoms and in treatment-seeking illustrate how structural gender inequities, such as access to economic resources and education, influence sexual and reproductive health amongst adolescents. Along with health system interventions, addressing gender inequities calls for strategies to strengthen parental engagement, social support and girls' access to resources.

OBJECTIVE:To examine the effectiveness of a multilevel intervention to reduce HIV stigma among alcohol consuming men living with HIV in India. DESIGN:A crossover randomized controlled trial in four sites. SETTING:Government ART centres (ARTCs) offering core services in the greater Mumbai area. PARTICIPANTS:Seven hundred and fifty two (188 per site) alcohol-consuming male PLHIV on ART were recruited. INTERVENTION:Multilevel intervention to reduce alcohol consumption and promote adherence by addressing stigma, implemented at the individual (individual counselling, IC), group (group intervention, GI) and community levels (collective advocacy, CA) in three distinct sequences over three cycles of 9 months each. MAIN OUTCOME MEASURE:HIV stigma, measured using the 16-item Berger Stigma scale. METHODS:The article examines the effectiveness of the interventions to reduce stigma using Linear Mixed Model regression. RESULTS:At baseline, 57% of participants had moderate-high levels of stigma (scores >40). All three counseling interventions were effective in reducing stigma when delivered individually, in the first cycle (collective advocacy: βcoeff = -9.71; p < 0.001; group intervention: βcoeff = -5.22; p < 0.001; individual counselling: βcoeff = -4.43; p < 0.001). At then end of the second cycle, effects from the first cycle were sustained with no significant change in stigma scores. At the end of the third cycle, the site, which received CA+IC+GI sequence had maximum reduction in stigma scores (βcoeff = -10.29; p < 0.001), followed by GI+CA+IC (βcoeff = -8.23, p < 0.001). CONCLUSION:Baseline findings suggest that stigma remains a problem even with experienced patients, despite advances in treatment and adherence. Results of multilevel stigma reduction interventions argue for inclusion in HIV prevention and treatment program.

We examined the association between alcohol consumption, adherence and viral load (VL) in a cohort of 940 alcohol-consuming, human immunodeficiency virus (HIV)-positive men receiving antiretroviral therapy in Mumbai. Some of the participants (16.7%) had missed >1 doses in the last four days and 17.6% reported >1 treatment interruptions in the last 12 months; 60.8% of the participants consumed alcohol >2 times/month, 62.8% consumed >3 drinks/typical day and 11.5% reported binge drinking >1 times/month; 76.4% of the participants had VL<200 copies/mL. Higher alcohol consumption was associated with nonadherence (odds ratio [OR]: 1.21; 95% confidence interval [CI]: 1.11–1.31) and treatment interruptions (OR: 1.20; 95% CI: 1.11–1.31). We found no association between alcohol use and VL. There was, however, a significant interaction effect of alcohol use and nonadherence on virological failure (Adjusted Odds Ratio [AOR]: 1.23; 95% CI: 1.03–1.47) implying that alcohol negatively impacts VL outcomes but mediated through adherence. Alcohol use was associated with poor adherence, which in turn was a strong predictor of virological failure.

INTRODUCTION:India is home to over 6 million women's groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women's and children's health. METHODS:We did a mixed-methods systematic review of quantitative and qualitative studies on women's groups in India to examine effects on women and children's health and to identify enablers and barriers to achieving outcomes. We searched 10 databases and included studies published in English from 2000 to 2019 measuring health knowledge, behaviours or outcomes. Our study population included adult women and children under 5 years. We appraised studies using standard risk of bias assessments. We compared intervention effects by level of community participation, scope of capability strengthening (individual, group or community), type of women's group and social and behaviour change techniques employed. We synthesised quantitative and qualitative studies to identify barriers and enablers related to context, intervention design and implementation, and outcome characteristics. FINDINGS:We screened 21 380 studies and included 99: 19 randomised controlled trial reports, 25 quasi-experimental study reports and 55 non-experimental studies (27 quantitative and 28 qualitative). Experimental studies provided moderate-quality evidence that health interventions with women's groups can improve perinatal practices, neonatal survival, immunisation rates and women's and children's dietary diversity, and help control vector-borne diseases. Evidence of positive effects was strongest for community mobilisation interventions that built communities' capabilities and went beyond sharing information. Key enablers were inclusion of vulnerable community members, outcomes that could be reasonably expected to change through community interventions and intensity proportionate to ambition. Barriers included limited time or focus on health, outcomes not relevant to group members and health system constraints. CONCLUSION:Interventions with women's groups can improve women's and children's health in India. The most effective interventions go beyond using groups to disseminate health information and seek to build communities' capabilities. TRIAL REGISTRATION NUMBER:The review was registered with PROSPERO: CRD42019130633.

Background: We evaluated the effectiveness of a cell phone counseling intervention to promote retention in care and HIV testing of infants among women with HIV accessing prevention of mother-to-child services in Kisumu, Kenya. Methods: Between May 2013 and September 2015, we recruited 404 pregnant women with HIV who were between 14 and 36 weeks of gestation and randomly assigned them to the intervention (n=207) or control arm (n=197). Retention was assessed at delivery and at 6 and 14 weeks postpartum. We also measured uptake of infant HIV testing. The intervention comprised a fixed protocol of counselor-delivered phone calls to provide one-to-one need-based support. The number of calls made varied depending on when participants presented for antenatal care services; the maximum number was 42. The control group received routine care. We evaluated retention at 3 time points using the complementary log-log regression model taking into account factors associated with retention and loss to follow-up time. We calculated the incidence rate for HIV transmission among infants and used binary logistic regression to identify predictors of HIV infection among infants. Results: Participants attended on average 63% of the required number of counseling calls during the study period. Retention was higher in the intervention arm than the control arm at delivery (95.2% vs. 77.7%, respectively); 6 weeks postpartum (93.9% vs. 72.9%, respectively); and 14 weeks postpartum (83.3% vs. 66.5%, respectively) (P<.001). The counseling intervention (hazard ratio [HR]=0.29; 95% confidence interval [CI]=0.12, 0.69) and positive health perceptions (HR=0.99; 95% CI=0.98, 1.00) were associated with lower hazards of being lost to follow-up. HIV testing of infants was higher in the intervention than control arm (93% vs. 68%, respectively; P<.001). In total, 9 of 308 (2.9%) infants tested positive for HIV infection (incidence rate=0.39 infections/100 infant-weeks). Medication Possession Ratio (MPR) >90%, used to assess adherence to ART, was associated with lower odds of a positive HIV test among infants (adjusted odds ratio=0.20; 95% CI=0.04, 0.99). Attendance at antenatal and postnatal care visits was higher among participants in the intervention arm than the control arm. Conclusions: The one-on-one tailored counseling delivered via cell phone was effective in retaining mothers with HIV infection in care and promoting uptake of infant HIV testing and antenatal and postnatal care services. Phone counseling offers a practical approach to reach and retain pregnant women with HIV infection and postpartum mothers in care, but greater emphasis on collection of medications and adherence is required.

To assess the prevalence and correlates of perinatal depression, 200 HIV-positive pregnant/post-partum women receiving antiretroviral therapy (ART) were interviewed at eight government ART centers in four states across India. 52.5% (105) participants had depressive symptomology (Edinburgh Postnatal Depression Scale score > 13) while 23% of the participants reported thoughts of self-harm; there was no difference between pregnant and postpartum participants. Poor illness perception was associated with depression (AOR, 1.09; 95%CI, 1.05, 1.14); there was no association between adherence and depression in this population.

This paper reports the results of a three-country study of the social, economic and health vulnerabilities of migrants from Bangladesh and Nepal living in India and of returnees. Overall, migration was found to be economically beneficial for those who succeed in the host labour market. However, it is associated with significant psychosocial and health vulnerabilities for most migrants in both communities. Further, migrants returning to their home countries with expectations of a better life continue to be in debt and experience poor health, indicating that migration may not always alleviate economic distress and high-lighting the need for financial guidance.

the World Health Organization in March 2020. Unlike the world’s persistent, high-burden infectious diseases—such as tuberculosis and malaria—that are more prevalent among the most vulnerable in lowand middle-income countries, COVID-19 is unique because of (1) its wide geographic spread across a range of populations, (2) its partially asymptomatic transmission, (3) a disproportionate effect on older people and those with underlying morbidities, and (4) potentially, the level of intensive care required when geographic areas experience a large number of severe cases. Many countries and states have chosen to place entire populations under lockdown to reduce mortality and mitigate the potential burden on health systems. Lockdowns vary greatly in severity, with some countries instituting full lockdowns, mandating social distancing, and strengthening public health responses, and other countries implementing shelter-in-place policies.