PB No. 20 Is there a seasonal pattern to births in Jharkhand?

Human births largely follow a seasonal pattern. In contrast, the absence of rhythms in the distribution of births throughout the year—or the absence of birth seasonality is not common and even considered abnormal. However, these seasonal patterns, are not uniform when they exist. Birth seasonality is characterized by temporal and geographical factors [1-2]. The factors that govern conception, followed by childbirth are different in urban and rural areas [3-4]. Seasonal variations in childbirths have been of empirical interest to many scholars both globally and in India [5-6]. A recent study also observed distinct seasonal childbirth patterns in different states of India [3]. Given the potential impact of birth seasonality on the health system, a state-level analysis could provide a nuanced view to local administrators to improve the delivery of services. The overall objective was to examine patterns of seasonality in the state and identify corresponding periods of conception in the state and whether there is a distinct link to agro-climatic conditions.

The current report analyses the child birth data of Jharkhand retrieved from the Health Management Information System (HMIS) that was previously available in the public domain. The HMIS was established under the National Rural Health Mission (NRHM), flagship healthcare program under the Ministry of Health and Family Welfare (MoHFW). The policy brief analyzed data between April 2017 to March 2020 a period just prior to the onset of the pandemic. While the state was the primary unit of analysis, district-level patterns were also looked at.

While there are issues with quality of HMIS data, few other sources provide granular level child birth data. Also, the reporting of live births is fairly robust, at least to the extent of revealing seasonal patterns in births [3].

Is there seasonal variation in births in Jharkhand?

The births between FY 18-FY 20 revealed a basic pattern of seasonality in the state of Jharkhand with high peaks during the months of August till November. The births decline thereafter with a notable dip in the month of February followed by another slump during May and June (Fig 1). These patterns are aligned to the “Northern agrarian” birth patterns observed in the neighbouring state Bihar [3].

Birth seasonality according to region

Patterns of birth seasonality in rural areas were similar to the state level. However, there were no clear or strong patterns of seasonality in urban areas where the births were erratic in the 36-month period. However, the number of urban births is small and it is likely that reporting from private health facilities is lacking. The two NSSO regions; Ranchi Plateau and Hazaribagh Plateau follow the state level pattern of birth peaks between August to October (Fig 1).

Source: HMIS

Factors that influence conception

Child birth in Jharkhand seems to be influenced by agro-climatic factors. The peak in births between August to November corresponds to conception (by appropriate lagging) in the months of November to February while the notable dip in births in February correspond to the month of May and the later dips during May and June corresponds to the months of August abd September which is also the kharif farming season. Kharif crops like maize are sown between May-June and rice between June -August [7]. Jharkhand is also divided into 3 agro-climatic regions i.e., Central and North-eastern Plateau (Region-I), Western Plateau (Region-II) and South-eastern Plateau (Region-III) (Figure 2). As seen in Fig 3, all three regions also follow a pattern of birth peak August to November and dip in February-March. It was observed however, that 3 of the 7 districts that largely witnessed a higher rate of births in the month of August belonged to the western plateau of Jharkhand.

Source: BAU (n.d.)

A peak in August favors conception in the plateau where kharif crops (maize, groundnut, pulses) are harvested between August to October followed by rabi crops sown in October (pulses, oilseeds). These patterns have been corroborated in the extant literature. Studies have found temperatures to be associated with the conceptions where chances of conception were high during the pleasanter winter period and lowest during summer months with high temperatures. However, in rural areas, the tiring work done in farms appear to also be an important factor that influences conception [4-5]. The months of lowest conception correspond to period where rabi crops are harvested, period where farmers undertake land preparation post pre-monsoon showers, sowing and harvesting of key kharif crops [7, 8].

Source: HMIS

In urban areas, births were erratic. It must be noted still that districts that comprise 94% of urban births (Purbhi Singhbhum, Dhanbad and Bokaro) are also industrially developed districts, and utilization and reliance on health facilities by temporary migrants and neighboring districts are expected.

Source: HMIS

The contour map of the standard deviation based low (<0.6SD), moderate (0.6-1SD) high (1-1.4 SD, and seasonal variations in births is provided in Figure 4. The map shows that for most districts, the variation was low to moderate. This was evident given that several districts did not demonstrate very clear or consistent peaks in births during the 36-month period. However, 5 of the 7 districts in Western plateau (agro-climatic region II) had either a moderate or high standard deviation. Several (7 of 10) districts with a high Scheduled Tribes population (>35%) had a moderate or high standard deviation [9]. At state level, the variation was low (0.53 SD).

Gap in coverage of Immunization at birth: Seasonality in births has implications for family planning services as well as the logistics for child vaccination. We examine the patters of birth dosage as reported in the HMIS.

Fig 5 compares month-wise data of births and coverage of birth doses of 4 vaccines for FY18-FY20 period. It is observed that the variations in the birth doses largely follow the variations in the birth patterns with a high peak during August to November and a decline thereafter with significant dip usually around February-March.

In terms of coverage of birth doses, the largest gap existed for vitamin K1 dose and Hepatitis B – birth doses. Even the gap between number of births and Oral poliovirus vaccines (OPV) was high. The numbers of Bacille Calmette-Guerin (BCG) exceeded that of children born through FY18-FY20 indicating significant over-reporting.

Source: HMIS

Key Takeaways & Policy Implications

Birth patterns appear to be influenced by agro-climatic factors.
The patterns of birth seasonality have critical implications on health system and policy. Family planning programs could develop strategies for improving their reach to meet unmet contraception needs of women in the state during the key conception months. It must be noted that Jharkhand has a high tribal population and their unmet needs for family planning is higher than other social groups.

From a public health perspective, an understanding of birth seasonality patterns can be useful in planning obstetric health care. Jharkhand is a state where few districts of Jharkhand have a high rate of preterm births per 1000 live births hence identifying months of birth peak is critical [10]. Most districts of Jharkhand have a very high-rate anemia among pregnant women and anemia in pregnancy has been strongly associated with preterm births in Jharkhand [11-12]. In some studies [13], high preterm prevalence has been observed in the post-monsoon months (September to November) which is the same period with high rates of childbirth in the state identified in this analysis. Identification of months of high or low births can help local health system to improve delivery of maternal health services.

In Jharkhand, important vaccines like Hepatitis B and oral polio have very low coverage for their birth doses. Further, guidelines to administer vitamin K1 at birth are also not being followed. The gaps in Vitamin K1 have been largely attributed to insufficient supply and poor awareness of health workers [14]. While government guidelines mandates administration of injection Vitamin K Prophylaxis at birth, the national immunization schedule has not included the vaccine which indicates needs for sensitization of health care workers [15-16]. With information of birth seasonality, local health facilities can effectively plan to ensure there is adequate stock of vaccines during the peak months.

References

1. Cancho-Candela, R., Andrés-de Llano, J. M., & Ardura-Fernandez, J. (2007). Decline and loss of birth seasonality in Spain: analysis of 33 421 731 births over 60 years. Journal of Epidemiology & Community Health, 61(8), 713-718.
2. Ferguson, A. G. (1987). Some aspects of birth seasonality in Kenya. Social Science & Medicine, 25(7), 793-801.
3. Nambiar, A., Chowdhury, D., & Agnihotri, S. B. (2022). Seasonal Variations in Childbirth A Perspective from the HMIS Database (2017–20). Economic & Political Weekly, 7(17).
4. Bernard, R. P., Bhatt, R. V., Potts, D. M., & Rao, A. P. (1978). Seasonality of birth in India. Journal of Biosocial Science, 10(4), 409-421.
5. Ogum, G. E. O., & Okorafor, A. E. (1979). Seasonality of births in south-eastern Nigeria. Journal of Biosocial Science, 11(2), 209-217.
6. Anand, K., Kumar, G., Kant, S., & Kapoor, S. K. (2000). Seasonality of births and possible factors influencing it in a rural area of Haryana, India. Indian pediatrics, 37(3), 306-311.
7. Government of India. (2018). New Crop Calendar. Pradhan Mantri Fasal Bima Yojana. Ministry of Agriculture and Farmers Welfare. Retrieved from https://pmfby.gov.in/pdf/New_Crop_Calendar_20.09.18.pdf
8. BAU. (n.d.) Agricultural Technology Modules for Jharkhand. Directorate of Extension Education Birsa Agricultural University (BAU). Retrieved from: http://bau-eagriculture.com/submit/download/publication/publication1.pdf
9. Government of India. (2011). Jharkhand district wise map-Percentage ST population. Census 2011. Retrieved from: https://www.censusgis.org/india/
10. Shaw, S., Chaudhuri, S., & Agnihotri, S. (2021). Policy Brief: Preterm delivery patterns in Jharkhand as revealed by HMIS data 2017-18 to 2019-20. Nutrition Group-IIT Bombay. Retrieved from: https://www.iitbnutritiongroup.in/policybrief-jharkhand/  
11. MoHFW. (n.d.). Anaemia in pregnant women, Jharkhand, NFHS5 2019-2021. Pregnancy-Manifestation in Jharkhand. HealthNutritionINDIA. Retrieved from: https://healthnutritionindia.in/dashboard/3/1/239
12. Kumari, S., Garg, N., Kumar, A., Guru, P. K. I., Ansari, S., Anwar, S., … & Sohail, M. (2019). Maternal and severe anaemia in delivering women is associated with risk of preterm and low birth weight: A cross sectional study from Jharkhand, India. One Health, 8, 100098.
13. Hughes, M. M., Katz, J., Mullany, L. C., Khatry, S. K., LeClerq, S. C., Darmstadt, G. L., & Tielsch, J. M. (2014). Seasonality of birth outcomes in rural Sarlahi District, Nepal: a population-based prospective cohort. BMC pregnancy and childbirth, 14(1), 1-9.
14. Bora, K. (2021). Gaps in the coverage of vitamin K1 prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System. Public Health Nutrition, 24(17), 5589-5597.
15. MOHFW. (2018). National Immunization Schedule. National Health Mission.Retrieved from https://nhm.gov.in/New_Updates_2018/NHM_Components/Immunization/report/National_%20Immunization_Schedule.pdf
16. Government of India. (2014). Operational Guidelines. Injection of Vitamin K Prophylaxis at Birth (In Facilities). Ministry of Health & Family Welfare . Retrieved from https://nhm.gov.in/images/pdf/programmes/child-health/guidelines/Vitamin_K_Operational_Guidelines.pdf

Authors

Marian Abraham is a Senior Research Analyst at the Koita Centre For Digital Health, IIT Bombay.

Krritika R Patel has completed her M.Tech in Technology and Development at CTARA, IIT Bombay.

Prof Satish B Agnihotri is an Emeritus Fellow CTARA at IIT Bombay.

Prof. Sarthak Gaurav is an Associate Professor at Shailesh J. Mehta School of Management, IIT Bombay.

Suggested Citation: Abraham, M., Patel, K., Agnihotri, S. B., & Gaurav, S. (2024). Is there a seasonal pattern to births in Jharkhand? Nutrition Group, IIT Bombay.