More than half a million women die each year as a result of complications related to pregnancy and childbirth in developing countries across the world; 1,2 in India, there were 68,000 maternal deaths in 2008. 3 Of the 7.7 million child deaths reported worldwide in 2010, 22% occurred in India. [1][2][3] Recent Indian National Family Health Survey (NFHS) data further show that 12% of children ever born to currently married women have died. 4 Available studies demonstrate that the chances of infant and maternal survival would be 2.5 times as high with birth intervals of 3-5 years as with intervals of two or fewer years. [5][6][7][8] In this context, the postpartum period is particularly important. Family planning method use in India leans heavily toward methods that limit fertility. The latest NFHS shows that 77% of sterilized women did not use a family planning method before sterilization. 4 Between the 1970s and the 1990s, the Indian Family Planning Program emphasized sterilization and set targets for the number of procedures. 9As a consequence, the name Family Planning Program became associated with sterilization. Despite changing its name to the Family Welfare Program and removing the target approach, the program has not been successful in educating people about the concept and advantages of interpregnancy spacing or the use of contraceptive methods for spacing births. Although contraceptive methods are available for free through the public health system at the village level, promotion of spacing methods is not considered important by health workers. Studies suggest that providers tend to focus their counseling on limiting methods and find it challenging to counsel young couples about spacing methods.9-13 Counseling about spacing methods can be time-consuming and providers must work against the myths and misconceptions about family planning use that are prevalent in the community. In addition, the lack of decision-making power about contraceptive use among young women makes providers view this counseling as futile. 12,13 Consequently, the interpregnancy interval has remained short. The median birth interval in India is 31 months; it is only 25 months for women aged 15-19 years. Young, low-parity, postpartum women in Uttar Pradesh are at high risk of closely spaced births; it is essential that programs focus their attention on this group to help prevent maternal and child mortalities and morbidities. The dependence of postpartum women on such traditional practices as postpartum abstinence and prolonged

This paper examines the relationship between indicators of mobility, socio-economic vulnerabilities, and HIV risk behaviours among 5,498 mobile female sex workers (FSWs) living in the four high HIV prevalence states in India. Female sex workers with greater degree of mobility reported significantly more often than the FSWs with lesser degree of mobility that they experienced physical violence, and consumed alcohol prior to sex. Further, FSWs with greater degree of mobility reported significantly more often than the FSWs with lesser degree of mobility that they had inconsistent condom use in sex with clients, even after controlling for several demographic characteristics and socio-economic vulnerabilities including experiences of violence. Additionally, short duration visits and visit to the Jatra (religious fairs) places found to have significant association with their inconsistent condom use in sex with clients as well as continuation of sex despite having STI symptoms. These findings suggest the need for screening FSWs for higher degree of mobility and to mobilize them to form community networks so as to deal with violence, reduce alcohol use and promote consistent condom use along the routes of mobility. HIV prevention interventions aimed at FSWs require an increased attention to address the socio-economic vulnerabilities including alcohol use, with particular emphasis on those FSWs who are on the move in India and elsewhere.

BackgroundIndia has large PWID (persons who inject drugs) population estimated at 177,000. PWIDs are at high risk for HIV, Hepatitis B (HBV) and Hepatitis C (HCV) infections. We report the prevalence of HIV, HBV and HCV infections and correlates of HIV-HCV co-infection among male PWIDs in Delhi.Methods3748 male PWIDs were recruited for a longitudinal HIV incidence study. Participants were tested for HBV and HCV infections at their first follow-up visit (FV1) using serum HBV-surface antigen, and HCV-antibody tests followed by HCV RNA PCR, respectively. All PWIDs who were HIV-negative at enrollment, were re-tested for HIV at FV1. Multinomial logistic regression was employed to identify predictors of HIV, HCV and HIV-HCV co-infection.ResultsOverall prevalence of HIV, HBV and HCV among 2,292 participants tested at FV1 was 25.9 %, 9.7 % and 53.7 %, respectively. 6.4 % of the participants had HIV mono-infection, 34.1 % had HCV mono-infection, and 19.6 % had HIV-HCV co-infection. 26 % of HIV-positive participants without HCV were HBsAg positive.In the regression model, having practiced at least one risky injection in the past month (relative risk ratio (RRR): 1.38; 95 % CI: 1.01-1.89) and not knowing his own HIV status (RRR: 1.65, 95 % CI: 1.25-2.17) were independent predictors for HIV-HCV co-infection. Longer duration of drug injections was associated with a higher likelihood of HCV mono-infection (2–5 years RRR: 2.13; 6–10 years RRR: 2.74; ≥11 years RRR: 3.14) and HIV-HCV co-infection (2–5 years RRR: 5.14; 6–10 years RRR: 8.53; >11 years RRR: 8.03). Higher frequency of injection days/month was associated with a higher likelihood of HCV mono-infection (≤10 days/month RRR: 1.61; 11–20 days/month RRR: 3.15; 21–30 days/month RRR: 3.47) and HIV-HCV co-infections (≤10 days/month RRR: 2.26; 11–20 days/month RRR: 3.46; 21–30 days/month RRR: 4.83).ConclusionsWe report a high prevalence of HIV, HCV and HIV-HCV co-infection among male PWIDs in Delhi. A tenth of the participants were HBsAg positive. Targeted Intervention programs should make HBV/HCV testing, prevention and care more accessible for PWIDs.

Point Pelee National Park of Canada in southwestern Ontario, an important migratory route and vital breeding area for many birds, has localized areas of organochlorine (OC) pesticide contamination from agricultural production during the 1950s and 1960s. During 2001 and 2002, we investigated movement of persistent contaminants through the food web with the insectivorous tree swallow (Tachycineta bicolor) as a sentinel. The a priori site classifications, contaminated or reference, were based on soil residues of dichlorodiphenyltrichloroethane (DDT) and its breakdown products (sigmaDDT), dieldrin, and other OC pesticides. In 2001, all nestling tissue samples were pooled by site, and residue levels did not reflect the soil contaminant status. To improve sampling accuracy in 2002, tissue residues were determined from birds in individual nests. This showed OC pesticides to be higher in samples from contaminated sites compared with reference sites (p = 0.031). Polychlorinated biphenyls (PCBs), which were not detected in soil samples, were present in the nestlings and were not related to site of origin (p = 0.422). In 2002, dietary samples were collected from nestlings and identified to taxon, and representative insects collected from nesting sites were analyzed for PCBs and other OCs. Consumption of terrestrial prey was positively correlated with tissue residues of sigmaDDT (p = 0.006), whereas PCBs came from aquatic prey, Hexagenia mayflies (p = 0.003). Dietary details proved valuable in this study of contaminant transfer in insectivorous vertebrates.