District-level trend analysis of low birth weight in India: National Family Health Surveys, 2016 and 2021

Currently, concerns persist regarding the slow and inconsistent progress in reducing low birth weight children, especially in India, and little is known about the geographical variability of the trajectories of its change. This study analyses data from the fourth and fifth rounds of India’s National Family Health Survey (NFHS), conducted in 2015–2016 (NFHS-4) and 2019–2021 (NFHS-5), respectively. A four-level logistic regression model was used to calculate precision-weighted probabilities of live births reported as low birth weight at the cluster level; which were summarised by 720 districts. As of 2021, around 18.2% of live births reported low birth weight in India, and there was no substantial improvement from 2016 to 2021. However, low birth weight declined by 2.05% points in the northern region and increased by 1.42% points in the eastern region. Out of 720 districts, 23.61% of districts experienced more than a 3% points reduction and 18.05% of districts experienced more than 3% points increase in low birth weight. The percentage of districts that have experienced more than 3% points increase varies from 28.57% in the eastern region to 8.51% in the southern region. While regional patterns of improvement and worsening are apparent, there are notable exceptions. For instance, districts such as Bangalore Rural in the south, Fatehabad in the north, Lohardaga in the east, and North Tripura in the northeast have shown improvements despite general trends of worsening in surrounding areas. Notable geographical variation in the percentage of low birth weight highlights the role of regional disparities in determinants of maternal and child healthcare. Addressing this issue necessitates an in-depth evaluation of policy implementation, incorporating best practices from districts that have demonstrated exceptions to the overall trends. These districts, which have successfully reduced the prevalence of low birth weight despite surrounding adverse conditions, are identified in this study.