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Background Birth weight is positively associated with physical and cognitive development of children and adversely associated with the use of unclean cooking fuels. Though studies have examined the contextual determinants of birth weight, no attempt has been made to understand the association of gradient of cooking fuels with birth weight in India. The objective of this paper is to understand the association of type of cooking fuel with low birth weight in India. Methods Unit data from the fourth round of the National Family Health Survey (NFHS) (2015–16), covering 8206 singleton births from four states of India, was used in the analysis. These states reported more than 80% of birth weights by way of health cards issued by a public authority. Linear regression analysis was used to estimate mean birth weight, adjusting for confounders. We computed a new wealth index, excluding electricity and cooking fuels, using principal component analysis to capture the economic gradient of cooking fuel. Results Our results suggest a strong gradient of cooking fuels on mean birth weight. The adjusted mean birth weight in households using electricity was 2957 g (95% CI: 2939–2975). It was 2908 g (95% CI: 2907–2910) for LPG, 2792 g (95% CI: 2784–2801) for biogas, 2819 g (95% CI: 2809–2829) for kerosene, 2841 g (95% CI: 2816–2866) for coal/lignite/charcoal, and 2834 g (95% CI: 2831–2836) in households using biomass. A difference of 165 g in predicted mean birth weight was found among children born in households that used electricity in relation to those that used biogas. The difference in relation to kerosene, coal/lignite/charcoal, and biomass was 138 g, 116 g, and 123 g respectively. Significant differences in mean birth weight were also observed by wealth quintiles, mother's underweight, social groups, birth interval, and mother's anemia status. Conclusion Findings from the study suggest to strengthen the policies on access to clean fuels and meet the interconnected goals of sustainable development.

Understanding the association between gradient of cooking fuels and low birth weight in India