21 Aug Despite Progress, Dalit in India Still Suffer From Excessive Pediatric Mortalitiy
MedicalResearch.com Interview with:
Jayanta Kumar Bora
& Ph.D. Scholar
Indian Institute of Dalit Studies
New Delhi, India
MedicalResearch.com: What is the background for this study?
Response: Although under-five mortality rate (U5MR) is declining in India, it is still high in a few selected states and among the scheduled caste (SC) and scheduled tribe (ST) population of the country. We examined the disparities in under-five mortality in high focus states of India. The high-focus states in India were designated as such by the Indian government because of their persistently high child mortality and relatively poor socio-economic and health indicators. This study re-examines the association between castes and under-five mortality in high focus Indian states using the most recent Indian Demographic Health Survey data conducted in 2015-16. The study also aims to quantify the relative contribution of socioeconomic determinants to under-five deaths by explaining the gap between socially disadvantaged (SC and ST) and non-disadvantaged castes in high focus states. Identifying disadvantaged groups in high focus states can help to reduce the absolute and relative burden of under-five deaths in India.
MedicalResearch.com: What are the main findings?
Response: Our study concluded that in high focus Indian states, the under-five deaths between well-off and deprived caste children has declined in the post-National Rural Health Mission (NRHM) period, indicating a positive impact in terms of reducing caste-based inequalities in the high focus states. Despite the reduction in under-five deaths, children belonging to the SC population experience higher mortality rates than children belonging to the non-SC/ST population from 1992 to 2016. Both macro level (district level mortality rates) and individual (regression analysis) analyses showed that children belonging to SCs experience the highest likelihood of dying before their fifth birthday. A decomposition analysis revealed that 83% of the caste-based gap in the under-five deaths is due to the distribution of women’s level of educational attainment and household wealth between the SC/ST and non-SC/ST population. Program indicators such as place of birth and number of antenatal care (ANC) visit also contributed significantly to widening caste-based gaps in under-five deaths.
MedicalResearch.com: What should readers take away from your report?
Response: Although U5MR has been continuously declining in India in recent decades, it is still substantially higher among certain social groups and regions in the country, particularly before the implementation of the NRHM. This study documented disparities in U5MR by caste groups in the high mortality regions of India in recent years, using nationally representative data. The novelty of the study lies therein that, to our knowledge, this is the first study in India that provides district-level estimates of U5MR and systematically investigates the factors explaining under-five deaths by caste groups using the most recent DHS data. Also, it is the first study to document the association between caste and under-five deaths in the post-NRHM period in India. We are somewhat surprised that despite pro-SC ST health interventions, they have higher under five mortality rates than that the rest.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The study indicates that there is still room to improve access to health facilities for mothers and children belonging to deprived caste groups in India. Continuous efforts to raise the level of maternal education and the economic status of people belonging to deprived caste groups should be pursued simultaneously. Given paucity of studies addressing district level mortality estimation among disadvantage caste groups in high focus states of India, we strongly believe that this is a crucial contribution to the knowledge on Indian context with respect to SDG3. The findings of this study can help to understand the factors behind the pervasive gap in U5MR between deprived and other caste groups in India. Further research can be done on the association between district level factors and child mortality among the disadvantage social group in India.
Also, creating awareness around preventive health care, maternal care, nutrition, awareness about infectious diseases, the benefits of hygiene and sanitation, and subsidized maternal health care services among SC and ST populations, should be increased through outreach programs.
Bora J, Raushan R, & Lutz W. The persistent influence of caste on under-five mortality: Factors that explain the caste-based gap in high focus Indian states. PLOS ONE, 2019 DOI: 10.1371/journal.pone.0211086
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