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The Pervasive and Persistent Influence of Caste on Child Mortality in India

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Abstract

This study examines the effect of caste on child mortality and maternal health care utilization in rural India using data from the National Family Health Survey (NFHS-2) carried out during 1998–1999. Results from multilevel discrete-time hazard models indicate that, net of individual-level and community-level controls, children belonging to low castes have higher risks of death and women belonging to low castes have lower rates of antenatal and delivery care utilization than children and women belonging to upper castes. At the same time, the controls account for most of the differences within the low castes. Further analysis shows that the mortality disadvantage of low castes is more pronounced in poorer districts. These results highlight the need to target low caste members in the provision of maternal and child health services.

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References

  • Adhikari, R. K. (2003). Early marriage and childbearing: Risks and consequences. In S. Bott, S. Jejeebhoy, I. Shah, & C. Puri (Eds.), Towards adulthood: Exploring the sexual and reproductive health of adolescents in south Asia (pp. 62–66). Geneva, Switzerland: World Health Organization.

    Google Scholar 

  • Alam, N. (2000). Teenage motherhood and infant mortality in Bangladesh: Maternal age-dependent effect of parity one. Journal of Biosocial Science, 32(2), 229–236.

    Article  Google Scholar 

  • Arnold, F., Choe, M. K., & Roy, T. K. (1998). Son preference, the family-building process and child mortality in India. Population Studies, 52(3), 301–315.

    Article  Google Scholar 

  • Bayly, S. (1999). Caste, society and politics in India from the eighteenth century to the modern age. Cambridge, England: Cambridge University Press.

    Google Scholar 

  • Béteille, A. (1996). Caste, class and power: Changing patterns of stratification in a Tanjore village (2nd ed.). New Delhi, India: Oxford University Press.

    Google Scholar 

  • Bhat, P. N. M., & Zavier, A. J. F. (2003). Fertility decline and gender bias in northern India. Demography, 40(4), 637–657.

    Google Scholar 

  • Bloom, S. S., Yupij, D., & Gupta, M. D. (2001). Dimensions of women’s autonomy and the influence on maternal health care utilization in a north Indian city. Demography, 38(1), 67–78.

    Article  Google Scholar 

  • Borooah, V. K. (2005). Caste, inequality, and poverty in India. Review of Development Economics, 9(3), 399–414.

    Article  Google Scholar 

  • Brockerhoff, M., & Hewett, P. (2000). Inequality of child mortality among ethnic groups in sub-Saharan Africa. Bulletin of the World Health Organization, 78(1), 30–41.

    Google Scholar 

  • Burgard, S. (2002). Does race matter? Children’s height in Brazil and South Africa. Demography, 39(4), 763–790.

    Article  Google Scholar 

  • Cohen, C. J., & Dawson, M. C. (1993). Neighborhood poverty and African American politics. American Political Science Review, 87(2), 286–302.

    Article  Google Scholar 

  • Constitution of India. Website of Ministry of Law and Justice (Legislative Department). Retrieved May 2006 from http://www.indiacode.nic.in/coiweb/.

  • Desai, S., & Alva, S. (1998). Maternal education and child health: Is there a strong causal relationship? Demography, 35(1), 71–81.

    Article  Google Scholar 

  • Deshpande, A. (2000). Does caste still define disparity? A look at inequality in Kerala, India. The American Economic Review, 90(2), 322–325.

    Article  Google Scholar 

  • Deshpande, A. (2001). Caste at birth? Redefining disparity in India. Review of Development Economics, 5(1), 130–144.

    Article  Google Scholar 

  • Dharmalingam, A., & Morgan, S. P. (2004). Pervasive Muslim-Hindu fertility differences in India. Demography, 41(3), 529–545.

    Article  Google Scholar 

  • Dirks, N. B. (1989). The invention of caste: Civil society in colonial India. Social Analysis, 25, 42–52.

    Google Scholar 

  • Dumont, L. (1980). Homo Hierarchicus: The caste system and its implications (M. Sainsbury, L. Dumont, & B. Gulati, translators). Chicago IL: The University of Chicago Press.

  • Filmer, D., & Pritchett, L. H. (2001). Estimating wealth effects without expenditure data—or tears: An application to educational enrollments in states of India. Demography, 38(1), 115–132.

    Google Scholar 

  • Frisbie, W. P., Song, S.-E., Powers, D. A., & Street, J. A. (2004). The increasing racial disparity in infant mortality: Respiratory distress syndrome and other causes. Demography, 41(4), 773–800.

    Article  Google Scholar 

  • Gang, I., Sen, K., & Yun, M.-S. (2002). Caste, ethnicity and poverty in rural India. IZA Discussion Paper No. 629. Bonn, Germany: The Institute for the Study of Labor (IZA) Retrieved May 2006 from http://www.iza.org/en/.

  • Ghosh, S. (2003). Demographic and socioeconomic correlates of neonatal, post-neonatal and childhood mortality in Uttar Pradesh, India: A study based on NFHS-2 data. Journal of Health & Population in Developing Countries, 06 December 2003. Retrieved at: http://www.jhpdc.unc.edu.

  • Ghuman, S. J. (2003). Women’s autonomy and child survival: A comparison of Muslims and non-Muslims in four Asian countries. Demography, 40(3), 419–436.

    Article  Google Scholar 

  • Goldstein, H. (1995). Multilevel statistical models (2nd ed.). London, England: Edward Arnold.

    Google Scholar 

  • Govindasamy, P., & Ramesh, B. M. (1997). Maternal education and the utilization of maternal and child health services in India. National Family Health Survey Subject Reports No. 5. IIPS, Mumbai and Macro International Inc., Calverton.

  • Guo, G., & Zhao, H. (2000). Multilevel modeling for binary data. Annual Review of Sociology, 26, 441–462.

    Article  Google Scholar 

  • Heck, K. E., Schoendorf, K. C., & Chavez, G. F. (2002). The influence of proximity of prenatal services on small-for-gestational-age birth. Journal of Community Health, 27(1), 15–31.

    Article  Google Scholar 

  • Hobcraft, J. N., McDonald, J. W., & Rustein, S. O. (1985). Demographic determinants of infant and early child mortality: A comparative analysis. Population Studies, 39(3), 365–385.

    Article  Google Scholar 

  • Hoff, K., & Pandey, P. (2004). Belief systems and durable inequalities: An experimental investigation of Indian caste. World Bank Policy Research Working Paper No. 3351. Retrieved May 2006 from http://www.econ.worldbank.org/files/36689_wps3351.pdf.

  • Hummer, R. A. (1993). Racial differentials in infant mortality in the U.S.: An examination of social and health determinants. Social Forces, 72(2), 529–554.

    Article  Google Scholar 

  • Inden, R. B. (1990). Imagining India. Cambridge, MA: Basil Blackwell.

    Google Scholar 

  • International Institute for Population Sciences [IIPS], & ORC Macro. (2000). National Family Health Survey (NFHS-2), 1998–1999: India. Mumbai, India: IIPS.

    Google Scholar 

  • Jaffe, D. H., Eisenbach, Z., Neumark, Y. D., & Manor, O. (2005). Does living in a religiously affiliated neighborhood lower mortality? Annals of Epidemiology, 15(10), 804–810.

    Article  Google Scholar 

  • Jeffrey, C. (2001). “A fist is stronger than five fingers”: caste and dominance in rural north India. Transactions of the Institute of British Geographers, 26(2), 217–236.

    Article  Google Scholar 

  • Kabir, Z. (2003). Demographic and socioeconomic determinants of post-neonatal deaths in a special project area of rural northern India. Indian Pediatrician, 40(7), 653–659.

    Google Scholar 

  • Kawachi, I., Bruce, P. K., Kimberly, L., & Deborah, P.-S. (1997). Social capital, income inequality, and mortality. American Journal of Public Health, 87(9), 1491–1498.

    Google Scholar 

  • Kijima, Y. (2006). Caste and tribe inequality: Evidence from India, 1983–1999. Economic Development and Cultural Change, 54(2), 369–404.

    Article  Google Scholar 

  • Kishor, S. (1993). May god give sons to all: gender and child mortality in India. American Sociological Review, 58(2), 247–265.

    Article  Google Scholar 

  • Kravdal, Ø. (2004). Child mortality in India: The community-level effect of education. Population Studies, 58(2), 177–192.

    Article  Google Scholar 

  • Laveist, T. A. (1993). Segregation, poverty, and empowerment: Health consequences for African Americans. Milbank Quarterly, 71(1), 41–64.

    Article  Google Scholar 

  • Longford, N. T. (1993). Random coefficient models. Oxford, England: Clarendon Press.

    Google Scholar 

  • Ludden, D. (1993). Orientalist empiricism: Transformations of colonial knowledge. In C. A. Breckenridge & P. van der Veer (Eds.), Orientalism and the postcolonial predicament: Perspectives on South Asia (pp. 250–278). Philadelphia: University of Pennsylvania Press.

    Google Scholar 

  • Mahadevan, K., Murthy, M. S., Reddy, P. R., Reddy, P. J., Gowri, V., & Sivaraju, S. (1985). Sociodemographic correlates of infant and childhood mortality. Rural Demography, 12(1–2), 21–40.

    Google Scholar 

  • Maharatna, A. (2005). Demographic perspectives on India’s tribes. New Delhi, India: Oxford University Press.

    Google Scholar 

  • Matthews, S., & Gubhaju, B. (2004). Contextual influences on the use of antenatal care in Nepal. DHS Geographic Studies 2. Calverton: ORC Macro International.

  • Matthews, Z., Ramakrishna, J., Mahendra, S., Kilaru, A., & Ganapathy, S. (2005). Birth rights and rituals in rural south India: Care seeking in the intrapartum period. Journal of Biosocial Science, 37(4), 385–411.

    Article  Google Scholar 

  • Mendelsohn, O., & Vicziany, M. (1998). The untouchables: Subordination, poverty and the state in modern India. Cambridge, England: Cambridge University Press.

    Google Scholar 

  • Milner, M. J. (1994). Status and sacredness: A general theory of status relations and an analysis of Indian culture. New York: Oxford University Press.

    Google Scholar 

  • Mishra, V., Roy, T. K., & Retherford, R. D. (2004). Sex differentials in childhood feeding, health care, and nutritional status in India. Population and Development Review, 30(2), 269–295.

    Article  Google Scholar 

  • Mondal, S. K. (1997). Utilization of antenatal care services in Rajasthan: Observations from NFHS. The Journal of Family Welfare, 43(3), 28–33.

    Google Scholar 

  • Moursund, A., & Kravdal, Ø. (2003). Individual and community effects of women’s education and autonomy on contraceptive use in India. Population Studies, 57(3), 285–301.

    Article  Google Scholar 

  • Muhuri, P. K. (1995). Health programs, maternal education, and differential child mortality in MATLAB, Bangladesh. Population and Development Review, 21(4), 813–834.

    Article  Google Scholar 

  • Nahar, S., & Costello, A. (1998). The hidden cost of “free” maternity care in Dhaka, Bangladesh. Health Policy and Planing, 13(4), 417–422.

    Article  Google Scholar 

  • Nath, D. C., Singh, K. K., Land, K. C., & Talukdar, P. K. (1993). Age of marriage and length of the first birth interval in a traditional Indian society: Life table and hazards model analysis. Human Biology, 65(5), 783–797.

    Google Scholar 

  • Nath, D. C., Leonetti, D. L., & Steele, M. S. (2000). Analysis of birth intervals in a non-contracepting Indian population: A evolutionary ecological approach. Journal of Biosocial Science, 32(3), 343–354.

    Article  Google Scholar 

  • Navaneetham, K., & Dharmalingam, A. (2002). Utilization of maternal health care services in southern India. Social Science & Medicine, 55(10), 1849–1869.

    Article  Google Scholar 

  • Navarro, V. (1990). Race or class versus race and class: Mortality differentials in the United States. The Lancet, 336(8725), 1238–1240.

    Article  Google Scholar 

  • Pallikadavath, S., Foss, M., & Stones, R. W. (2004). Antenatal care: Provision and inequality in rural north India. Social Science & Medicine, 59(6), 1147–1158.

    Article  Google Scholar 

  • Pandey, A., Choe, M. K., Luther, N. Y., Sahu, D., & Chand, J. (1998). Infant and child mortality in India. National Family Health Survey Subject Reports No. 11. IIPS, Mumbai and East-West Center, Honolulu.

  • Pebley, A. R., Goldman, N., & Rodriguez, G. (1996). Prenatal and delivery care and childhood immunization in Guatemala: Do family and community matter? Demography, 33(2), 231–247.

    Article  Google Scholar 

  • Robert, S. A. (1999). Socioeconomic position and health: The independent contribution of community socioeconomic context. Annual Review of Sociology, 25, 489–516.

    Article  Google Scholar 

  • Rogers, R. G. (1989). Ethnic differences in infant mortality: Fact or artifact. Social Science Quarterly, 70(3), 642–649.

    Google Scholar 

  • Sapolsky, R. M. (2004). Social status and health in humans and other animals. Annual Review of Anthropology, 33(1), 393–418.

    Article  Google Scholar 

  • Sastry, N. (1996). Community characteristics, individual and household attributes, and child survival in Brazil. Demography, 33(2), 211–229.

    Article  Google Scholar 

  • Sen, A. (2003). Missing women—revisited. BMJ, 327(7427), 1297–1298.

    Article  Google Scholar 

  • Shariff, A., & Singh, G. (2002). Determinants of maternal health care utilization in India: Evidence from a recent household survey. New Delhi, India: National Council For Applied Economic Research.

    Google Scholar 

  • Singh-Manoux, A., Adler, N. E., & Marmot, M. G. (2003). Subjective social status: Its determinants and its association with measures of ill-health in the Whitehall II study. Social Science & Medicine, 56(6), 1321–1333.

    Article  Google Scholar 

  • Srinivas, M. N. (1989). The cohesive role of sanskritization. New Delhi, India: Oxford University Press.

    Google Scholar 

  • Stephenson, R., & Tsui, A. O. (2002). Contextual influences on reproductive health service use in Uttar Pradesh, India. Studies in Family Planning, 33(4), 309–320.

    Article  Google Scholar 

  • Sugathan, K. S., Mishra, V., & Retherford, R. D. (2001). Promoting institutional deliveries in rural India: The role of antenatal-care services. National Family Health Survey Subject Reports No. 20. IIPS, Mumbai and East-West Center, Honolulu.

  • Suwal, J. V. (2001). The main determinants of infant mortality in Nepal. Social Science & Medicine, 53(12), 1667–1681.

    Article  Google Scholar 

  • Talukdar, S. (1983). Patterns of fertility and mortality in four caste groups in West Bengal. Man India, 62(2), 151–163.

    Google Scholar 

  • Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science & Medicine, 38(8), 1091–1110.

    Article  Google Scholar 

  • Thorat, S., & Lee, J. (2005). Caste discrimination and food security programmes. Economic and Political Weekly, 40(39), 4198–4201.

    Google Scholar 

  • Tulasidhar, V. B. (1993). Maternal education, female labour force participation and child mortality: Evidence from the Indian census. Health Transition Review, 3(2), 177–192.

    Google Scholar 

  • Vincentnathan, S. G. (1996). Caste politics, violence, and the panchayat in a south Indian community. Comparative Studies in Society and History, 38(3), 484–509.

    Article  Google Scholar 

  • Wagstaff, A. (2000). Socioeconomic inequalities in child mortality: Comparisons across nine developing countries. Bulletin of World Health Organization, 78(1), 19–29.

    Google Scholar 

  • Whitworth, A., & Stephenson, R. (2002). Birth spacing, sibling rivalry and child mortality in India. Social Science & Medicine, 55(12), 2107–2119.

    Article  Google Scholar 

  • Williams, D. R., & Collins, C. (1995). US socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology, 21(1), 349–386.

    Article  Google Scholar 

  • Zachariah, K. C., & Patel, S. (1983). Trends and determinants of infant and child mortality in Kerala. Janasamkhya, 1(2), 125–142.

    Google Scholar 

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Dommaraju, P., Agadjanian, V. & Yabiku, S. The Pervasive and Persistent Influence of Caste on Child Mortality in India. Popul Res Policy Rev 27, 477–495 (2008). https://doi.org/10.1007/s11113-008-9070-0

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