The persistent influence of caste on under-five mortality: Factors that explain the caste-based gap in high focus Indian states

16037 9 88189 2 251709 document 88189 journal.pone.0211086.pdf application/pdf af4780f34cca99fad990de4cb746ac15 MD5 1497789 2019-08-21 07:47:34 https://pure.iiasa.ac.at/id/eprint/16037/1/journal.pone.0211086.pdf 16037 1 1 application/pdf text en public cc_by_4

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http://eprints.org/relation/isVersionOf https://pure.iiasa.ac.at/id/document/88189 http://eprints.org/relation/isVolatileVersionOf https://pure.iiasa.ac.at/id/document/88189 http://eprints.org/relation/issmallThumbnailVersionOf https://pure.iiasa.ac.at/id/document/88189 archive 353 disk0/00/01/60/37 2019-08-21 07:51:30 2023-08-05 05:01:22 2019-08-21 07:51:30 article show Bora J. 9176 Raushan R. Lutz W. 1124 0000-0001-7975-8145 The persistent influence of caste on under-five mortality: Factors that explain the caste-based gap in high focus Indian states pub prog_pop Objective 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. This study re-examines the association between caste and under-five deaths in high focus Indian states following the implementation of the country’s National Rural Health Mission (NRHM) program. In addition, we aim to quantify the contribution of socioeconomic determinants in explaining the gap in under-five death risk between the SC/ST population and non-SC/ST population in high focus states in India. Data and method Using data from the National Family Health Survey (NFHS), we calculated the U5MR by applying a synthetic cohort probability approach. We applied a binary logistic regression model to examine the association of under-five deaths with the selected covariates. Further, we used Fairlie's decomposition technique to understand the relative contribution of socioeconomic variables on under-five death risk between the caste groups. Findings In high focus Indian states, the under-five mortality risk between well-off and deprived caste children has declined in the post-NRHM period, indicating a positive impact in terms of reducing caste-based inequalities in the high focus states. Despite the reduction in under-five death risk, 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 U5MR. Conclusion 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. 2019-08-20 published Public Library of Science (PLoS) 10.1371/journal.pone.0211086 2971 190 public PLoS ONE 14 8 e0211086 TRUE 1932-6203 FALSE no info:eu-repo/semantics/article