Introduction

Mortality in children under-five yearof age has declined in most countries, with the decline accelerating since 2000.There is a well-established body of literature documentingmaternal education as a significant determinant of child health outcome. TheIndian caste system, out of all the caste groups, the most disadvantaged anddeprived ones are the Scheduled Castes (SCs) and Scheduled Tribes (STs), withsome expansion into Other Backward Classes (OBCs). In this study, we firstdocumented the trends in infant and under-five mortality by caste groups during1992–2016, and then we investigated the contribution of education in explainingthe average gap in infant and under-five mortality between SC/ST and non-SC/STpopulations in India.

Data

We used data from four rounds of NationalFamily Health Surveys (NFHS) conducted during the years 1992-93, 1998-99, 2005-06and 2015-16 in the present study. However, we did detailed analysis on the fourthround of NFHS survey conducted during 2015-16 (IIPSand ICF 2017).

Results

Trends in the social group’sgap for infant and under-five mortality in India

Figure 1 shows the trends in IMR andU5MR within the SC, ST and non-SC/ST populations for 1992-93 to 2015-16. BothIMR and U5MR are higher among SCs and STs than non-SC/ST population during 1992to 2016. The infant mortality rate among SCs dropped to 47 deaths per 1000 livebirths in 2016 from 107.2 in 1992-93, a 56 percent decline, and for STs (46.4in 2016 and 90.9 in 1992) there was a 49 percent decline. Among non-SC/STs (40.1in 2016 and 82.2 in 1992) the decline was around 51 percent. The picture is similarfor under-five mortality. It is notable that the decline was more among SCs thanamong STs.                                                                                                                     

We carried out binary logisticregression analysis to examine the association between maternal education with infant/under-fivemortality for each caste group (Table 1). Mother’s education is found to have astatistically significant effect on reducing infant and under-five mortality forSC, ST and non-SC/ST populations. Children are less likely to die when theirmother had completed secondary and higher education than children born to illiteratemothers. Moreover, as expected, infant and under-five mortality also showssignificant declines simultaneously with increases in the educational level ofthe mother.

Table 1 Logit estimates in infant andunder-five mortality by mother''s education, media exposure & socio-economicempowerment among SC, ST& non-SC/ST populations, India, 2015-16

Notes:(a) *** p<0.01, ** p<0.05, * p<0.1 (b) The entries in parenthesisrefer to standard errors (c) ® indicate referencecategory

Result of the Decomposition Analysis

In this study we used the Fairliedecomposition analysis to quantify the contribution of different socio-economic and demographic predictors explaining the gap in infant mortality and under-fivemortality between SCs/STs and the non-SC/ST population. Results of the detaileddecomposition are presented in Table 2. To make our result more readable, wepresent the coefficient in terms of percentage in Fig. 2.

Table 2 Fairliedecomposition of average gap in Infant and under-five mortality risk betweensocial groups in India, 2015–16

 Note:(a)*** p< 0.01, ** p< 0.05 & * p< 0.10

Conclusion

Our findings suggest that increasingmaternal education among socially deprived groups should be prioritised toreduce infant and under-five mortality as well as the overall state of healthof children in India. In order to reduce childmortality, the Government of India launched an ambitious National Rural HealthMission (NRHM- now as NHM: National Health Mission) to improve child health andaddresses factors contributing to infant and under-five mortality. A furthersuccess in lowering child mortality is needed by focusing on disadvantagedsocial groups and helping to achieve the sustainable development goals (SDG)for child mortality by 2030.