Contribute of education to Infant and under-five mortality disparities among caste groups in India: Evidence from nationally representative surveys

Jayanta Bora, Indian Institute of Dalit Studies

Objective: Infant and under-five mortality is declining In India and many other countries but the level of it is high among scheduled castes (SCs) and scheduled tribes (STs) population in India. This study intends to quantify the contribution of education in explaining the gap in infant and under-five mortality between SCs/STs and non-SC/ST population in India with a special focus on the effect of education.

Data and method: The four rounds of NFHS data were used. The synthetic cohort approach from Full Birth Histories, logistic regression and Fairlie''s decomposition model were used.

Findings: The infant mortality rate (IMR) and under-five mortality rate (U5MR) among children born to illiterate mothers is about 3 times higher than those born to mothers with higher education across all the caste groups. The proportion of secondary and higher educated SC and ST mothers are relatively lower than among non-SC/ST mothers. Regression analysis shows that mother’s education has a statistically significant effect on reducing IM and U5M across all the caste groups. A number of socioeconomic covariates are found associated with IM and U5M; such as father’s education, mother’s age at first birth, birth order, sex of the child, household wealth, exposure to media and socio-economic empowerment of the mother. Decomposition analysis shows that more than 80 percent of the gap in IM and U5M between social groups is explained by the differences in the distribution of parental education and household wealth. Mothers media exposure also significantly contribute to widening the caste gap in infant (15 percent) and under-five mortality (10 percent) risk.

Conclusion: The findings of this study emphasise the need to strengthen on education to disadvantaged girls and health counselling to women, particularly among SC/STs with more focus on backward regions at the lower administrative level, to further reduce IM and U5M in India.


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

 

Variables

IM

U5M

SC

ST

Non-SC/ST

SC

ST

Non-SC/ST

Odds ratio

Odds ratio

Odds ratio

Odds ratio

Odds ratio

Odds ratio

Mother’s literacy

 

 

 

 

 

 

Can''t read ®

Partly read

0.87**(0.06)

0.79***(0.05)

0.90**(0.04)

0.86**(0.05)

0.78***(0.05)

0.88***(0.03)

Completely able to read

0.85*(0.08)

1.12(0.09)

0.96(0.05)

0.83**(0.07)

1.04(0.08)

0.94(0.05)

 

Mother’s education

No education ®

Primary

1.06(0.05)

1.02(0.05)

1.00(0.03)

1.03(0.05)

0.96(0.05)

0.96(0.03)

Secondary

0.92(0.09)

0.63***(0.06)

0.72***(0.04)

0.86*(0.08)

0.62***(0.05)

0.67***(0.03)

Higher

0.58***(0.08)

0.42***(0.06)

0.48***(0.03)

0.51***(0.06)

0.39***(0.05)

0.43***(0.03)

 

Mother’s media exposure

Without media exposure ®

With media exposure

0.73***(0.02)

0.92**(0.03)

0.79***(0.02)

0.72***(0.02)

0.87***(0.03)

0.78***(0.01)

 

Mother’s socio-economic empowerment

Doesn’t take decisions alone®

Takes decisions alone

0.87(0.09)

0.95(0.09)

0.92(0.05)

0.85*(0.08)

1.00(0.09)

0.94(0.05)

 

Constant

0.07***(0.00)

0.05***(0.00)

0.06***(0.00)

0.09***(0.00)

0.07***(0.00)

0.08***(0.00)

 

Observations

1,10,623

54,004

3,49,696

1,10,623

54,004

3,49,696

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

 

Covariates

IM

U5M

Contribution

Contribution

Mother’s education

0.84**

0.90**

Father’s education

0.76**

1.35***

Mother’s age at 1st birth

0.10

0.10

Sex of the child

-0.04

-0.03

Birth Order

-0.03

0.09

Mothers working status

-0.14

-0.11

Wealth

1.83**

3.01***

Type of residence

0.15

0.18

Mother’s media exposure

0.60**

0.61**

Mother’s socio-economic empowerment

0.02

0.01

Total gap

5.83

8.56

Explained gap

4.11(71%)

6.12(72%)

Number of observations

93,461

93,461

 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.

Presented in Session 1186: Mortality and Longevity