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.

The progress of Indigenous people or the Scheduled Tribes (STs) on developmental indicators is much poor than expected, especially their status of health. They report the highest mortality and malnutrition, low level of obstetric care, and are also among the poorest users of healthcare services in the country. This study examines the prevalence of acute and chronic morbidities and treatment-seeking behaviour among the ST in India. Second wave of India Human Development Survey (IHDS-2) data, 2011–2012, has been used in the study. Considering that culture and religion shape the demographic and health outcomes of people, this article has tried to seek a deeper understanding on morbidity and health-seeking behaviour by categorising the ST into four tribo-religious groups: namely, Hindu ST, Christian ST, Indigenous ST and the rest along ethnicity and religion lines. The study found evidence of an early epidemiologic transition in tribal areas and associated increase in the incidence of chronic and lifestyle diseases such as hypertension, diabetes, asthma. Other emerging concerns are prevalence of high untreated morbidity, dependence on private healthcare providers and increasing dependence on pharmacists among the ST.

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The level of infant and under-five mortality is high among scheduled castes (SCs) and scheduled tribes (STs) 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 maternal education. We used data from three rounds of National Family Health Survey (NFHS) : 1992-93, 1998-99 and 2005-06. The synthetic cohort probability approach using full birth histories was used to estimate childhood mortality. We performed binary logistic regression analysis to examine the association of infant mortality (IM) and under-five mortality (U5M) with maternal education and selected other covariates. Further, we applied Fairlie's decomposition technique to understand the relative contribution of maternal education and other covariates on IM and U5M risk between the caste groups. The IM rate (IMR) among children born to illiterate mothers is about 3 times higher than those born to mothers with higher education across all caste groups. Similarly, the U5M rate (U5MR) is 5 times higher among ST population and 3 times higher among SC population during the 14-year observation period (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). The proportions of secondary and higher educated SC and ST mothers are relatively lower than among non-SC/ST mothers. The regression analysis shows that mother's education has a statistically significant effect on reducing IM and U5M. A number of socio-economic covariates are found associated with IM and U5M; such as father's education, mother's age at first birth, mother's work status, household wealth, exposure to media and socio-economic empowerment of the mother. A decomposition analysis shows that more than 90 percent of the gap in IM and U5M between social groups is explained by the differences in the distribution of maternal education and household wealth. The findings of this study emphasise the need to provide education to disadvantaged girls and health counselling to women, particularly among SC/STs with more focus on backward regions or states, to further reduce IM and U5M in India.

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