Examining gender inequalities across castes: The case of a rural Keralite community

Background

Gender inequalities are often studied through sex-segregated data analysis, but may not dissect the effect of gender according to the social context. We explored gender bias in children's health care utilization in Kerala given its distinction from the rest of India to examine the relationship between gender and caste.

Study Design

A panel survey conducted in 2003 recorded events of health care utilization among 545 households of Kottathara Panchayat, Kerala. A total of 879 children had 439 severe episodes of illness.

Methodology

Multilevel multivariate response analysis were performed on severe episodes of illness to control of socio-demographic variables. Variance analysis were also conducted using children as a unit of analysis.

Results

Girls were almost twice less likely to have utilized health services (OR=0.58 [95% CI 0.31-1.07]) when having a severe episode of illness. Among episodes where at least one outpatient visit occurred, girls were also almost twice less likely to have sought care on the first day of the episode of illness (OR=0.50 [95% CI 0.31-0.81]) and to consult a private medical practitioner (OR=0.54 [95% CI 0.37-0.80]). When examining health expenditures by episode, we noticed a gender gap only among middle castes: girls spend approximately one tenth of what boys use (p=0.04). A similar pattern is repeated for average annual health expenditures.

Conclusion

Public health initiatives directed at children need to address the bias against girls if equitable utilization of health care is to be achieved.