180218 Examining gender inequalities across castes: The case of a rural Keralite community

Monday, October 27, 2008

Riswana Soundardjee, BScN, RN , Unité de santé internationale, Université de Montréal, Montréal, QC, Canada
Slim Haddad, MD, PhD , Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
D. Narayana, PhD , Centre for Development Studies, Thiruvananthapuram, India
Pierre Fournier, MD, PhD , Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada
Katherine S. Mohindra, PhD , Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada

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.


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.


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.


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

Learning Objectives:
(1) Analyze the differential effect of gender in relation to the specific context in which discrimination in health care utilization is manifested. (2) Assess at least three factors that influence the gender-caste relationship for health care utilization patterns.

Keywords: Access to Health Care, Gender

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Primary investigator of project and thesis advisor of first author. Student will not be able to present since she has been hired by an international NGO and is now based in Kashmir, Pakistan.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.