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What's in a country average? Wealth, gender, and regional inequalities in immunization in India


  • Pande, Rohini P.
  • Yazbeck, Abdo S.


Recent attention to Millennium Development Goals by the international development community has led to the formation of targets to measure country-level achievements, including achievements on health status indicators such as childhood immunization. Using the example of immunization in India, this paper demonstrates the importance of disaggregating national averages for a better understanding of social disparities in health. Specifically, the paper uses data from the India National Family Health Survey 1992-93 to analyze socioeconomic, gender, urban-rural and regional inequalities in immunization in India for each of the 17 largest states. Results show that, on average, southern states have better immunization levels and lower immunization inequalities than many northern states. Wealth and regional inequalities are correlated with overall levels of immunization in a non-linear fashion. Gender inequalities persist in most states, including in the south, and seem unrelated to overall immunization or the levels of other inequalities measured here. This suggests that the gender differentials reflect deep-seated societal factors rather than health system issues per se. The disaggregated information and analysis used in this paper allows for setting more meaningful targets than country averages. Additionally, it helps policy makers and planners to understand programmatic constraints and needs by identifying disparities between sub-groups of the population, including strong and weak performers at the state and regional levels.

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  • Pande, Rohini P. & Yazbeck, Abdo S., 2003. "What's in a country average? Wealth, gender, and regional inequalities in immunization in India," Social Science & Medicine, Elsevier, vol. 57(11), pages 2075-2088, December.
  • Handle: RePEc:eee:socmed:v:57:y:2003:i:11:p:2075-2088

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    References listed on IDEAS

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    Cited by:

    1. Choi, Jin Young & Lee, Sang-Hyop, 2006. "Does prenatal care increase access to child immunization? Gender bias among children in India," Social Science & Medicine, Elsevier, vol. 63(1), pages 107-117, July.
    2. Xie, Jipan & Dow, William H., 2005. "Longitudinal study of child immunization determinants in China," Social Science & Medicine, Elsevier, vol. 61(3), pages 601-611, August.
    3. Oster, Emily, 2009. "Does increased access increase equality? Gender and child health investments in India," Journal of Development Economics, Elsevier, vol. 89(1), pages 62-76, May.
    4. Pathak, Praveen Kumar & Singh, Abhishek, 2011. "Trends in malnutrition among children in India: Growing inequalities across different economic groups," Social Science & Medicine, Elsevier, vol. 73(4), pages 576-585, August.
    5. Rammohan, Anu & Awofeso, Niyi, 2015. "District-level variations in childhood immunizations in India: The role of socio-economic factors and health infrastructure," Social Science & Medicine, Elsevier, vol. 145(C), pages 163-172.
    6. Anu Rammohan & Niyi Awofeso & Kazi Iqbal, 2014. "Gender differentials in the timing of measles vaccination in rural India," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 30(67), pages 1825-1848, June.
    7. Parashar, Sangeeta, 2005. "Moving beyond the mother-child dyad: Women's education, child immunization, and the importance of context in rural India," Social Science & Medicine, Elsevier, vol. 61(5), pages 989-1000, September.
    8. Zimmer, Zachary, 2008. "Poverty, wealth inequality and health among older adults in rural Cambodia," Social Science & Medicine, Elsevier, vol. 66(1), pages 57-71, January.
    9. Pulver, Ariel & Ramraj, Chantel & Ray, Joel G. & O'Campo, Patricia & Urquia, Marcelo L., 2016. "A scoping review of female disadvantage in health care use among very young children of immigrant families," Social Science & Medicine, Elsevier, vol. 152(C), pages 50-60.


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