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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. [Copyright &y& Elsevier]

Abstract: Despite its economic success, India has made little progress towards meeting its Millennium Development Goal targets of reducing undernourishment, particularly among children. In this paper, we use nationally representative datasets, the National Family Health Surveys (NFHS II and NFHS III) and the National Sample Survey (55th and the 61st rounds) to analyse the link, if any, between child nutritional outcomes and calorie intakes. Our analysis finds evidence of an improvement in the height-for-age z-scores, but a worsening in weight-for-height z-scores for children aged 0–3 over the period 1998/1999–2005/2006. There is also evidence of a sharp decline in per adult equivalent calorie intake from the principal food items over roughly this same period. Moreover, this decline was observed across all the expenditure quintiles. Our analysis is therefore able to identify a co-movement of declining nutritional intake for both adults and children and a lack of progress in improving nutritional outcomes of children. [Copyright &y& Elsevier]

Abstract: This paper investigates the extent of socioeconomic inequalities in antenatal care use and related medical procedures in Brazil and India, which represent transition economies with contrasting geographical and sociocultural composition and health care provision. Concentration indices and regression analyses applied on recent Demographic Health Survey data reveal high and proportionate distribution of antenatal coverage in Brazil, whereas the Indian case present problems of both scale and equity. Inequalities in access to four or more antenatal visits are significantly pronounced in India, and in Brazil the differences are significant only for those who had six or more visits. Brazil''s universal healthcare model which proved effective in promoting equitable distribution of antenatal care could be implemented in India. Future interventions should emphasis quality of care in monitoring essential antenatal services especially targeting the poor and deprived communities. [Copyright &y& Elsevier]