Decomposing malnutrition inequalities between Scheduled Castes and Tribes and the remaining Indian population.

Objective. In India, Scheduled Castes and Scheduled Tribes (ST/SC) have been excluded from Hindu society for thousands of years. Together, they comprise over 24% of India's population and still suffer worse health conditions compared to the rest of the Indian population. This paper decomposes the gap in child malnutrition between the ST/SC and the remaining Indian population, looking at both the ST/SC's disadvantageous distribution of health determinants and possible discriminatory or behavioral differences. Design and setting. A Blinder-Oaxaca decomposition was applied to decompose the gap in children's average height-for-age z scores, using data from the 1998/1999 Indian Demographic Health Survey. Results. The gap was found to be primarily caused by the ST/SC's lower wealth, education and use of health care services, but also differences in the effects of health determinants played an important role. It was found that within rural areas ST/SC are not necessarily located further from educational and health care facilities. Conclusions. The use of Oaxaca type decomposition can be very useful when studying ethnic inequalities in health as it explicitly allows for discriminatory or behavioral effects. The results did not point to discrimination against ST/SC regarding health care or education. However, in the quest to increase health care use and education among ST/SC, policy makers will have to take into account all the barriers to these services, including those related to cultural sensitivity and acceptability. [ABSTRACT FROM AUTHOR]