research institute for compassionate economics

Social inequality

Social inequality and health in India

Widespread discrimination based on social rank in India takes a large toll on the health of the population.  By shedding light on how caste is linked to open defecation, and how discrimination against young women is liked to poor maternal nutrition, r.i.c.e. research helps understand the impacts of social hierarchy on child and maternal health in India.

Caste and open defecation

Caste continues to define a person’s status and position in Indian society; it is also an important marker of economic and educational inequality.  It is even related to a child’s height, a marker of her health and cognitive ability. Although caste hierarchy is neither linear nor fixed, there is consensus on which groups are at the bottom of this social hierarchy.  People from “untouchable,” or dalit groups continue to face severe discrimination and social exclusion.

r.i.c.e.’s research on open defecation shows that ideas about purity and pollution, which are central to the caste system, help explain widespread open defecation in India. Many people see the sorts of simple, affordable latrines that are used to reduce open defecation and improve health in other countries as impure and polluting. Although in other parts of the world, people use simple pit latrines rather than defecate in the open, but people in rural India do not adopt these latrines in part because they feel intense disgust at the idea of emptying latrine pits. This disgust is related to the fact that the most socially excluded among dalit castes traditionally cleaned human feces.  Thus, pit emptying, which is a normal activity in rural parts of other developing countries, and which makes latrine use affordable, presents deep challenges in India due to concepts of purity and pollution and caste and untouchability.  For these reasons, reducing open defecation in rural India is a far more complex problem than is generally understood.

Gender, age and maternal health

Discrimination against women in India is severe – girls in India are less likely to survive infancy, less well educated, and less well taken care of than boys. The 2011 Indian census found that for every 1000 boys under 6 years old, there are just 914 girls. The sex-selective abortion and neglect of female children that lead to this skewed sex ratio are symptoms of a deep social problem that has consequences for the health of the whole population.

The social position of young women of child bearing age in India is related to the poor health of Indian children. Indian mothers are underweight, and gain too little weight during pregnancy. Part of this nutritional deficit is due to disease, but part of it is due to the stress they experience because of their lack of autonomy and low social rank, and the fact that in many households, they are expected to be self-sacrificing to the point of eating last, and eating little. When women are undernourished during pregnancy, their babies have lower birth weight, and grow up to be less healthy. Discrimination against young women has such an impact on infant health that r.i.c.e. researchers have even been able to document an effect of women’s status within households on child height, an important indicator of life-long health and wellbeing.

What is r.ic.e. doing now?

There are no easy policy solutions for these deep social problems.  At the moment, we at r.i.c.e. are trying to educate policy makers and the public about how social inequality in India relates to poor health.

Maps and graphs

Policy Outreach