Content area
Abstract
In this dissertation I examine the impact of health interventions on socio-economic differentials in infant and child mortality in a rural population of Punjab, India. The data come from the Narangwal Health Project, which took place in the late 1960's and early 1970's.
The conceptual framework presented in Chapters 2 and 3 indicates that a health intervention is likely to reduce mortality differentials by social class, provided all members of society receive equal care from the program. Socio-economic differentials are expected to be reduced, simply because the marginal benefit derived from each additional unit of resource will be greater the poorer a child's initial health status. Public health interventions can change the disease environment, the information available to families regarding health, the cost of providing health to families and the resource levels available to the community to deal with health problems.
Multivariate analyses of infant and child survival during the first two years of life reveal that the impact of interventions depends on the type of services offered and on the criterion by which social class is measured. Examining socio-economic differentials in infant and child mortality as measured by mother's education, caste and family income, I find that in one intervention group a set of combined nutrition-health care-family planning interventions differentially benefitted children of uneducated mothers, while the mortality of children of educated mothers was unaffected. In these particular villages, it appears that the interventions were substitutes for the advantages that accrue to children when their mothers are educated. In a different set of villages that received curative and preventive health care only, the interventions reduced mortality for all children, but the decline in mortality for children of high caste families was substantially greater than the decline in lower caste families. I conclude that the impact of health interventions on differential mortality is sensitive to the preexisting social structure, as well as the type of intervention offered.
