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Income-related Inequity in Child Immunisation in India: Accounting for Horizontal and Vertical Inequity
Azharuddin Akhtar, Indrani Roy Chowdhury, Pallabi Gogoi, Sripriya Reddy ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5The study looks at how child immunisation in India differs by household income. It uses concentration indices to measure unfair differences (inequity) in incomplete immunisation and then breaks them down into contributing factors. Incomplete immunisation is concentrated among children from poorer households, and this remains true after accounting for need factors. Lower education, lower consumption and rural residence drive most of the inequity. Public health services such as Anganwadi reduce it.
Key points
- Incomplete immunisation is significantly concentrated among children in poorer households.
- After controlling for need factors, the inequity is still significantly pro-poor, which indicates horizontal inequity.
- Lower education, lower consumption and rural dwelling are the major factors driving the inequity.
- Differences in the effect of needs between all children and the target groups (based on education) were not large enough to produce vertical inequity.
- Public health services such as Anganwadi were the major factor reducing the inequity.
Limitations
The abstract does not give the data source, sample size, survey year or numeric index values. It describes associations in a cross-sectional style of analysis and cannot show causes or test an intervention.
Abstract
India witnesses more than one million deaths of under-five children annually and two-third of all these deaths occur due to vaccine preventable diseases High share of incomplete immunization in India (WHO, 2022) leaves socioeconomically disadvantage group exposed to high morbidity and mortality risk factors. It demands comprehensive assessment of nature and extent of socioeconomic related inequity in child immunisation. Using the indirect standardisation method and Erreygers (2009); corrected concentration index we first measured the degree of horizontal and vertical inequities, and then linearly decompose them to identify the major factors contributing towards the respective indices. We also adopt several strategies for robustness and sensitivity check on our findings. Our findings show that the incomplete immunisation is significantly concentrated among children belonging to poorer households. After controlling for the confounding effects of need factors, the inequity is still significantly pro-poor (indicating horizontal inequity). Its decomposition reveals that lower education, lower consumption and rural dwelling are the major factors driving the corresponding inequity. Further, the differential effect of needs between all and the target groups (at least based on education), is observed however is not significant enough to realise into inequity (indicating vertical equity). Hence, the direction and magnitude of vertical inequity is ambiguous but not significant. Overall, the inequity is being induced via non-need factors, but public health services (like Anganwadi) found to be the major reducing factor.