Peer-reviewed article
Decomposition of Wealth-Related Inequality in Child Immunization Among Aspirational and Non-Aspirational Districts in India.
Pooja Goel, Cyril Philip, Phanindra Goyari ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines wealth-related inequality in child immunization coverage across Indian districts between 2015-16 and 2019-2021. Full immunization coverage increased in both aspirational and non-aspirational districts, with inequality decreasing but remaining higher in aspirational districts. The research identifies mother's education, healthcare utilization, residence, and region as key factors driving immunization inequality.
Key points
- Full immunization coverage increased from 60.91% to 75.97% in non-aspirational districts and from 57.93% to 74.73% in aspirational districts
- Wealth-related inequality in child immunization decreased between survey rounds but remained higher in aspirational districts
- Mother's education, healthcare utilization variables, residence, and region are the main contributors to immunization inequality
- The study found convergence of immunization estimates between aspirational and non-aspirational districts in the later survey period
- Recommendations focus on improving maternal education, health cards, antenatal care, and reducing distance to health facilities
Limitations
This analysis is based on cross-sectional survey data and cannot establish causation. The study does not provide information about specific interventions or their effectiveness, only identifies factors associated with inequality.
Abstract
OBJECTIVES: To determine the change in inequalities in full immunization coverage among children aged 12-23 mo in aspirational districts (ADs) and non-aspirational districts (NADs) in India from 2015-16 to 2019-2021 and decompose its causes. METHODS: The authors used the National Family Health Survey (NFHS-4 and NFHS-5) data for the analysis. The two-sample proportions test and linear probability model were used. Further, the corrected concentration index (CCI) was used to measure inequality, and Wagstaff’s decomposition analysis was used to decompose the inequality. RESULTS: Full immunization coverage among Indian children increased from 60.91% (NFHS-4) to 75.97% (NFHS-5) in NADs, and from 57.93% to 74.73% in ADs. The study shows an important finding of convergence of immunization estimates among ADs and NADS during NFHS-5. Inequality in child immunization, measured by CCI, decreased from NFHS-4 to NFHS-5 but remained higher in ADs. Mother’s education, healthcare utilization variables, residence, and region are the key contributors to immunization inequality. CONCLUSIONS: The findings suggest that the focus should be on improving mothers’ education, providing health cards, and antenatal care visits, and reducing the distance to health facilities. Improving the provision of healthcare utilization variables can help mitigate inequalities in full immunization coverage, especially in ADs, thereby reducing inequalities between ADs and NADs.