A fresh study sponsored by US-based organization, East-West Management Institute (EWMI), in alliance with Gujarat’s human rights NGO, Navsarjan Trust, has found “dramatic differences in the delivery of immunization services between Dalits and non-Dalits.” Carried out among 2,308 children ages 5 and under from 77 villages in eight Gujarat districts in consultation with Dr Dileep Mavalankar of the Public Health Foundation of India, and Dr Ankur Sarin of the Public Systems Group, Indian Institute of Management, Ahmedabad, the survey says that 20.4 per cent of Dalit children, age 2-5 years, were unvaccinated for the poliovirus in Gujarat’s rural areas, and this rate was “more than twice as high as non-Dalits in comparable geographic regions.”
Combining rural and urban areas, the report, titled “Blind Spots to the Polio Eradication Endgame: Measuring the Limitations of Polio Vaccination Delivery in Dalit Communities in Gujarat, India”, prepared in January 2013, finds that on the whole 15.8 per cent Dalit missed in polio vaccination campaigns (15.8 per cent), as against non-Dalit children’s 6.0 per cent.
The report comments that this is happening “despite the extensive pulse polio campaign in India”. Things are especially bad in ”traditionally marginalized communities living in hard-to-reach areas… “Although some non-Dalit children are also missed in these remote areas, the very high rate for Dalits raises notice that the endgame of polio eradication is at risk if greater monitoring is not directed at Dalit communities. With 25 million Dalit children age six and under living in India, a 15.8 per cent rate of missed children could extrapolate nationally into nearly four million, a significant roadblock to the goal of polio eradication”, it adds.
The report warns, “The missed vaccination rates for Dalit children present a particularly acute danger because unvaccinated Dalit children generally come from communities with less access to proper nutrition and sanitation, creating weakened immune system response to convert the polio vaccine24, and because some Dalit sub-castes have a higher exposure to activities at risk for transmission of the poliovirus. The Valmiki sub-caste, for example, performs the traditional work of manual scavenging, which includes the removal of human feces by hand…”
It says, “By some estimates, 50,000 Valmiki are currently employed in the manual removal of human waste by quasi-state agencies in Gujarat alone. With the overall population of Valmiki in Gujarat at approximately half a million, those actively employed as manual scavengers represent 10 per cent of the total Valmiki population. With the profession dominated by women, it is estimated that there is one actively employed manual scavenger in as many as half the Valmiki families in Gujarat.”
It adds, “Because Dalits are particularly vulnerable for transmission, the herd immunity protecting Dalit communities is more fragile: this higher transmission risk, coupled with less effective vaccination programmes and monitoring of these programmes, makes outbreaks in the Dalit community more likely. In Gujarat this vulnerability carries heightened significance because Gujarat lies just 100 miles east of Karachi in Pakistan, where that nation’s first case of polio for 2013 was reported in January.”
The study further says that for Dalits and non-Dalits alike, the rates of missed children were significantly higher in rural areas than in urban areas. Carried out in eight districts of Ahmedabad, Bhavnagar, Gandhinagar, Kheda, Mehsana, Patan, Rajkot and Surendranagar, the study found that in Ahmedabad district, which has a predominantly urban population, two per cent of non-Dalit children in age group 2-5 and 4.8 per cent of Dalit children ages 2-5 had received ≤ 1 OPV dose, whereas the rates of missed children in districts outside of Ahmedabad were 8.4 per cent of non-Dalit children and 20.4 per cent of Dalit children. This, it insists, is due to “several barriers facing rural populations: less access to transportation, information, and education, as well as the residents’ agricultural labor duties, all of which can create interference during pulse polio campaign days.”
Saying that “untouchability practices” contributed “significantly” in a higher rate of missed vaccinations among Dalits over non-Dalits, the study compares vaccination data of the Dalits with that of Other Backward Castes (OBCs) in the rural areas. The premise is: Families from the OBC castes have income levels closer to Dalit families than to non-Dalit families, yet they do not experience untouchability in the way that Dalits do. Based on this similarity in income levels, but dissimilarity in untouchability status, “it was hypothesized that Dalit children would have similar levels of missed vaccination as OBC children if family income were a significant contributing factor to these rural children being missed by the pulse polio campaign”, the report says.
It adds, “Because Dalits are particularly vulnerable for transmission, the herd immunity protecting Dalit communities is more fragile: this higher transmission risk, coupled with less effective vaccination programmes and monitoring of these programmes, makes outbreaks in the Dalit community more likely. In Gujarat this vulnerability carries heightened significance because Gujarat lies just 100 miles east of Karachi in Pakistan, where that nation’s first case of polio for 2013 was reported in January.”
The study further says that for Dalits and non-Dalits alike, the rates of missed children were significantly higher in rural areas than in urban areas. Carried out in eight districts of Ahmedabad, Bhavnagar, Gandhinagar, Kheda, Mehsana, Patan, Rajkot and Surendranagar, the study found that in Ahmedabad district, which has a predominantly urban population, two per cent of non-Dalit children in age group 2-5 and 4.8 per cent of Dalit children ages 2-5 had received ≤ 1 OPV dose, whereas the rates of missed children in districts outside of Ahmedabad were 8.4 per cent of non-Dalit children and 20.4 per cent of Dalit children. This, it insists, is due to “several barriers facing rural populations: less access to transportation, information, and education, as well as the residents’ agricultural labor duties, all of which can create interference during pulse polio campaign days.”
Saying that “untouchability practices” contributed “significantly” in a higher rate of missed vaccinations among Dalits over non-Dalits, the study compares vaccination data of the Dalits with that of Other Backward Castes (OBCs) in the rural areas. The premise is: Families from the OBC castes have income levels closer to Dalit families than to non-Dalit families, yet they do not experience untouchability in the way that Dalits do. Based on this similarity in income levels, but dissimilarity in untouchability status, “it was hypothesized that Dalit children would have similar levels of missed vaccination as OBC children if family income were a significant contributing factor to these rural children being missed by the pulse polio campaign”, the report says.
The survey data suggest that “the rate of missed vaccination by Dalit children far exceeded the rate of OBC children, with the latter missing vaccinations at a rate similar to non-Dalits. “Based on this divergence between income levels and vaccination rates, it can be argued that untouchability has a greater bearing on the likelihood of missed vaccination for the poliovirus than economic status”, the report says.
Coming to the gender disaggregation of unvaccinated children, the study says, “In all caste categories – non-Dalit, OBC and Dalit – girls missed vaccinations at a higher rate than boys in both urban and rural districts.” It adds, “The differences were most significant in non-Dalit and OBC children, although Dalit girls were also missed in vaccinations more often than Dalit boys... 14.4 per cent of Dalit boys went unvaccinated while the rate for girls was 16.4 per cent.“
Saying that there are “several possible explanations for the higher rate of missed vaccinations amongst girls in the study”, the report says, a plausible explanation is that “girls are more likely to be enlisted for assisting their mothers with housework and child care than their male siblings, and this may cause them to be unavailable to attend vaccination days at the polio booths. This explanation is supported by the higher rate of missed vaccinations in older girls (the gender difference was more significant among girls age 3-5 years than girls 2-5 years).”
Coming to the gender disaggregation of unvaccinated children, the study says, “In all caste categories – non-Dalit, OBC and Dalit – girls missed vaccinations at a higher rate than boys in both urban and rural districts.” It adds, “The differences were most significant in non-Dalit and OBC children, although Dalit girls were also missed in vaccinations more often than Dalit boys... 14.4 per cent of Dalit boys went unvaccinated while the rate for girls was 16.4 per cent.“
Saying that there are “several possible explanations for the higher rate of missed vaccinations amongst girls in the study”, the report says, a plausible explanation is that “girls are more likely to be enlisted for assisting their mothers with housework and child care than their male siblings, and this may cause them to be unavailable to attend vaccination days at the polio booths. This explanation is supported by the higher rate of missed vaccinations in older girls (the gender difference was more significant among girls age 3-5 years than girls 2-5 years).”
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