Women's health in a rural community in Kerala, India: do caste and socioeconomic position matter?

Objectives: To examine the social patterning of women's self-reported health status in India and the validity of the two hypotheses: ( 1) low caste and lower socioeconomic position is associated with worse reported health status, and ( 2) associations between socioeconomic position and reported health status vary across castes. Design: Cross-sectional household survey, age-adjusted percentages and odds ratios, and multilevel multinomial logistic regression models were used for analysis. Setting: A panchayat ( territorial decentralised unit) in Kerala, India, in 2003. Participants: 4196 non-elderly women. Outcome measures: Self-perceived health status and reported limitations in activities in daily living. Results: Women from lower castes ( scheduled castes/scheduled tribes (SC/ST) and other backward castes (OBC)reported a higher prevalence of poor health than women from forward castes. Socioeconomic inequalities were observed in health regardless of the indicators, education, women's employment status or household landholdings. The multilevel multinomial models indicate that the associations between socioeconomic indicators and health vary across caste. Among SC/ST and OBC women, the influence of socioeconomic variables led to a "magnifying'' effect, whereas among forward caste women, a "buffering'' effect was found. Among lower caste women, the associations between socioeconomic factors and self-assessed health are graded; the associations are strongest when comparing the lowest and highest ratings of health. Conclusions: Even in a relatively egalitarian state in India, there are caste and socioeconomic inequalities in women's health. Implementing interventions that concomitantly deal with caste and socioeconomic disparities will likely produce more equitable results than targeting either type of inequality in isolation.