A closer look at child mortality among Adivasis in India Maitreyi Bordia Das, Soumya Kapoor and Denis Nikitin<sup>1</sup>

# **INTRODUCTION**

Almost every monsoon the Indian media is rife with stories of child deaths in tribal<sup>2</sup> areas, with furious debates in Parliament and state legislative assemblies and outrage among civil society activists. This is the starkest manifestation of Adivasi deprivation in India – an average Indian child has a 25 percent lower likelihood of dying under the age of five compared to an Adivasi child. In rural areas, where the majority of Adivasi children live, they made up about 11 percent of all births but 23 percent of all deaths in the five years preceding the National Family Heath Survey 2005. While there has been progress in child survival over the years and greater awareness of the hazards, which often leads to these stories surfacing in the media at all, the fact remains that children in tribal areas are at much greater risk of dying than those in other areas.

The rich and longstanding demographic and medical literature on child mortality can broadly be classified into three groups – the first focuses on “routes to low mortality” and aggregate declines in mortality through cross-country studies (for instance, Caldwell 1986; Claeson et al, 2000); the second on the determinants of child mortality (for instance see Mosley and Chen 1984); and the third on inequalities in child mortality across countries, within countries and across households (for instance see Hill and Pebly 1989; Cesar et al, 2003). Differential fertility and mortality patterns within India by caste and tribal status have received greater attention over the last few decades (see Murthi et al, 1996; Dyson and Moore, 1993; Dreze and Gazdar, 1997; Maharatna, 1998; 2000). The preoccupation of such studies on child mortality has however been on correlates of mortality and the slow decline in child mortality in recent years. There is a good reason for this as India looks likely to falter on achieving this important Millennium Development Goal – a fear expressed in 2000 by Claeson et al.

The anthropological literature has also focused on access to health for India’s Adivasis. Excess mortality of tribal children during monsoons in particular has been analyzed by activists more recently through a food security lens. The Right to Food movement and the recent Supreme Court judgments exhort governments to take more aggressive action to address malnutrition nationally but more so in tribal areas. The evidence from the grassroots highlights the peculiar problems in tribal areas because of which poverty is higher, and health and education outcomes are lower. There is for instance, wide acknowledgment that excess mortality in childhood for tribals is partly due to poverty and partly to poor access to services. Our own previous analysis of mortality using data from India’s Reproductive and Child Health Surveys, 2005 (see World Bank, 2006) and a recent study on Orissa also shows that once poverty levels are controlled for, the effect of tribal (or indeed Dalit or Scheduled Caste (SC)) status goes away. By and large, therefore, much of the analytical work on Scheduled Tribes (STs) in India has confirmed what we already know about child mortality and its correlates. This paper is an attempt to drill deeper

> 1 The authors are grateful to Julie McLaughlin and Rinku Murgai for comments. 2 We use the terms Scheduled Tribes, tribes and the self-preferred term Adivasis interchangeably in this paper.

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