caste and dalit children sit on the floor in class, and to talk to them in derogatory terms (Kabeer 2000); doctors and nurses have also been found to withhold care and behave in ways consistent with prejudiced attitudes, as illustrated in Maria’s story.

Frontline service providers’ negative attitudes are routinely felt by service users. The LiTS asked respondents about their experiences with health services. Nearly 17% answer yes to a question about ever having been treated disrespectfully by health staff.<sup>5</sup> The Moving out of Poverty study (Narayan, Pritchett and Kapoor, 2009) reported that in the countries included in the study, access to many government programs was conditioned on caste, ethnicity or political party affiliation. Kabeer comments on this aspect of exclusion in the context of the MDGs, citing the reluctance of Indian health workers to visit dalit households as a partial explanation for the incomplete immunization coverage of dalit children. Moreover, people often self-exclude: “both real and anticipated discriminatory behavior and attitudes on the part of health workers deters dalits from using health providers, public and private, particularly for services which involve physical contact, such as giving birth” (Kabeer, 2005 p. 21). A study of dignity in Malawi’s health care system described in detail rude behavior by midwives toward women in labor. One midwife explained that: “patients from the rural areas are treated with less respect but those who are clean and smart are treated with respect because it is assumed that they know their rights”. Another midwife explained that “most patients especially the non-paying patients they don’t know their rights so they do not complain” (Chigwenembe, 2011). Practices that fail to respect patients’ dignity remain widespread even though they violate established professional standards.

Thus, negative attitudes toward certain groups appear to be widespread and are likely to find expression in behavior, sometimes leading to exclusion. In order to better understand what might drive intolerant attitudes, we next turn to our statistical analysis.

# **3. Statistical analysis of intolerant attitudes**

This section presents an empirical analysis of unwelcoming attitudes and their determinants, using LiTS survey responses. We find three distinct clusters or components of unwelcoming attitudes. This means that the degree to which people are welcoming or rejecting of other groups can be traced back to three distinct sets of values. This allows us to propose a novel distinction of social exclusion attitudes not previously identified in the empirical or theoretical literature: (1) intolerance for the poor and for different lifecycle stages; (2) intolerance toward stigmatized attributes and behaviors; and (3) intolerance to specific identity groups. We infer that that these three distinct value clusters systematically shape attitudes to other groups. Further, our empirical analysis demonstrates that

> ‘non-institutional behavior’, that is behavior not guided by any norms, and that of Kabeer (2000) who uses the term ‘unruly practices’ in referring to corruption, for example , or discriminatory behavior by teachers. We understand ‘off-protocol’ behavior to be that which is either non-institutional, or that which relies on norms from other institutions. The existence of these behaviors means that even where the norms of a given institution are not inherently discriminatory, or even where institutions attempt to address inequalities, the day to day practices of individuals may nevertheless be discriminatory in nature.

> 5 The survey question cannot discern what might have caused the disrespectful behavior, however, negative attitudes on the part of the service provider are likely to be an important factor. In comparison, among various complaints about health services, disrespectful treatment by staff ranks broadly similar to bribery and absence of drugs but below problems of long waiting times at health facilities.

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