Human Development in India - NCAER

child well-being 127privileged and vulnerable sections of the society. Dalit andAdivasi children have higher mortality rates than other socialgroups with Dalit children being particularly vulnerable.Educational and income differences are important, as wellas those between less developed villages and metropolitancities. Gender differences are also important and discussedin greater detail in the following section. Figure 8.2 providesan interesting snapshot of infant and child mortality by birthorder.While children of mothers at higher parities are generallydisadvantaged, when it comes to neonatal mortality, thefirst-born children face higher risks than those born towomen who already have one child. First births are usuallymore risky than second births, but most of these risks arerelated to delivery complications and mostly affect neonatalmortality rates. However, children at parity 4 and at parity5 and beyond face substantially higher mortality risks. Thesehigher risks are undoubtedly partly attributable to the lowereducation and income of parents who have large families,but a higher birth order also poses some risks.IMMUNIZATIONIn spite of the emphasis on immunization for vaccinepreventablediseases—polio, diphtheria, whooping cough,tetanus, measles, and tuberculosis—universal immunizationremains far from reality. The World Health Organizationrecommends three doses of polio vaccine, three dosesof DPT (diphtheria-pertussis-tetanus), one dose of BCG(Bacillus Calmette-Guérin) against tuberculosis, and onedose of measles vaccine before 12 months. Only about 48per cent of children under five in the IHDS sample receivedfull vaccination (see Table A.8.2a). About 7 per cent receivedno vaccine, and the remaining 45 per cent received anincomplete series of vaccinations. These figures are comparableto those from the NFHS-III, which found that only44 per cent of those aged 12–23 three months received allbasic vaccinations.Given the tremendous fanfare with which Pulse Poliocampaigns are being conducted, this low level of vaccinecoverage might seem surprising. However, an examinationof trends in vaccination in the three waves of NFHS surveysdocuments that although polio coverage increased sharplyfrom 54 per cent in 1992–3 to 63 per cent in 1998–9 andto 78 per cent in 2005–6, improvement in the full seriesof DPT vaccinations was far more limited, 52 per cent in1992–3, 55.1 per cent in 1998–9, and 55.3 per cent in2005–6. The stagnation in DPT coverage between 1998–9and 2005–6 is in striking contrast to the growth in the rateof polio vaccinations. In many ways it points to the limits ofcampaigns for providing basic health services. The Pulse Poliocampaigns have focused on vaccinating as many children aspossible on specified days, with vaccination booths being setup at train stations, on street corners, and in schools. This hasclearly borne fruit with rapid increase in polio immunization.However, it may well have diverted attention from regularimmunization services, causing the proportion of childrenreceiving full vaccinations to lag behind the proportion ofchildren receiving polio vaccinations. The results from theIHDS indicate that while 71per cent of children receivedthree or more doses of polio, only 55 per cent received threedoses of DPT (see Table A.8.2a).Vaccination is an area in which family education playsa particularly important role. While inequalities in incomeand residence are reflected in vaccination status, thedifference, between families in which no one has attendedschool and those in which even one adult has completedSource: IHDS 2004–5 data.Figure 8.2Mortality Rate by Birth Order and Age