Differences in Health and Social Indicators by Dalit and Non-Dalit women Findings from the Final Evaluation of the Nepal CRADLE CS Project As CARE looks to expand our programmatic and policy work related to maternal health, it’s critical to understand why women are dying and look for ways to engage communities and governments to take action to address these concerns.  Community-based maternal death reviews are a proven strategy for doing both of these things! Parini M. Shah Child Survival Intern

Outline Background Research Question Methods Results Conclusions Recommendations

Background As of 2010, 86% of the population is rural, and many communities remain remote (CIA). 41% are under age 15 and 13% are under age 5 and only 4% is over the age of 65 (NDHS 2006). Agriculture is the mainstay of the economy, providing a livelihood for 75% of the population and accounting for 38% of the GDP (NDHS 2006).

Background More than one-third of households reported that at least one household member had traveled away from the home in the 12 months before the survey (NDHS 2006). Men are three times as likely as women to have migrated, and two-thirds of men had been away for at least six of the last twelve months (NDHS 2006).

Dalits Nepal has an extensive caste system which is still in place today Caste groups are differentially treated, with the lowest caste groups suffering the most in terms of health and poverty Dalits are the lowest caste in Nepal

Background According to the International Labor Organization in 2005, 12.82% of the Nepali population is Dalits.

Methods As part of the final evaluation March 2011 documentation process for the CRADLE project: 660 recently delivered women 123 Dalit women 537 non-Dalit women 30-cluster sampling design ward was the cluster Cross Sectional Conducted in the Doti and Kailai of the Far Western Region

Results A very significant difference between literacy in the Dalit and non-Dalit caste women, where 62.6% of Dalit women were illiterate, while only 34.7% were illiterate in all of the other caste groups (p= <0.001) No difference in nutrition or feeding practices between Dalit and non-Dalit women No difference in place of delivery between Dalits and non-Dalits

Arrangement of Delivery Services

Comparison of survey results with NDHS 2006 results Variable Survey Dalits (%) DHS 2006 Dalits (%)*** DHS 2006 Lowest Wealth Quintile (%) DHS 2006 Far West Region (%) Illiterate 62.6 65 63.3 51.9 Migration in Last 6 Months 79.7 - 41.0 (Male)/ 48.4 (Female) Currently Using Family Planning 15.4 41** 32.9 51.7 Ever had an ANC 78.9 Rural: 74 At least 4 ANC visits 50.4 Rural: 26 ANC Provider Doctor 5.2 14.8 10.4 ANM/Nurse 68.0 25.4 12.4 15.5 MCHW 26.8 13.7 16.5 34.2 TT Vaccination (2 or more) 67.4 38.8 64.7 Iron/Folic Acid Tablets 81.3 34.3* 60.0

Conclusions Dalit women and non-Dalit women facing similar issues. Families with migrants also show more home births and lower use of family planning. The high levels of illiteracy in Dalits can serve as barriers to accessing health care or other health affecting services

Recommendations Largely health indicators for Dalit and non Dalits maternal and child health are the same. The data analysis showed differences in health indicators by migration status, which may also differentially affect Dalit and non-Dalit women’s health. This should be further studied.