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Disability, Caste, and Intersectionality: Does Co-Existence of Disability and Caste Compound Marginalization for Women Seeking Maternal Healthcare in Southern Nepal?

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  • Hridaya Raj Devkota

    (Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London WC1E 6BT, UK)

  • Andrew Clarke

    (Global Programmes, Save the Children UK, 1 St. John’s Lane, London EC1M 4AR, UK
    Division of Health Research, Lancaster University, Lancaster LA1 4AT, UK)

  • Emily Murray

    (Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London WC1E 6BT, UK)

  • Maria Kett

    (The International Disability Research Centre, Department of Epidemiology and Health Care, University College London (UCL), 1-19 Torrington Place, London WC1E 6BT, UK)

  • Nora Groce

    (The International Disability Research Centre, Department of Epidemiology and Health Care, University College London (UCL), 1-19 Torrington Place, London WC1E 6BT, UK)

Abstract

Background: Disability and caste are two different forms of oppression; however, people of the Dalit caste in Nepal and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15–49 years. Maternal healthcare service utilization was assessed by antenatal care (ANC), health facility (HF) delivery, and postnatal care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitted separately in models. Secondly, the intersectionality of disability and caste was tested by inclusion of a disability*caste interaction term. Finally, the confounding effect of socio-demographic factors was investigated. Results: Out of surveyed women, 73% had 4+ ANC visits, 65% had HF delivery, and 29% had a PNC visit during their last pregnancy. Women with a disability had lower odds of HF delivery (OR 0.50, CI 0.30–0.84) and PNC (OR 0.47, CI 0.25–0.88) than women without a disability. Adjustment for women’s age and household wealth explained associations in HF delivery by women with disabilities. There was no association between caste and service utilization. Disability overrode caste, and there was no other evidence of effect modification by women’s caste status in the utilization. However, a weak interaction effect in the utilization of ANC services was found in the caste group by their education (OR 0.19, 95% CI 0.05–0.74). Conclusions: Disabled women—whether Dalit or non-Dalit—had lower rates of utilizing all maternal healthcare services than non-disabled women. Interestingly, Dalit women with disabilities were more likely to receive PNC than non-Dalit women with disabilities. Increasing equity in maternal healthcare service utilization requires that traditional approaches to service development and program intervention be re-examined and more nuanced interventions considered to ensure improved access and outcomes among all vulnerable groups.

Suggested Citation

  • Hridaya Raj Devkota & Andrew Clarke & Emily Murray & Maria Kett & Nora Groce, 2021. "Disability, Caste, and Intersectionality: Does Co-Existence of Disability and Caste Compound Marginalization for Women Seeking Maternal Healthcare in Southern Nepal?," Disabilities, MDPI, vol. 1(3), pages 1-15, August.
    • Handle: RePEc:gam:jdisab:v:1:y:2021:i:3:p:17-232:d:616516
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    References listed on IDEAS

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    1. Saifuddin Ahmed & Andreea A Creanga & Duff G Gillespie & Amy O Tsui, 2010. "Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries," PLOS ONE, Public Library of Science, vol. 5(6), pages 1-6, June.
    2. Celik, Yusuf & Hotchkiss, David R., 2000. "The socio-economic determinants of maternal health care utilization in Turkey," Social Science & Medicine, Elsevier, vol. 50(12), pages 1797-1806, June.
    3. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
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