Social Affiliation and the Demand for Health Services: Caste and Child Health in South India

Nancy Luke, Brown University
Kaivan Munshi, Massachusetts Institute of Technology

This paper assesses the role of community affiliation, measured by caste, in shaping investments in child health. The special setting that we have chosen for the analysis--tea estates in South India--allows us to control nonparametrically for differences in income, access to health services, and patterns of morbidity across low caste and high caste households. Using data from a survey of 4000 female tea workers the authors conducted in 2003, we find that low caste households spend the same amount as the high castes on treatment for children's routine illnesses, but more on treatment for their children's serious, non-routine illnesses, reversing the pattern we would expect to find elsewhere in India. Moreover, health expenditures do not vary by gender within either caste group, in contrast with the male-child preference documented throughout the country. A simple (caste) network-based model of household resource allocation is proposed to explain these striking results.