Background: The study aims to explore to what extent the intersection of education, wealth and caste/ethnic inequality among mother affect their children’s health care service utilization.
Methods: The 2011 Nepal Demographic and Health Survey was utilized. Descriptive statistics, univariate, multivariate logistic regression analyses, and the effects of intersections (hierarchically well-formulated modeling) were used to test for significant effects between and among the level of maternal education completed, maternal economic status, and mother’s caste/ethnic identity to child health care access.

Results: The study found that the mother’s level of education completed, higher economic status, and Hindu women of high caste were positively associated with child health care service utilization in all models. The intersection results show that indigenous illiterates (OR = 0.39), the untouchable poor (OR = 0.43) and the Madeshi & Muslim poor (OR = 0.35) were less likely to use the child health care services. Similarly, the poor and illiterate (OR = 0.47) were less likely to use child health care services.

Conclusions: The vicious cycle of exclusion has been explored. The study suggests national-level policy making to ensure basic health rights, particularly in advocating a universal health insurance scheme for all sections of the population. In particular, for those people who are disadvantaged at multiple levels, specific social welfare programs need to be designed and delivered. The study emphasizes the improvement of living conditions via socially inclusionary programs for the marginalized and/or the most neglected people that are identified from intersectional analysis.

Learning Areas:

Advocacy for health and health education
Diversity and culture
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health
Learning Objectives:
Analyze the effect of social inequalities (different treatment of people on the basis of gender, caste/ethnicity/race, and class) on the achievement of opportunities in ways that are unfair, unjust, avoidable and unnecessary. Do these differences cause other inequalities? This is a central concern for movements toward social justice. Nepal’s social mosaic includes a social structure based on stratified castes and ethnicities, widespread poverty, and a higher level of illiteracy among women. Here, Nepal is taken as an example in order to explore the association between social inequalities among mother and child health care service utilization.