Historical and contextual pathways of inequity in child nutritional status: A case study of Paniya and Kurichiya Adivasi communities in Wayanad District, Kerala

Abstract

AbstractBackground:Adivasi communities in Kerala continue to bear a disproportionately high burden of child undernutrition compared with other communities in Kerala. Furthermore, different ethnic groups within the Adivasi communities have different patterns of nutritional inequality that require understanding the historical and contextual pathways of nutritional inequity. This paper examines the historical and contextual pathways of inequity in child nutritional outcomes between thePaniyaandKurichiyaAdivasi communities in the Wayanad district of Kerala.Methods:This study used a mixed-method approach with quantitative cross-sectional and qualitative case study components. The Diderichsen framework was used as the conceptual framework of the study. The quantitative cross-sectional component was done using a survey involving 314 children aged 2–5 years and their mothers as participants chosen using a multi-stage cluster sampling that was conducted using a structured interview schedule. Qualitative data were collected using in-depth interviews, observation diary notes, and document reviews and analysed using inductive and deductive approaches.Results:ThePaniyaandKurichiyaAdivasi children reported stark disparities in the prevalence of stunting, underweight, and wasting; the prevalence of these conditions among thePaniyawas 52.3%, 58.9%, and 25.2%, respectively, whereas the prevalence among theKurichiyawas 28.2%, 31.1%, and 12.3%, respectively. Historical accumulation of poverty through land alienation and overall social exclusion from developmental reforms among thePaniyacontributed to their lower socio-economic position, which in turn explains the higher prevalence of child undernutrition amongPaniyacompared to that ofKurichiya. These historical pathways continue to drive an experience of stigma and discrimination while using health and nutritional services, thus intergenerationally contributing to their inequalities in the social determinants of child nutrition.Conclusions:The tribal health and nutritional policies and programmes that are currently targeted at Adivasi communities need to integrate particular Adivasi identities into their strategies and implementations.