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Paper short abstract

Drawing on NFHS-5 (2019–2020) data, this study explores caste-based disparities in Indian women’s perception of distance as a barrier to healthcare. Results show gaps largely driven by mobility and financial constraints, with persistent ST disadvantage pointing to deeper structural marginalization.

Paper long abstract

Despite significant improvements in health infrastructure and policy reforms under Indian Public Health Standard (IPHS), caste-based disparities in Indian women’s access to healthcare continue to persist. Drawing on NFHS-5 (2019-2020) data, this study shows differences in women’s perception of distance to health facilities as a barrier, focusing on SC, ST, OBC, and General caste groups. Sequential logistic regression and decomposition analyses reveals that SC, ST, and OBC women have higher odds of reporting distance as a barrier compared to General caste women. These gaps reduce substantially after adjusting for socioeconomic status, access to enabling resources and exposure to structural barriers. In fully adjusted models, disparities for SC and OBC women are fully mediated by mobility, financial, and supply-side barriers, while ST women continue to face residual disadvantage. Decomposition results identify transport-related barriers as the primary driver of caste gaps, accounting for over half of the SC–General difference and nearly two-fifths of the ST–General gap. On balance, the findings indicate that caste inequalities in perceived distance are driven primarily by mobility and socio-economic constraints, while the persistent disadvantage among ST women highlights deeper structural and spatial marginalization beyond observable barriers.