Beyond socio-economic disadvantage: Religio-cultural practices and the Muslim advantage in child survival in India

Despite declining child mortality in India over three decades, religious disparities persist. Muslim children consistently exhibit lower under-five mortality than Hindu children, despite Muslims occupying a more disadvantaged socio-economic position on average. Explanations based solely on urban residence or caste composition remain incomplete.

This study examines the persistence of the Muslim child survival advantage in India and investigates whether religio-cultural practices, beyond conventional socio-economic determinants, help explain this paradox.

Pooled data from five National Family Health Survey (NFHS) rounds (1992-2021) are analysed using Cox proportional hazards models, controlling for socio-economic, demographic, and health-related factors. A complementary mixed-methods field study conducted in North-East Delhi between August 2022 and June 2023 integrates household survey data (n = 400) and qualitative interviews (n = 45), analysed using the Framework Analysis Method, to capture cultural mechanisms not measurable in large-scale surveys.

Muslim children exhibit consistently lower under-five mortality across all five NFHS rounds; in NFHS-5 this stands at 8.4%. The advantage persists - and in some specifications strengthens - after adjusting for socio-economic, demographic, and healthcare factors, despite Muslims being disadvantaged on 15 of 25 key mortality determinants. Factors favouring Muslim children include better sanitation, higher dietary protein intake, alcohol abstinence, lower son preference, and community-based redistribution. Field evidence indicates these practices are embedded in religio-cultural norms.

The findings suggest that socio-economic explanations alone are insufficient to account for religious differentials in child survival in India. Religio-cultural practices are associated with patterns of child survival and represent plausible pathways through which observed differences may arise. Policies aimed at reducing child mortality must therefore engage not only with material deprivation and healthcare access but also with culturally embedded practices that influence caregiving, nutrition, hygiene, and social support.