1 Draft submitted to Social Science and Medicine, July 2004 Please do not quote without author’s permission Immunization in India 1993-1999: Wealth, Gender, and Regional Inequalities Revisited Sylvestre Gaudin* and Abdo Yazbeck** Abstract: Six years have made a significant difference in childhood immunization in India. The grim picture revealed by the National Family and Health Survey of 1992/3 has significantly improved overall but large differences still exist between states. The paper gives an update of India’s successes and failures in childhood immunization along five dimensions: heterogeneity between states, rural-urban differentials, gender differentials, and wealth induced inequalities. Recently developed methodology is used to calculate an extended achievement index that captures immunization performance along dimensions of efficiency (change in overall immunization rates) and equity (wealth-based distribution of outcomes) using increasing degrees of inequality aversion. An analysis of the change in this index between 1993 and 1999 reveals a positive correlation between efficiency and equity improvements. JEL classification: I18, O12, O53 Key Words: Immunization, Inequality, Gender, India Acknowledgements: Support for this research was provided by the Global Alliance for Vaccines and Immunization (GAVI). The authors thank Amie Batson, Davidson Gwatkin, G. N. V. Ramana, Thomas Uthup and Kenneth Kuttner for their support, comments, and suggestions, and David Kwakye and Laura Wallerstein for research assistance. Preliminary results were presented at a Conference in Washington D.C., February 2003, on Reaching the Poor and we would like to thank the conference participants who provided comments and encouraged us to finalize and submit the paper for publication. All analyses, views and any remaining errors in this paper are the responsibility of the authors. *Oberlin College, Department of Economics. Cooresponding author, please send all enquiries to sylvestre.gaudin@oberlin.edu ** Lead Health Economist, The World Bank Institute