Caste and Proximity in Accessing Preventive Services: A Geospatial Study of Community Pesticide Storage Facilities in India

Abstract

This thesis investigates the usage patterns of community pesticide storage facilities (CSFs) as a suicide prevention intervention in rural India, with a specific focus on how spatial and social inequalities shape access. Drawing on Andersen’s Behavioural Model of Health Service Use and caste-based social exclusion theory, the study examines (H1) whether geographic proximity to a CSF predicts its usage and (H2) whether caste identity moderates this relationship. Using longitudinal data from the SPIRIT cluster-randomised controlled trial in Mehsana district, Gujarat, and integrating geospatial analysis with usage records, the study finds a small but statistically significant negative association between distance and locker usage. Moreover, caste moderated this relationship for Other Backward Classes (OBC), for whom usage declined more sharply with increasing distance. Scheduled Caste (SC) households consistently used the facilities less, regardless of proximity, suggesting the influence of non-spatial exclusionary mechanisms. These findings highlight that physical infrastructure alone is insufficient; public health interventions must account for entrenched social hierarchies and spatial inequalities to ensure equitable access. The study contributes to suicide prevention policy by demonstrating the necessity of locally grounded, socially inclusive, and context-sensitive approaches to means restriction.