A/HRC/31/56 time with them, and staff use derogatory or demeaning words and avoid physical contact when examining them.74 84. Caste-based discrimination has a direct impact on the health status of affected individuals. Statistics reveal significant disparities in health indicators, with individuals in lower castes presenting poorer health indicators than those in higher castes. 85. Women in lower castes present the worst health outcomes. For instance, a study in India75 demonstrated stark disparities between Dalit and non-Dalit women in terms of life expectancy and access to prenatal and postnatal care. 86. In 2009, a survey by the Ministry of Health76 in Nepal found that the maternal mortality rates for Dalit women and women from the Therai and Madhesi castes were significantly higher than those for women from higher castes. 87. Manual scavenging, the digging of graves, the cleaning of human excretions and forced prostitution also expose individuals in lower castes to a range of health hazards. 77 Research further indicates that children in lower castes are at greater risk of infections and nutritional deficiencies.78 4. Right to education 88. Marginalization of caste-affected groups translates into considerable disparities in educational opportunities, educational attainment and treatment by school teachers. Such differences undermine equality of opportunity in employment and hinder social advancement. According to the Special Rapporteur on contemporary forms of racism, racial discrimination, xenophobia and related intolerance, discrimination against Dalits at all levels of the educational system is widespread in caste-affected countries.79 89. The types of structural discrimination and abuse faced by Dalit children in schools are particularly disturbing, as they are carried out by teachers and replicated by fellow students. They include segregation in classrooms, the use of derogatory terms for their caste, forcing them to perform manual work such as cleaning toilets and picking up garbage, and corporal punishment.80 90. Caste-based discrimination in education results in higher rates of illiteracy, a larger number of dropouts from school, and a higher risk of children from lower castes being recruited as child labourers, soldiers or sex workers and subjected corporal punishment and torture.81 74 75 76 77 78 79 80 81 Sanghmitra Acharya, “Access to health care and patterns of discrimination: a study of Dalit children in selected villages of Gujarat and Rajasthan”, working paper series, vol. 1, No. 2 (Indian Institute of Dalit Studies and UNICEF, 2010), pp. 15 ff. Vani Borooah and others, “Gender and caste-based inequality in health outcomes in India”, working paper series, vol. VI, No. 3 (Indian Institute of Dalit Studies, 2012), pp. 14-15. Bal Krishna Suvedi and others, “Nepal: maternal mortality and morbidity study 2008/2009 – summary of preliminary findings” (Family Health Division of the Department of Health Services of the Ministry of Health, 2009). See A/68/333, para. 65. P. Vart and others, “Caste-based social inequalities and childhood anemia in India: results from the National Family Health Survey 2005-2006” in BMC Public Health (2015). See A/HRC/23/56, para. 46. Human Rights Watch, “They Say We’re Dirty”: Denying an Education to India’s Marginalized (2014), pp. 20 ff. See CERD/C/IND/CO/19, para. 25. 17