Trends & Patterns of Child Malnutrition in India: A Disaggregated Analysis.
| Author | Sharma, Anand |
Introduction
Children of today represent the human capital of tomorrow (Nair, 2007) and therefore, no country can afford to neglect the health and ell-being of children. Previous studies have found a positive association between human capital and economic growth (Barro, 2001; Collin & Weil, 2018). This i plies that neglecting the nutritional and ell-being aspects of children may have negative effects on overall economic growth and development. The literature has also established that child malnutrition is likely to have an adverse effect on cognitive development, learning outcomes in school, labor productivity, and wage earnings (e.g. Strauss & Thomas, 1998; Grantham-McGregor et. al., 1999; Hoddinott, 2009; Niti Aayog, 2017).
India ranks at 103 out of 119 countries in the Global Hunger Index 2018 and accounts for the highest number of stunted children (nearly 47 million) in the world (Global Nutrition Report, 2018). Child malnutrition rates in India exceed those in sub-Saharan Africa and are about five times more than in China (Gragnolati et. al., 2006; Kumar, 2007; World Bank, 2013). In 2015-16, more than one-third of children below five years were stunted and underweight in India (IIPS& ICF, 2017). This dismal performance by India in child nutrition coupled with strong economic growth has led to considerable research in this area (Nie, Rammohan, Gwozdz, Sousa-Poza, 2016; Haddad, 2009). Scholars have used the term "South Asian enigma" (Ramaling aswami et al., 1996) to explain India's paradoxical case. At the all-India level, child malnutrition rates vary by place of residence (rural/urban), caste, and wealth. For example, in 2015-16, 38.3 percent children (below five years) were underweight in rural India whereas about 29 percent children were underweight in urban India (IIPS & ICF, 2017).
There are considerable disparities in industrial and economic development across the Indian states (Sharma, 2017). The trends in child malnutrition at national level do not reveal the considerable disparities across different states. For example, in 2015-16 about 12 percent of children below five years were underweight in Sikkim whereas this figure was 47.8 percent for Jharkhand (IIPS & ICF, 2017). The proportion of stunted children across states also ranges from 20 percent (in case of Goa) to about 48 percent (in case of Bihar). It is generally believed that a mere focus on economic growth is likely to reduce the incidence of child malnutrition in various states. However, the poor nutritional performance of economically advanced states such as Gujarat, Maharashtra, and Karnataka does not provide support to this argument. On the other hand, low income north-eastern states such as Manipur, Nagaland, Mizoram, and Arunachal Pradesh have shown better performance with respect to child malnutrition. These observations warrant a detailed analysis of child malnutrition at the regional level.
Several studies have attempted to analyze and explain the extent of child malnutrition in India. Majority of the existing studies focus on explaining the regional disparities in child malnutrition in India over last few decades (e.g. Nair, 2007; Radhakrishna & Ravi, 2004; Kumar, 2007; Cavatorta, Shankar & Flores-Martinez, 2015; Yadav, Ladusingh & Gayawan, 2015). However, most of the existing studies are restricted to 2005-06 and therefore do not provide any information about the child malnutrition at state level during recent years. The present study examines in detail the trends and patterns of child malnutrition at regional level. The study also examines the socio-economic inequalities in child malnutrition during 2005-06 to 2015-16.
Related Literature on Child Malnutrition
Using NFHS data, several studies find the existence of significant inter-state and rural-urban disparities in child malnutrition in the case of India. One of the important findings of these studies is that middle income states have shown better performance with respect to child nutrition than high-income states. These studies also argue that poverty reduction has not led to substantial improvement in nutritional outcomes of Indian children (e.g. Radhakrishna, Rao, Ravi & Reddy, 2004; Nair, 2007; Deaton & Dreze, 2009).
Studies have attempted to provide several explanations for the prevalence of inter-state disparities in child malnutrition. Cavatorta et. al., (2015) have extensively reviewed the two strands of literature which explain these variations. The first strand of literature argues that states differ with respect to nutritional achievements because of differences in endowments (UNICEF, 1990; Nair, 2007; Kumar & Kumari, 2014). These endowments include factors such as availability of health facilities, hospitals, maternal literacy, agricultural production and household wealth. Nair (2007) finds that these disparities have increased between NFHS-1 (1992-93) and NFHS-3 (2005-06). He argues that economically underdeveloped and populous states such as Uttar Pradesh (U.P.) and Bihar have witnessed an increase in the extent of child malnutrition which cannot be tackled by merely emphasizing on achieving high economic growth. In order to achieve better nutritional outcomes, the study suggests measures like increasing women's age at first child birth, implementing timely lactating practices and improving maternal literacy. Other studies at the regional level have also reached similar conclusions on the extent of inter-state and rural-urban disparities with respect to child malnutrition in India (e.g. Kumar, 2007; Pathak & Singh, 2011).
On the other hand, second strand of literature argues that similar endowments in some states may give rise to drastically different nutritional results (Harriss& Kohli, 2009; Cavatorta et. al., 2015). This may happen because states differ in terms of quality of public services, institutions, and policies. Cavatorta et. al., (2015) analyze the interstate disparities in child malnutrition (measured by height for age) by comparing the performance of Bihar, Uttar Pradesh, Madhya Pradesh and Gujarat (poor performing states) with that of Tami Nadu (good performing state). Their results highlight that differences in stunting across states are not significantly explained by differences in endowments. Other studies have also examined the role of institutions and policies in affecting child malnutrition in India (Walton, 2009; Balarajan & Reich, 2016). Differences in stunting across states are not significantly explained by differences in endowments.
It is argued that interaction of social and economic factors affects the extent of child malnutrition. Studies have established that there exists a close link between the socio-economic factors and child health (Wagstaff, 2000; Kumar, Kumari & Singz, 2015; Pulok, Sabah &Enemark, 2016). There are several studies for developing countries which have examined the extent of socioeconomic inequalities in child malnutrition (e.g. Wagstaff, 2000; Subramanyam, Kawachi, Berkman & Mazumdar, 2010; Kumar et. al., 2015; Prakash & Jain, 2016; Pulok et. al., 2016; Nie et. al., 2016). The relationship between poverty and socioeconomic inequalities and child malnutrition is analyzed by Mazumdar (2010) using NFHS-3 data (for 2005-6). He finds importance of poverty in explaining the observed disparities in child malnutrition among different sections of the society. His results also highlight that the poor sections of the population bear a relatively greater burden of child malnutrition. However, this study is restricted to a single point of time and does not analyze the how these inequalities have changed over time.
There exist studies which have examined the trend of socioeconomic inequalities in child malnutrition during NFHS-1 (1992-93) and NFHS-3 (2011-12). Majority of these studies find that these inequalities have witnessed an increase in India over the last two decades (e.g. Subramanyam et. al., 2010; Pathak & Singh, 2011; Kumar et; al., 2015; Prakash & Jain 2016). A study by Pathak & Singh (2011) which studies only the trends of economic inequalities with regard to child malnutrition finds an increase between NHFS-1 (1992-93) and NFHS-3 (201112). This study also argues that poor children are at a greater disadvantage and suffer from severe malnutrition. In addition to economic inequalities (measured by household wealth), Subramanyam et. al., (2010) analyze the trends of social disparities in child malnutrition by examining factors such as caste, gender, and maternal education. This study finds no inequalities in child malnutrition by caste and gender. It also asserts that inequalities in malnutrition by maternal education are significantly lesser than those by household wealth. However, for urban India Kumar et. al. (2015) find exactly the opposite result. They find evidence of increasing socioeconomic inequalities in India during the last two decades and advocate the implementation of policies specific to urban areas of the country.
In addition to the trend analyzes of inequalities in malnutrition, various scholars have also attempted a detailed examination by doing a decomposition analysis of the inequalities (e.g. Joe, Mishra &Navaneetham, 2009; Kumar & Kumari, 2014; Cavatorta et. al., 2015; Prakash & Jain 2016; Nie et. al., 2016). Using concentration indices and concentration...
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