Indian policy-makers neglect poverty reduction, social factors: Chronic child undernutrition

By Rajiv Shah
A new study on risk factors for chronic undernutrition among children says that India’s policy makers have disproportionately focused on “what can be termed ‘nutrition-specific’ interventions targeted at addressing the immediate causes of undernutrition”, and considerably less emphasis on “social and structural factors, including poverty reduction, improvements to socioeconomic status and maternal education.”
Carried out by Daniel J Corsi, Iván Mejía-Guevara, and SV Subramanian, and published in a top American journal, “Social Science & Medicine”, the study says, the issue is particularly important because, despite reduction in childhood stunting and underweight in India, the country accounts for “38% of the global burden of stunting (nearly 62 million children) underscoring the importance of reducing undernutrition in India.”

“The prevalence of childhood stunting and underweight in India remains persistently high”, the study says. “In 1992–93, amongst children aged 0–47 months, 57% and 49%, were stunted and underweight, respectively, declining to 47% and 42% in 2005–2006, and to 39% and 29% in 2013–14, the most recent year for which national data are available.”
It adds, “There appears to be momentum to make direct investments in programmes and interventions aimed at nutrition (e.g., breastfeeding, complementary feeding, micronutrient nutrition, and therapeutic and supplementary feeding), health (e.g., prevention and management of infectious diseases) and water, sanitation, and hygiene (WASH) programmes”, calls these as “considered in isolation.”

Based on a survey of 109,041 households across India, and 124,385 women, who agreed to participate in the survey, the methodology used in the study includes using the wealth index, a variable already available in the National Family Health Survey (NFHS). “The index used was derived from a weighted sum of household assets that included televisions, telephones, motorcycles/scooters, cars, mattresses, other possessions and household characteristics (e.g. windows), and materials used for wall/floor construction”, the study says.
Results of the survey suggest that “the prevalence of stunting and underweight in the study sample were 51.1% and 44.9%, respectively”, but the “levels of risk factors were common in the sample including low household wealth (28.6%), no formal education (50.0%), short maternal stature (<145 cm, 12.1%), and poor dietary diversity (31.4%).”

The survey results show that the “five most important predictors of stunting were short maternal stature, no education, lowest wealth quintile, poor dietary diversity, and maternal underweight/low BMI”; and “the five risk factors with the weakest association with stunting… were no access to safe water, unsafe disposal of stools, infectious disease prior to survey, no vitamin A supplementation and delayed initiation of breast feeding.”
It adds, “For underweight, the results were largely similar with some differences in the relative ordering of risk factors.”
The authors conclude, “Our findings indicated substantially larger effects for maternal height, BMI, household wealth, education, and children's dietary diversity and this underscores the importance of improving the overall environmental and socioeconomic conditions at the child, maternal and household levels.”

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