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Changing Wealth Inequalities in Child Nutrition in Indian States
How have wealth inequalities in child nutrition changed in the major states of India between the last two rounds of the National Family Health Survey? The temporal change in the likelihood of child stunting in the poorest quintile of households vis-à-vis the richer quintiles is examined. Alternative measures of wealth inequality in child nutrition, based on the ranking of the households’ wealth scores (namely the concentration index and the extended concentration index), are also used to see how the magnitudes have changed. The poorly performing states have not only retained the last ranks in terms of average stunting, but have also faltered in the reduction of stunting during the decade under study. In three of these states, the improvement in child stunting has disfavoured the poor by all measures. Comparing the concentration index and the extended concentration index for the two rounds, it is found that inequality in stunting has increased in all the states excluding Uttarakhand. This calls for immediate policy attention, since children from the poorest households in the backward states seem to suffer from the dual burden of the state effect and the class effect.
The authors thank the anonymous referee for providing extensive and insightful comments on the paper.
India has been infamous for its high child undernutrition figures that exceed those of many poorer and lower growth countries of Sub-Saharan Africa. India’s high child undernutrition attracted a lot of attention, particularly after the results of the National Family Health Survey-3 (NFHS-3) conducted in 2005–06 were published. The NFHS-4 was carried out after a long gap of 10 years in 2015–16. Though the latest round shows a decline in child undernutrition (particularly in stunting and underweight), the figures are still quite high compared to other developing countries. While child stunting declined from 48% to 38% and child underweight fell from 43% to 36%, wasting among children below five years has disturbingly increased by 1 percentage point from 20% (IIPS and ORC Macro 2017).
An overall decline in the average level often hides the fact that children in all socio-economic groups do not experience the same. In the context of such non-income dimension as the nutritional status, group inequality deserves greater attention compared to interpersonal inequality. Interpersonal inequality (or what is often called “pure” inequality) in indicators with a natural upper limit, such as anthropometric scores is expected to fall with an improvement in the average level. However, a low-average level of undernutrition may be consistent with high between-group inequality, if the few remaining undernourished children mostly belong to the lowest socio-economic strata. Much of the work on group inequalities in child nutrition has been focused on the axis of economic status, proxied by household wealth, as available in the demographic and health surveys. Child undernutrition has been shown to be associated significantly with household wealth (Borooah 2005; Mukhopadhyay 2013), and wealth-related inequality in child nutrition varies considerably across the Indian states (Joe et al 2008; Mukhopadhyay 2011). To quote the National Report of NFHS-3,
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