Deciphering disparities in childhood stunting in an underdeveloped state of India: an investigation applying the unconditional quantile regression method

Saswata Ghosh,Debarshi Bhattacharya,Santosh Kumar Sharma

doi:10.1186/s12889-020-09559-8

Abstract

BackgroundUnacceptably high rate of childhood stunting for decades remained a puzzle in the eastern Indian state of Bihar. Despite various programmatic interventions, nearly half of the under-five children (numerically about 10 million) are still stunted in this resource-constrained state.Data and methodsUsing four successive rounds of National Family Health Survey (NFHS) data spread over more than two decades and by employing unconditional quantile regressions and counterfactual decomposition (QR-CD), the present study aims to assess effects of various endowments as well as returns to those endowments in disparities in childhood stunting over the period.ResultsThe results show that although the child’s height-for-age Z-scores (HAZ) disparity largely accounted for differing levels of endowments during the earlier decades, in the later periods, inadequate access to the benefits from various development programmes was also found responsible for HAZ disparities. Moreover, effects of endowments and their returns varied across quantiles. We argue that apart from equalizing endowments, ensuring adequate access to different nutrition-centric programmes is essential to lessen the burden of childhood stunting.ConclusionThe state must focus on intersectoral convergence of different schemes in the form of state nutrition mission, and, strengthen nutrition-centric policy processes and their political underpinnings to harness better dividend.

Highlights

High rate of childhood stunting for decades remained a puzzle in the eastern Indian state of Bihar
The height-for-age Z-scores (HAZ) values of Bihar were compared with the HAZ values of overall India
One can note that absolute increase in overall HAZ scores was the highest between the second and third rounds of National Family Health Survey (NFHS) followed by the third and fourth rounds i.e. between 2005-06 and 2015-16

Summary

Introduction

High rate of childhood stunting for decades remained a puzzle in the eastern Indian state of Bihar. Despite significant economic growth during the past two decades, prevalence of childhood stunting has dropped only by 27% (about 14 points) [1]. Jose et al emphasized that despite a moderate decline in child undernutrition during the past decade, a large and graded socio-economic disparity in child undernutrition continues to persist [4]. A systematic review on the prevalence of child undernutrition in India has concluded that the burden of child undernutrition is still unacceptably high in India and there is an urgent need to understand the risk factors in greater details [5]. It is needless to mention that a rapid reduction of child undernutrition in India is imperative to lessen the global burden of child malnutrition

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Conclusion