Decomposing the gap in undernutrition among under-five children between EAG and non-EAG states of India

Abstract

In India, the Empowered Action Group (EAG) states (Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, Uttarakhand, Odisha, Jharkhand, and Chhattisgarh, including Assam) have a higher prevalence of undernutrition among children under the age of five (U5) than non-EAG states. However, no research has attempted to explain the difference in U5 child undernutrition between EAG and non-EAG states. To fill this gap, this study used data from the fourth round of the National Family Health Survey (NFHS-4) and applied modified Blinder–Oaxaca decomposition (also known as Fairlie decomposition). This decomposition helps quantify the relative contribution of various factors explaining the gap between EAG and non-EAG states in U5 child undernutrition. In EAG states, nearly four out of ten U5 children suffered from being underweight and stunted, and one out of five suffered from wasting. The prevalence of undernutrition was relatively higher in the EAG states than in the non-EAG states. The decomposition results revealed that almost two-thirds of the gap in U5 undernutrition between EAG and Non-EAG states was explained by the variables used in the analysis. Household wealth explained about half the difference in stunting and wasting, while religion accounted for a quarter of the difference in underweight and wasting. Maternal education explained a fourth of the difference in stunting between EAG and Non-EAG states. The disparity in undernutrition between EAG and non-EAG states could be reduced by introducing suitable long- and short-term interventions and programs. Increasing access to the public distribution system (PDS), raising awareness among low-income mothers regarding optimal inter-birth intervals, proper health and hygiene, appropriate family planning, and the importance of maternal and child health care services by frontline workers (ASHAs, Anganwadi workers, etc.) could be some of the ways to bridge the gap in undernutrition between EAG and non-EAG states in the near future.