Inequality in child undernutrition among urban population in India: a decomposition analysis

S K Singh,Shekhar Chauhan,Shobhit Srivastava

doi:10.1186/s12889-020-09864-2

Abstract

BackgroundWith increasing urbanization in India, child growth among urban poor has emerged as a paramount public health concern amidst the continuously growing slum population and deteriorating quality of life. This study analyses child undernutrition among urban poor and non-poor and decomposes the contribution of various factors influencing socio-economic inequality. This paper uses data from two recent rounds of National Family Health Survey (NFHS-3&4) conducted during 2005–06 and 2015–16.MethodsThe concentration index (CI) and the concentration curve (CC) measure socio-economic inequality in child growth in terms of stunting, wasting, and underweight. Wagstaff decomposition further analyses key contributors in CI by segregating significant covariates into five groups-mother’s factor, health-seeking factors, environmental factors, child factors, and socio-economic factors.ResultsThe prevalence of child undernutrition was more pronounced among children from poor socio-economic strata. The concentration index decreased for stunting (− 0.186 to − 0.156), underweight (− 0.213 to − 0.162) and wasting (− 0.116 to − 0.045) from 2005 to 06 to 2015–16 respectively. The steepness in growth was more among urban poor than among urban non-poor in every age interval. Maternal education contributed about 19%, 29%, and 33% to the inequality in stunting, underweight and wasting, respectively during 2005–06. During 2005–06 as well as 2015–16, maternal factors (specifically mother’s education) were the highest contributory factors in explaining rich-poor inequality in stunting as well as underweight. More than 85% of the economic inequality in stunting, underweight, and wasting among urban children were explained by maternal factors, environmental factors, and health-seeking factors.ConclusionAll the nutrition-specific and nutrition-sensitive interventions in urban areas should be prioritized, focusing on urban poor, who are often clustered in low-income slums. Rich-poor inequality in child growth calls out for integration and convergence of nutrition interventions with policy interventions aimed at poverty reduction. There is also a need to expand the scope of the Integrated Child Development Services (ICDS) program to provide mass education regarding nutrition and health by making provisions of home visits of workers primarily focusing on pregnant and lactating mothers.

Highlights

With increasing urbanization in India, child growth among urban poor has emerged as a paramount public health concern amidst the continuously growing slum population and deteriorating quality of life
The rate of stunting in India has declined from 48% to 38.4%, wasting has increased slightly from 19.8% to 21%, and underweight has decreased from 42.5% to 35.8% between the two time-periods of NFHS3 and National Family Health Survey (NFHS)-4 [17]
It is evident from the results that three key indicators of growth among children under age five, namely stunting, underweight, and wasting were higher among urban poor children than among urban non-poor children for both the time-periods

Summary

Introduction

With increasing urbanization in India, child growth among urban poor has emerged as a paramount public health concern amidst the continuously growing slum population and deteriorating quality of life. The rapid increase in the urban population due to urbanization in the last one decade has contributed to the urban poverty in India [47]. It is manifested in the form of inadequate provision of housing and shelter, water, sanitation, health, education, social security, livelihoods, and food security along with the special needs of vulnerable groups like women, and children [13]. Malnutrition among children under age five is a paramount public health concern in many developing countries, and India is no exception [33]. In a study conducted in Indian settings, it was found that the spatial clustering of malnutrition was visible in those geographical pockets where poverty was high, women’s education was low, and BMI level among women was below average [22]

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