The Potential Impact of Monthly Income Transfers on Child Stunting in India: A Sub-National Geospatial Perspective

Abstract

Background: Approximately one-third of the world’s stunted (low height-for-age) preschool-aged children live in India and is related to poverty. However, the potential impact of intervention like increments on household income are not known at a granular sub-district level, nor linked to existing wealth. Methods: Geolocations of primary sampling units from National Family Health Survey-4 were used to map stunting prevalence at 14x14 square kilometres resolution and by wealth. These data were statistically matched with data from the National Sample Survey Office-68 to approximate monthly consumer expenditure per capita and estimate the impact of monthly income transfers on stunting at this granular scale. Findings: A monthly transfer of $7 (₹500) per capita was estimated to reduce stunting across India by 3·8% (95% Uncertainty Interval: 0.14–10%), but with substantial geographical variation. Higher income transfers had larger effects for households in the Gangetic Plain and in pockets of Northern and North-Eastern India. The largest effect was observed in North-Eastern Odisha, with the potential to reduce stunting by as much as 10·8% (95% UI:8·8–12·7%). Interpretation: Higher household income, achieved through transfers, has the potential to reduce stunting in some regions of India where the burden of both stunting and poverty are high. For other regions, income improvement may contribute to improved nutrition, but it would need to be supplemented by other complementary programs for effectively reducing stunting. While having value for the whole country, the impact of improved household income will vary by context and will need nuanced, complementary interventions. Funding Statement: Exceptional Fellow Funding of Margdarshi Fellowship, The Wellcome Trust / DBT India Alliance Grant # IA/M/14/1/M/501681 to AVK India Alliance (Wellcome Trust/Department of Biotechnology) Clinical/Public Health Research Centre Grant # IA/CRC/19/1/610006 to TT, HPSS and AVK. Declaration of Interests: None to declare Ethics Approval Statement: The analysis was reviewed by the St. John’s Medical College Institutional Review Board; it was considered exempt from full review because it is based on an anonymous public use data set with no identifiable information on survey participants.