Abstract
Dietary diversity is a crucial pathway to child nutrition; lack of diversity may deprive children of critical macro and micronutrients. Though water along with hygiene and sanitation is a known driver of child undernutrition, a more direct role of household water in shaping dietary diversity remains unexplored. Existing literature provides a sound theoretical basis to expect that water could affect dietary diversity among young children. Here, we test the proposition that suboptimal household access to water and low regional water availability associate with lower dietary diversity among young children. Using the nationally representative 2015–2016 India Demographic and Health Survey data, we conducted a probit analysis on the sample of 69,841 children aged 6–23 months to predict the probability that a child achieves minimum standards of dietary diversity (MDD). After controlling for relevant socioeconomic and gender‐related covariates, we found that children in household with suboptimal household water access were two percentage points less likely to achieve MDD, when compared with those from households with optimal water access. Children in high water availability regions had nine percentage points greater probability of achieving MDD compared with children from low water availability regions, accounting for household water access. As dietary diversity is central to nutrition, establishing the role of water access in shaping early childhood dietary diversity broadens the framework on how household material poverty shapes child malnutrition—independent of sanitation and hygiene pathways. This provides additional window for nutrition planning and intervention wherein water‐based strategies can be leveraged in multiple ways.
Highlights
Despite decades of focused interventions, childhood undernutrition persists
Our finding that suboptimal household water access is associated with lower probability of a child achieving minimum dietary diversity (MDD) advances the emergent body of research that offers insights into a few ways through which the linkage between water access and dietary diversity unfold (e.g., Collins et al, 2019; Gibson, Ferguson, & Lehrfeld, 1998; Schuster, Butler, Wutich, Miller, Young, & HWISE Consortium, n.d)
Our analysis provides evidence that inadequate water access— associated as it may be with low household wealth—provides additional pathway to child nutrition as defined in terms of access to minimum dietary diversity
Summary
Despite decades of focused interventions, childhood undernutrition persists. Increasingly, nutrition campaigns in middle and lower income countries are advocating multidimensional approaches. We examine the effect of water availability and access on an important infant and young child feeding indicator—minimum dietary diversity (MDD)—in context of India using the nationally representative Demographic and Health Survey (DHS) data. We have chosen not to use child linear growth or stunting as an outcome in our analysis as we are focused on explicating the degree to which water affects what foods are available to and prepared in the household for infants and young children This approach aligns with recent scholarship recognizing that a focus on linear growth and stunting as ultimate nutrition outcomes “discounts the importance of other outcomes” and risks overlooking the “positive, meaningful, and observable effects before linear growth improves” of other interventions (see Leroy & Frongillo, 2019). As per the probit model, the probability that a child achieves minimum dietary diversity can be expressed as We first estimate this model for all of India including various water availability regions as dummy variable. The data analysis has been conducted using Stata v16 software
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