The Enigma of Malnutrition in India

One third of the world’s malnourished children live in India. Puzzlingly, the child malnutrition rate in India is higher than in most of Sub-Saharan Africa, yet on most other indicators of development, including other health indicators, India fares better than Africa. This problem has drawn the attention of top leaders in India. In January 2012, Prime Minister Manmohan Singh described child malnutrition as “a national shame,” (Times of India, 11 January 2012). He highlighted the link between well-nourished children and economic productivity: "In the years to come, these children will join our workforce as scientists, farmers, teachers, data operators, artisans and service providers. We cannot hope for a healthy future for our country with a large number of malnourished children.” Indeed, child malnutrition can hinder economic growth because malnourished children grow up to be less productive workers, on average. First, malnutrition reduces adult cognitive skills. Undernutrition in utero and in childhood has been linked to impaired cognition and lower educational attainment. Second, child malnutrition reduces physical capacity in adulthood; for example, child malnutrition increases the incidence of cardiovascular disease and other chronic diseases. This project uses Demographic and Health Surveys (DHS) and the National Family Health Surveys for India data to examine why the rate of malnutrition is higher in India and other South Asian countries compared to sub-Saharan Africa. We examine data from 2004 to the present for 26 countries for which anthropometric data are available, giving us a sample of 200,000 children under age five. We use regression analysis to make comparisons between South Asia and Africa, examining how the regional gap in child malnutrition varies with demographic and other characteristics. Specifically, we focus on how child malnutrition varies with a child’s gender and birth order to examine questions such as, how much does favouritism toward eldest sons contribute to the high rate of child stunting and wasting in India and the rest of South Asia? How much does poor maternal health explain? The policy aim of the project is to provide new facts that help us understand the root causes of malnutrition in India and inform policy-making to improve maternal and child nutritional outcomes. For example, the findings are relevant for large government schemes such as India’s Integrated Child Development Services programme.