To Fix Childhood Stunting in India, Focus on Women's Health: Study

Researchers found that low women’s BMI could explain almost a fifth of the difference between high and low burden stunting districts.

New Delhi: At 63 million stunted children, India has one-third of the world’s population of stunted pre-schoolers. This means the global struggle against stunting is not going to change for the better unless India acts seriously.

With stunting, as with several other social and development outcomes, women play a key role. This has been highlighted by a new research, the authors of which have conducted a deep examination into freshly released government data from the National Family Health Survey 4 (2015-2016).

“Women-related factors contribute to more than half of the factors we analysed, which are linked to stunting. This is not new news. But the fact that this still has to be said as news is a concern. When women are not tended to, we are looking at discrimination across the life-course,” says Purnima Menon, senior research fellow at the International Food Policy Research Institute (IFPRI), and lead author of this study.

The research by IFPRI is also being reviewed by the NITI Aayog, with whom they have entered into an agreement to provide analytical and technical support on related issues. This study could find a place in discussions at the National Nutrition Mission, as well as some use in NITI Aayog’s plan to give targeted social sector interventions in 100 “aspirational districts”.

The paper has tried to understand the geographical burden of stunting across districts, using data from the National Family Health Survey 4 (2015-2016). It has also relied on Census data from 2011. Indian researchers have not had access to district-level data for the country for about ten years, and the paper says that this “lack of disaggregated stunting data at the district level has been a challenge for policy and programme strategies in a decentralized governance system”.

What role do women play in childhood stunting?

Stunting in early childhood is a marker of poor nutrition. It is calculated in children under the age of five.

India did see an improvement in stunting between 2006 and 2016 – stunting declined from 48% to 38.4%. But across states, the range remains challenging, from 12.4% to 65.1%.

In fact, north India alone is keeping the global average high – 52.6 million stunted children are in north India, while 8.1 million of them are in all southern states combined.

Credit: IFPRI

“The key to South Asia’s high rates of child malnutrition is not to be found in the obvious,” said a UNICEF publication released 21 years ago, co-authored by the former director general of the Indian Council of Medical Research, Vulimiri Ramalingaswami.

The authors began their paper by going through a number of factors which could intuitively be linked to malnutrition, such as poverty or food production. The authors instead said, “the exceptionally high rates of malnutrition in South Asia are rooted deep in the soil of inequality between men and women.”

Little appears to have changed in these basic underlying factors, ensuring that the basic phenomenon of poor nutrition and subsequently, of stunting, remains.

Menon recalls this 1997 paper and calls for attention to the gender dimension.

“Research shows that it may not be new policy that we need – there are wide disparities within the same policy geography. Some states, or some districts within states, perform well, and some don’t, even under the same policy. What we need remains proper implementation of these policies,” she says.

The paper has examined immediate and underlying determinants and nutrition-specific as well as nutrition-sensitive interventions.

Across districts, they examined eight factors which contribute to the difference in stunting prevalence between very high burden and low burden districts: women’s body mass index, women’s education, age at marriage, antenatal care, children’s diet, assets, open defecation and household size.

Just the first four, which are related to women, account for 46% of the factors which impact stunting.

“Variables reflecting women’s well being – BMI, education, early marriage and access to ante natal care – explain close to half the difference between high and low stunting districts,” says the paper. The authors say that “Discrimination against women is a widely suspected cause of India’s unusually high rate of stunting.”

For example, nearly a quarter of women in India have low BMI. And while more than 40% of children were breastfed within an hour of their birth, only 55% were exclusively breastfed. Early marriage and thus early childbearing is more likely to lead to pre-term babies as well.

“A focus on addressing women’s nutrition emerges as a key priority area in our analyses,” says the study.

Their research found that low women’s BMI could explain almost a fifth of the difference between high and low burden stunting districts, which corroborates existing research on maternal undernutrition being a major determinant of poor fetal growth and childhood stunting.

“India faces a critical challenge because preconception undernutrition among women can influence birth outcomes and child growth,” says the paper.