The Social Determinants of Stunting Among Indian Children

Background and Purpose:  

The World Health Organization has recently recognized that childhood stunting is not caused by dietary insufficiencies and inadequacies alone; economic, social and environmental practices and structures play a critical role in the increased number of stunted children throughout the world. This study was undertaken to understand the relationship between poor sanitation and hygiene, clean drinking water, toilet use, mother’s education, religious practices and stunting in India. A human rights theoretical framework was utilized for this study. The purpose of this paper is to examine the causal linkages between childhood stunting and rights based determinants such as respectfully challenging age-old cultural and religious practices by providing sound educational opportunities about the dangers of open defecation and unhygienic sanitation practices.

Methods:

The study used data from the Third National Family Health Survey (NFHS-3; International Institute for Population Sciences, 2006). The sample consisted of 17,239 women between the ages of 15-49 with a child between the ages of 2-5. According to UNICEF, stunting is defined as a child measuring at least 2 standard deviations below the median height for age of the reference population. The dependent variable, stunting, is dichotomized to create stunted and non-stunted groups. Religion (Hindu/non Hindu), maternal education (completed a secondary education or did not), toilet use, and access to clean water were also dichotomized. Logistic regression and factorial ANOVA were used to test how access to clean drinking water, toilet use, mother’s education, and religious practices impact childhood stunting.

Results:  

Almost 16% of Hindu children were stunted. Children of mothers that have a secondary education, children who use sanitary toilet facilities, and children who have access to a clean drinking water supply are less likely to be stunted. Mothers that have at least a secondary education are eight times more likely to use sanitary toilet facilities, and children from Hindu families are 70% less likely to use sanitary toilets facilities. Results from the ANOVA indicated that children of mothers who have completed a secondary education are significantly less stunted than those whose mothers did not finish secondary school. Children who use sanitary toilet facilities were less stunted than children that did not use sanitary toilet facilities. The interaction between toilet type and maternal education was also significant. Children with access to flushing or pit toilets whose mothers had completed a secondary education were the least stunted, while children without access to sanitary facilities whose mothers were not educated had higher rates of stunting.

Conclusion and Implications: 

Our finding underscores the importance of socio structural and multi-variable approach toward improving childhood stunting. Although current campaigns in India focus on eradicating public defecation, providing access to clean drinking water and educating women, behavioral norms reinforced by religious practices are difficult to influence. International social work efforts should focus on working with social institutions that improve women’s status and enlist their participation in public sanitation campaigns. These efforts will potentially save India from losing its most valuable resource—children.