Answers to India's Child Malnutrition Paradox: Role of Maternal Autonomy and Health Related Awareness (WITHDRAWN)

Answers to India’s Child Malnutrition Paradox: Role of Maternal Autonomy and Health Related Awareness  

Background & Purpose: India has the world’s highest burden of child undernutrition (World Bank, 2013). The UN Millennium Development Goals (MDG) report (UN MDG, 2015) highlighted India’s failure to reduce prevalence of child undernutrition to 26% by 2015. To achieve the post-2015 SDGs 2 and 3 which aim to reduce child hunger and malnutrition by 2035, the approach towards tackling undernutrion needs to be reevaluated. This study recognizes that financial support is not sufficient to improve the nutritrional status of children in India as well as globally. There is need to address underlying social norms and power relations that restrict capabilities of certain individuals and impact their well-being during childhood and throughout the life course. Method: The 2005-06 National Family Health Survey (NFHS-3) was utilized for this cross-sectional study. The study sample consisted of urban women (15-49 years), who were married and had at least one living child (0-5 years) [N= 9,092]. Confirmatory Factor Analysis (CFA) was used to develop and validate scales on maternal autonomy and health related awareness. Three ordered logistic regression models (OLS) with mediation effect were conducted to examine the effect of maternal autonomy and health related awareness on child nutritional status, when mediated by maternal health. Child nutritional status was measured using Z scores for stunting, wasting and underweight. Sociodemographic variables including maternal age, education, caste, location of household and income; sex of child and enrollment in the Integrated Child Development Scheme (ICDS), were used as control variables. Results: The study findings indicated that caste, education, enrollment in ICDS, sex of the child and residing in high gender equality states were significant predictors of child nutritional status. Maternal autonomy and health related awareness did not have a significant direct effect on child nutritional status. However the relationship was fully mediated by maternal health, while controlling for socioeconomic status. Maternal health accounted for 7% of the total effect for stunting and 36% for underweight. This model was not significant for wasting.  Conclusion & Implications: The results of this study highlight the continued prevalence of child undernutrition in India. It suggests that socioeconomic status is not the only predictor of child nutritional status. Deep-rooted cultural values need to be challenged to achieve any headway in the nutritional status of children in India. Thus, efforts need to be made to (i) understand how to tackle underlying social and cultural values that fail to invest in girls and women who are critical for child development, and (ii) recognize and learn from best practices of low income mothers who have been able to successfully tackle the issue of poor child nutrition in their community.