(WITHDRAWN) Assessing Income Inequality for Growth Faltering Among Children in Urban India: A Decomposition Approach

Background& Purpose: Undernutrition effectively contributes to nearly half of the total deaths in children under age five years. India ranks 102 in the Global Hunger Index, depicts the critical condition of under-nutrition in India. Despite impressive economic growth, high rates of under-nutrition persist in India. This study aims to understand the dynamics of growth faltering among urban poor and non-poor children aged 0-5 years. Also, this study compares how the pattern of growth faltering has changed from 2005-06 to 2015-16. Study decomposed the contribution of various factors in determining the change in economic inequality in undernutrition over the two survey periods.

Methods: Data were drawn from the National Family Health Survey, III & IV carried out in 2005-06 and 2015-16, respectively. State-level data were examined to estimate mean height-for-age z scores (HAZ), mean weight-for-age z scores (WAZ), and mean weight-for-height z scores (WHZ) among children aged 0-59 months. We did a stratified analysis by age group to understand the growth faltering. Income-related inequality in stunting, underweight, and wasting was measured by the concentration index (CI) and the concentration curve (CC). The study used Wagstaff decomposition analysis to decompose the concentration index. The covariates predicting economic inequality in under-nutrition were segregated into five groups; mother’s factor, health-seeking factors, environmental factors, child factors, and household factors.

Results: Mean WAZ, HAZ and WHZ scores for children under five years were (-0.95, -1.54, -1.11), and (-0.36,-1.05, -1.00) in 2005-06; and (-0.86, -1.49, -1.09), and (-0.33, -1.18, -1.25) in 2015-16 for urban poor and non-poor respectively. Of the total growth faltering in underweight at 59 months among urban poor and non-poor in 2005-06, 71% (-1.54) and 68% (-1.05) of growth took place at first five months after birth. During 2005-06 as well as 2015-16, maternal factors (specifically mother’s education) were the highest contributory factors in explaining rich-poor inequality in stunting and underweight among urban children. More than 85% of the economic inequality in stunting, underweight, and wasting among urban children were explained by maternal factors, environmental factors, and health-seeking factors.

Conclusions and Implications: Several important observations emerge from this study; the most important is that growth faltering among children reaches its peak by the end of two years after birth. Since the cognitive and developmental deficiency resulting from under-nutrition may significantly be irreversible after two years of age, it is encouraged that policy-makers shall evenly target children for nutritional programs, with emphasis on children aged below two years. Rich-poor inequality in under-nutrition calls out for the expedite policy interventions aimed at poverty reduction in urban areas. There is also a need to provide mass education regarding nutrition and health, along with focussing on the correlates that aim at improving mother’s education. Environmental factors also promoted the inequality in stunting, wasting, and underweight in urban children; there is a need to focus the enigma of open defecation in India. Information, Education, and Communication (IEC) activities are encouraged to clamp down the economic inequality in stunting, underweight, and wasting among urban children.