Poster #95 - Progress in Ameliorating Stunting in India: Trends in Prevalence and Social Determinants.

• In Event: Poster Session 20

Abstract

Early childhood stunting, that is low height-for-age as classified by being ≤ 2 standard deviations from the WHO Child Growth Standards median, is associated with poor developmental outcomes, low educational attainment, and high risk of chronic disease, which taken together impedes human capital and economic productivity (de Onis & Branca, 2016; Rolfe et al., 2018; Victora et al., 2008). India currently has roughly one-quarter of the world’s stunted children and has implemented numerous national policies and interventions to mitigate stunting (World Health Organization, 2021). However, there is a paucity of research examining the progress India has made in reducing stunting and the specific factors impacting progress.
We leveraged data from the three most recent rounds of India’s National Family Health Survey conducted in 2005-06 (n = 41 306), 2015-16 (n = 225 002), and 2019-21(n = 206 025) to describe trends in national-level stunting prevalence and in nationally pertinent social determinants predicting stunting: family wealth, residence, marginalized social group belonging, maternal education, and sex of the child.
Binary logistic regression analyses were deployed to observe trends of predicting stunting by each level of the selected social determinants and across intersecting groups of family wealth, marginalized social group belonging, residence, and maternal education. The Oaxaca-Blinder decomposition method was executed to examine the change in stunting prevalence between 2005 and 2021 and how the selected social factors contributed to the observed change in prevalence. We predicted a closing in urban-rural disparities, a shift toward a male disadvantage, and a consistent marginalized social group belonging disadvantage. We also predicted that increased family wealth and maternal education would explain most of the national decrease in stunting prevalence.
Results showed the prevalence of stunting decreased from 48.3% in 2005-06 to 35.7% in 2019-21. Family wealth and maternal education were the most prominent factors in both predicting stunting and explaining the change in stunting prevalence (See Figure 1). A diminishing protective effect of high family wealth was observed from 2015 onwards, whereas the protective effect of higher maternal education was stable across all three time points (See Table 1). The decrease in stunting prevalence was attributable to families becoming wealthier and increasing educational attainment of mothers. Although marginalized social group belonging was non-significant in explaining stunting prevalence change, there was an increased likelihood of children from these groups being stunted with each time point (See Table 1). Residence and sex of the child were non-significant in explaining the change in stunting prevalence. However, analyses of intersecting groups revealed an urban advantage for children from socially marginalized groups. Sex of the child significantly predicted stunting from 2015 onwards, where male children were more likely to be stunted compared to their female counterparts.
Overall, this study reveals a laggard decrease in stunting prevalence and persisting social group disparities in stunting in India. This slow decrease should be interpreted in the context of rapidly decreasing under-five mortality rates increasing survival. However, needs-based interventions are necessary to promote the thriving of children across intersecting social groups.

Authors

• Manya Bala, University of Hong Kong (HKU)
  Presenting Author

• Nirmala Rao, The University of Hong Kong (HKU)