Is economic growth associated with reduction in child undernutrition in India?

Economic growth is widely perceived as a major policy instrument in reducing
childhood undernutrition in India. We assessed the association between
changes in state per capita income and the risk of undernutrition among
children in India. Data for this analysis came from three cross-sectional waves
of the National Family Health Survey (NFHS) conducted in 1992–93, 1998–
99, and 2005–06 in India. The sample sizes in the three waves were 33,816,
30,383, and 28,876 children, respectively. After excluding observations
missing on the child anthropometric measures and the independent variables
included in the study, the analytic sample size was 28,066, 26,121, and 23,139,
respectively, with a pooled sample size of 77,326 children. The proportion
of missing data was 12%–20%. The outcomes were underweight, stunting,
and wasting, defined as more than two standard deviations below the World
Health Organization–determined median scores by age and gender. We also
examined severe underweight, severe stunting, and severe wasting. The main
exposure of interest was per capita income at the state level at each survey
period measured as per capita net state domestic product measured in 2008
prices. We estimated fixed and random effects logistic models that accounted
for the clustering of the data. In models that did not account for survey-period
effects, there appeared to be an inverse association between state economic
growth and risk of undernutrition among children. However, in models
accounting for data structure related to repeated cross-sectional design
through survey period effects, state economic growth was not associated
with the risk of underweight (OR 1.01, 95% CI 0.98, 1.04), stunting (OR 1.02,
95% CI 0.99, 1.05), and wasting (OR 0.99, 95% CI 0.96, 1.02). Adjustment for
demographic and socioeconomic covariates did not alter these estimates.
Similar patterns were observed for severe undernutrition outcomes. We
failed to find consistent evidence that economic growth leads to reduction
in childhood undernutrition in India. Direct investments in appropriate health
interventions may be necessary to reduce childhood undernutrition in India.