Socioeconomic inequalities in childhood undernutrition in India: analyzing trends between 1992 and 2005

India experienced a rapid economic boom between 1991 and 2007. However,
this economic growth has not translated into improved nutritional status
among young Indian children. Additionally, no study has assessed the trends
in social disparities in childhood undernutrition in the Indian context. We
examined the trends in social disparities in underweight and stunting among
Indian children aged less than three years using nationally representative
data. We analyzed data from the three cross-sectional rounds of National
Family Health Survey of India from 1992, 1998 and 2005. The social factors
of interest were: household wealth, maternal education, caste, and urban
residence. Using multilevel modeling to account for the nested structure and
clustering of data, we fit multivariable logistic regression models to quantify
the association between the social factors and the binary outcome variables.
The final models additionally included age, gender, birth order of child,
religion, and age of mother. We analyzed the trend by testing for interaction
of the social factor and survey year in a dataset pooled from all three surveys.
While the overall prevalence rates of undernutrition among Indian children
less than three decreased over the 1992-2005 period, social disparities in
undernutrition over these 14 years either widened or stayed the same. The
absolute rates of undernutrition decreased for everyone regardless of their
social status. The disparities by household wealth were greater than the
disparities by maternal education. There were no disparities in undernutrition
by caste, gender or rural residence. There was a steady decrease in the
rates of stunting in the 1992-2005 period, while the decline in underweight
was greater between 1992 and 1998 than between 1998 and 2005. Social
disparities in childhood undernutrition in India either widened or stayed
the same during a time of major economic growth. While the advantages
of economic growth might be reaching everyone, children from better-off
households, with better educated mothers appear to have benefited to a
greater extent than less privileged children. The high rates of undernutrition
(even among the socially advantaged groups) and the persistent social
disparities need to be addressed in an urgent and comprehensive manner.