Bioecological determinants of malnutrition in underprivileged children in India

Abstract

India has made considerable progress towards tackling child malnutrition since the launch of the ICDS scheme in 1975, with currently 1.3 million centres across the country. The latest NFHS-5 data (2018–20), however, shows limited improvement in the percentage of stunted, wasted, and underweight children, at 36%, 19%, and 32%, respectively. Given the persistent state of malnutrition in India, we probe, are there more nuances and unexplored dimensions to malnutrition issue that can add to the existing literature and support policy making? Demographic and Health Survey (2015–16) data of 70,618 children between the age of 2 and 5 years, from underprivileged communities in India, were investigated using the Bronfenbrenner's Bioecological Theory Model. Three malnutrition outcome measures were calculated as per WHO standards, namely, height-for-age, weight-for-height, and weight-for-age. Binary and multinomial logistic regression models brought out two noteworthy results, namely, the importance of vaccination and the paradox of maternal working status. Vaccination status positively impacts the outcome measures, and maternal working status demonstrates a paradoxical situation. The children of non-working mothers had better health statistics, indicating positive impact of a higher amount of time spent on direct childcare. However, working women in poor households bring economic capital to the house, indirectly bringing positive impacts on family health and nutrition. The results also confirmed the significance of maternal and child health status, access to healthcare, and need for dietary diversity. The importance of vaccination, especially in the context of COVID-19, has been emphasized by policymakers. The policymakers need to relook at the existing welfare programs like ICDS and Creche Scheme to incorporate better-supporting structures for working mothers for health access and childcare activities.