Decomposition of Gender Differential in Malnutrition in Indian Children

J. Soc. Econ. Dev. https://doi.org/10.1007/s40847-017-0047-x RESEARCH PAPER Decomposition of gender differential in malnutrition in Indian children Shyma Jose1 Ó Institute for Social and Economic Change 2017 Abstract The nutritional status and health of Indian children is exacerbated due to poor and inadequate diet. However, intra-household gender disparity in provision of nutrition, health care and allocation of food increases the plight of the girl child. The prevalence of son preference in the Indian society has led to make the sex ratio more masculine in the recent years. The present paper tries to capture the gender differential in malnutrition and other health indicators. The paper found considerable heterogeneity existing in nutrient intake in India across both genders in various states. The study showed how different child- specific, household and exogenous factors manifest in gender disparity in nutritional status. The decomposition of the gender gap in underweight children showed that the difference in effect of the determinant affected the gender gap more than the difference in distribution of the factors. This shows the prevalence of some gender favouritism toward the male children in nutritional outcomes is as effective as the difference in endowment of the factors against the girl child. Keywords Gender gap Á Malnutrition Á Son preference Á Blinder–Oaxaca Introduction Child malnutrition is a major public health concern and a core issue of development in a country like India. Recent estimates show more than 40% of undernourished children in the world are in India. The nutritional status in India is characterized by malnourishment and morbidity, which aggravate the predicament of the Indian children due to poor and inadequate diet. National Family Health Survey (2005–2006) estimates show more than half of the Indian children suffer from malnutrition. Malnutrition coupled with gender & Shyma Jose [email protected] 1 Jawaharlal Nehru University, Room No 208, Shipra Hostel, New Delhi 110067, India 123 J. Soc. Econ. Dev. discrimination prevalent in nutritional and health measures exacerbates the plight of female children. Intra-household gender discrimination against female in provision of nutrition, health care, education and resource allocation has increased the predicament of the girl child which manifests in excess female mortality rate (Tarozzi and Mahajan 2007; Chaudhri and Jha 2011; Sen and Sengupta 1983). India has largest share of missing women1 in the world. Gender inequality is not just a social, political but also an eco- nomical issue and has accorded as one of the Millennium Development Goals (MDG). The gender disparity has become more evident in the Indian society as the gap between male and female sex ratio has increased over temporally and has become more masculine for children below 10 years of age (Arokiasamy and Pradhan 2006). This secular decline in child sex ratio over the years arises due to sex differential in child mortality rates. In India, the sex ratio declined from 972 in 1901 to 927 in 1991, but it increased to 933 in 2001 and then to 940 in 2011. The interstate differential in sex ratio is also quite abysmal with Kerala having sex ratio of 1084 and Haryana having lowest sex ratio of 879 in 2011. Intra-household gender bias is prevalent in India in allocation of food, preventive and curative health care, education, work, wages and fertility choices. Sen and Sengupta (1983) found females below 5 years of age to be more malnourished than males in two villages of West Bengal. The eradication of ill practices in child’s health and nutrition differentiating between female and male children is necessary for gender parity. This disparity in malnutrition is caused by factors such as allocation of food, feeding practices, birth order, sex of the sibling, poverty and parental literacy. Large household size linked with high fertility rate and low monthly per capita expenditure tends to increase gender disparity (Mishra et al. 2004; Lancaster et al. 2006). Girls are less likely to be educated and less valued than brothers because of whom they are more deprived of food and health care. The gender bias in nutritional level can create greater debility among the surviving girls and may have inter-generational effect (Patra 2008). In India, wider gender differentials exist in health care services than in food allocation (Das Gupta 1987). Many studies have reported a strong correlation between hunger and gender inequali- ties. The health outcomes of low maternal autonomy extend beyond mothers and translate into health consequences for their children and may be a significant casual factor in child malnutrition. The literature suggests that son preference and low status of women are the two important factors contributing to the gender bias, which is prevalent due to the patriarchal intra-familial economic structure coupled with the cultural, religious and economic utility of boys over girls (Arokiasamy and Pradhan 2006). Various studies have observed that women autonomy may lead to higher survival chances of female child (Das Gupta 1987; Mehrotra 2006). The nutritional status of children has found to be affected by use of health care services, which in turn is determined by maternal education, bargaining power within households and their control over household resources. There is mutually reinforcing relationship between expanding social and economic opportunities for women. Son preference is prominent phenomenon in the India, which affects the nutritional outcomes as well as mortality rate of the girl child (Arokiasamy and Pradhan 2006; Patra 2008; Das Gupta 1987; Bhat and Zavier 1999, 2003; Miller 1981). The literature suggests that son preference is prevalent because of parental preference for boys as it yields higher returns from investment in sons (Patra 2008). The potential worth of a child to the household has both an economic and cultural dimension. The underinvestment of resources in females can be explained by the low expected returns to such investment. In a 1 Missing women refer to the millions of women who were not born due to malpractices as selective female abortions, female infanticide and female neglect leading to low sex ratio (Patra 2008). 123 J. Soc. Econ. Dev. patriarchal and male-centred kinship structure, more sons are preferred to be the source of social and political power. The present paper will study the gender differential in malnutrition indicators, health indicators and heterogeneity in nutrient intake in India across various states and also at unit level. The paper will also trace the factors involved in gender disparity in nutritional level and its consequences. The paper will make use of Blinder–Oaxaca decomposition technique to decompose these factors that cause the gap in nutritional outcomes between male and female children using nonlinear Blinder–Oaxaca decomposition technique. The paper is divided into five sections. The first section will introduce the main premise of the paper. ‘‘Data and methodology’’ section deals with the data source used in the study and also discusses methodology. ‘‘Gender differential in household nutrients intake’’ section deals with the gender differential analysis with respect to nutritional intake, anthropometric indicators and other health indicators. ‘‘Factors affecting gender disparity in nutrition’’ section discusses various factors that affect gender disparity in nutritional status and also examines the decomposed gap in nutritional outcome among children to assess the exis- tence of effect of differential treatment against the female child. ‘‘Discussion’’ section gives some cautionary remark and finally, the study is concluded in ‘‘Conclusion’’ section with policy implications. Data and methodology The paper makes use of National Sample Survey (NSS) rounds of Consumption Expen- diture Survey (CES) for the year 2004–2005 and the National Family Health Survey (NHFS) rounds for the years 1992–1993, 1999–2000 and 2005–2006. The paper uses anthropometric indictors given in z-scores2 (standard deviation scores) for malnutrition,3 which include: underweight (weight-for-age) which is an indicator of chronic deficiency and is a composite measures of both chronic and acute undernutrition, stunting (height-for- age) is a measure of chronic undernutrition; it measures deficiency in the food energy intake over a long duration and wasting (weight-for-height) measures acute undernutrition. Children whose anthropometric measure (given in z-score) is less than 3 standard deviation (SD) below the median value of National Centre for Health Statistics (NCHS) international reference population are severely malnourished and with z-score less than 2 SD below the median value of NCHS international reference population are moderately malnourished (IIPS and ORC Macro 1994, 2000; Pathak and Singh 2011).4 The unit of analysis in the paper is children below 3 years of age and has been used unvaryingly, if otherwise specified, to measure the nutritional status of children in all three rounds of NFHS. The paper uses nonparametric Kernel density estimates using Epanechnikov kernel smoother 2 z-score is used to standardize the variable to be unit free and is calculated as z-score = (observed value - median value of the reference population)/(standard deviation of value in the reference population). 3 Malnutrition indicators utilize norms of National Centre for Health Statistics (NCHS) based on standard deviation as well as WHO standards, but this study will make use of only NCHS standards to make comparisons between the three rounds as the new WHO reference population published by WHO Multi- center Growth Reference Study Group (2006) is not available in NFHS-I and NFHS-II datasets. 4 In NFHS-I, height and weight were measured for children below 4 years of age and in NFHS-II below 3 years age. Due to the shortage of proper measuring tools, height was not measured during fieldwork in the some of the states covered by NFHS-I (IIPS and Macro 2007; Pathak and Singh 2011; Jose 2016, Arnold et al.

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