XXVIII IUSSP International Population Conference Full paper - PDF document

XXVIII IUSSP International Population Conference Full paper submission Title : Trends of Inequalities in Child Malnutrition in Nepal: Does they Swimming against Tide? Authors Harchand Ram ( Corresponding and presenting Author ) Doctoral Student Centre for the Study of Regional Development (CSRD) School of Social Sciences (SSS) Jawaharlal Nehru University (JNU) Phone No: +91 7506541092 Email: hm8460@gmail.com; harcha28_ssf@jnu.ac.in Mohammad Zahid Siddiqui Doctoral Student Centre for the Study of Regional Development (CSRD) School of Social Sciences (SSS) Jawaharlal Nehru University (JNU) Dr. Srinivas Goli Assistant Professor Centre for the Study of Regional Development (CSRD) School of Social Sciences (SSS) Jawaharlal Nehru University (JNU) Abstract: This study examines the trends and patterns of averages vis-a-vis inequalities in child malnutrition by wealth status of population across regions and place of residence of Nepal. Data from the two rounds of Nepal Demographic and Health Survey (NDHS) 2006 and 2011 were analysed. The proportion of children Underweight, Stunting and Wasting (moderate and severe) have been used as a dependent variable and wealth index as a proxy for economic status of the population. Bivariate analysis, Poorest-Richest (P-Rt) ratio, Poorer-Richer (P-Rr) ratio and concentration indices were used to examine the trends in averages vis-a-vis economic inequalities in children nutritional status. Results indicated that, in spite of a substantial improvement in average nutritional status from 2006 to 2001 (Underweight declined by 10 percentage points), but the corresponding improvement was not observed in inequality in nutritional status (P-Rt ratio rose by 1.5 times and concentration indices rose by -0.59). The

similar finding was observed in Wasting and Stunting. Further, the findings suggest that the inequalities in child malnutrition in Nepal are swimming against its progress in averages. This implies that the benefits of improvements in child nutritional status by passed the children of poorest wealth quintiles while it disproportionately benefiting children of richer and richest wealth quintiles. Therefore, Policies and programmes that are targeting to improve nutritional status need to focus on both efficiency and equity. Introduction: ‘S ocial inequalities are killing peopl e on a grand scale’ this statement of the World Health Organization (WHO) report on health inequality has rejuvenated the earlier debates on social inequalities in health (WHO 2008). Even now a majority of the people doesn’t enjoy the good health that is biologically and naturally possible. A burgeoning volume of research before and after this report have documented that the toxic combination of exclusive socioeconomic and public health policies, and the politics are accountable for this (Wagstaff & Wanatable, 2000; Wagstaff et al., 2003; Marmot, 2005; Deaton, 2013). Monitoring socioeconomic inequalities and formulating policy in order to try to combat them had a long tradition in the developed world since the first half of the nineteenth century. The evidence suggests that for long run there is an increasing gap in mortality at all ages between poor and well off section of society in most industrialized countries. These gaps have frequently claimed to be unjust and policies were made to reduce them (Drever and Whiteland 1997, Acheson 1998) whereas in developing countries, the issues of socioeconomic inequalities in health have been started to receive attention recently. Prior to this, the main focus is on improving the health averages. The health progress in any country is measured based on the progress in health averages (Wagstaff and van Doorslaer, 1991; Kakwani et al., 1997; Gwatkin 2000; Goli and Arokiasamy, 2013; Hosseinpoor et al., 2006). Nepal is small, food deficit, landlocked and less developed country in South Asia (Goli et al., 2015). The country has never documented any economic miracle or debacle. According to United Nations Development Programme (UNDP) report on human development, Nepal ranks 145 th out of 187 countries in terms of Human Development Index (UNDP, 2013). Among the numerous health challenges faces by Nepal, the reduction of the child malnutrition needs instantaneous attention of program and policy maker (Martorell et al., 1984; Joshi, 2012; Niraula, 2013). Adequate nutrition is most important for the development of the country as well as well-being of the individuals. Generally poor nutritional status affects the entire population and especially it affects the women and children more because of their unique physiological

needs and greater vulnerability to socioeconomic deprivation (Walkins and Marmot, 2003). The Nepal nutrition report card documented that: approximately 1.7 million children, i.e. nearly half of all the children five years old in the country are stunted or suffer from under nutrition. About 47 percent of children below age five are underweight (less weight as per the height); 54 percent of them are stunted (less height as per the age), and 7 percent being wasted (thinner for height) (Nepal micronutrient status survey, 1998) . The reduction of absolute poverty from 46 in 1996 to 31 in 2004 is a significant improvement in economic condition of Nepal. Per capita income has also increased and improvements in public health indicators occurred due to advances in medicines, openness of economy, agricultural advancement and remittance. The last 15 years in Nepal witnessed a substantial reduction of child mortality; by large the most contributing factor is reduced in nutritional deficiency. Programs and policies targeted towards reduction of malnutrition are the fruits of surveys that start long back and lighten the intensity of problem. Government of Nepal is prioritizing their motive to the improvements of nutritional status of children and mothers, including food security scrutinizing and early caution. But the improvements in health status or fruits of economic growth are not uniformly distributed and the better off sections are achieving highest level of health whereas poor and downtrodden sections of people are receiving negligible health improvements. This period also witnessed the widening inequality in income, health of mother and child, consumption and in assets. Similarly, the scenario of poverty and malnutrition reduction was not uniform among the caste and ethnic groups and even in all regions of the country (NLSS I, 1996 and NLSS II, 2004 and NDHS 4, 2011, Central bureau of statistics, Nepal government). In this context, an important question arises is “ Does improvements in average of child malnutrition leading to greater uniformity in health distribution or health inequalities are swimming against the averages ” . The several health inequality studies referred above either excluded Nepal or did not an alyze the relationship between “ averages of children nutrition versus inequalities in child nutrition” . Moreover, understanding the relationship between “averages of children nutrition versus inequalities in child nutrition” is critical in monitoring and evaluation of existing socioeconomic, health and nutrition policies, especially to know how inclusive are they? Literature suggests that from early 2000, Nepal is at the peak of nutritional transition, but, whether the economically poor and other disadvantaged children are part of such transition or not, is need to be examined. Examining the inequalities in nutritional status during transition help us to understand the question, whether the benefits are uniformly distributed or