Spatial Inequality in Child Nutrition in Nepal: Implications of Regional context and Individual/Household Composition
Vanneman, Reeve Doering
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With nearly 42% of children below age five nutritionally stunted, child malnutrition is a social, economic, and public health issue in Nepal. Even more disheartening is the wide variation of malnutrition across sub-regions within country, which seems to disproportionately disadvantage children in certain regions as opposed to others. This dissertation aims to understand the extent and causes of child stunting from a regional inequality perspective. Household data from the Nepal Demographic and Health Surveys (NDHS) 1996, 2001, and 2006 are used to analyze national and regional trends of stunting of children age 6-59 months. Various data sources including the Nepal Census and the Health Management and Information System are used for regional level data. Both household and regional data are then analyzed using two-level Hierarchical Linear Modeling (HLM). The results show that stunting is declining albeit very slowly in Nepal and across all thirteen regions. But there are significant and consistent disparities across regions that are not decreasing over time. HLM analyses show that the regional variance in child stunting is due to both household and regional (i.e. contextual) factors. Specifically, women's literacy at the regional level is found to have a profound impact as it explains 60% of the regional variance in stunting. Among other factors, road accessibility and food production also appear to have important roles but not as large as women's literacy. Together, these three contextual factors explain 75% of the regional variance. Adding household compositional factors- socioeconomics in particular- reduces the residual regional variance only by few additional points. One important finding from the household-level analysis is that the so-called lower caste children are disproportionately stunted compared to other caste groups. Regional women's literacy remains a strong factor influencing child stunting above and beyond mother's education at the household level. Hence, women's literacy at the contextual level should comprise the most important policy agenda against malnutrition in Nepal which is not the case now. Moreover, a special emphasis on the disadvantaged castes is of utmost important so that potential inter-generational transfer of malnutrition could be reduced.