Introduction Childhood stunting has declined in India between 2006 and 2016, but not uniformly across all states. Little is known about what helped some states accelerate progress while others did not. Insights on subnational drivers of progress are useful not just for India but for other decentralised policy contexts. Thus, we aimed to identify the factors that contributed to declines in childhood stunting (from 52.9% to 37.6%) between 2006 and 2016 in the state of Chhattisgarh, a subnational success story in stunting reduction in India.
Methods We examined time trends in determinants of stunting using descriptive and regression decomposition analysis of National Family Health Survey data from 2005 to 2006 and 2015–2016. We reviewed nutrition-relevant policies and programmes associated with the drivers of change to construct a policy timeline. Finally, we interviewed multiple stakeholders in the state to understand the changes in the drivers of undernutrition.
Results The regression decomposition analysis shows that multiple factors explain 66% of the change in stunting between 2006 and 2016. Improvements in three key drivers—health and nutrition services, household assets, and sanitation and hygiene—explained 47% of the change in stunting. A shared vision for impact, political stability and capable bureaucracy, state-level innovations, support from development partners and civil society, and community mobilisation were found to contribute to improvements in programmes for health, poverty and sanitation.
Conclusion Change in multiple sectors is important for stunting reduction and can be achieved in subnational contexts. More work lies ahead to close gaps in various determinants of stunting.
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Handling editor Sanni Yaya
Contributors NK conducted literature review, policy timeline analysis, stakeholder interviews and analysed them, wrote significant sections of the manuscript and revised the manuscript. PHN conducted the statistical analyses, prepared tables and figures, wrote significant sections of the manuscript and revised the manuscript. RA co-led the body of work on the state-level success case studies, supported data interpretation, wrote significant sections, reviewed and edited the manuscript, and contributed substantially to the manuscript revisions. PM co-led the body of work on the state-level success case studies, reviewed the statistical analyses, supported data interpretation, reviewed and edited the manuscript. All authors read and approved the final submitted manuscript.
Funding Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval All research procedures were carried out in accordance with the ethical approval for the study which was obtained through the Internal Review Board of the International Food Policy Research Institute.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on request. We used the National Family Health Survey data, which are public datasets.
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