Gender, family, and the nutritional status of children in three culturally contrasting states of India

Abstract

This paper has three main aims: to measure the clustering of children with low weight for age z-scores within families, to establish whether significant differences exist by gender in weight for age z-scores, and to demonstrate whether the presence of a mother-in-law in the household has any significant impact on the nutritional status of young children. Regression modelling is used to examine the weight for age z-scores of children under the age of four years in Maharashtra, Tamil Nadu and Uttar Pradesh using the 1992–93 Indian National Family Health Survey data. Random effects models measure the clustering of children with low weight for age z-scores in families, controlling for a number of other family factors.

Our findings do not reveal significant gender differences in weight for age z-scores. Although little variation was found between family structures in the nutritional status of children, there were significant differences between families after controlling for family type. This suggests that there are differences between families that cannot be explained by a cross-sectional demographic survey. The evidence from this work suggests that nutrition programs need to adopt community nutrition interventions that aim resources at young children from families where children with low weight for age z-scores are found to cluster. However, there is a need for further inter-disciplinary research to collect data from families on behavioural factors and resource allocation in order that we might better understand why some families are more prone to having children with low weight for age z-scores. The diversity in the significant covariates between the three states in the models has shown the need for Indian nutrition programs to adopt state-specific approaches to tackling malnutrition.

Introduction

The United Nations (1994) reported that over half of the underweight children in the world are living in South Asia. Underweight children are at increased risk of both mortality and morbidity (Mosley & Cowley, 1991; Gage & Zansky, 1995), the increased risk of mortality rising with the degree of malnutrition. In addition, there is evidence to suggest that children who are malnourished at an early age are more likely to have reduced educational attainment (Pollit, 1984). Clearly then, there is a need to tackle the problem of malnutrition in the sub-continent. The 1992–93 National Family Health Survey (NFHS) is the first national-level sample survey to examine the nutritional status of young children in India. It provides an opportunity to study the associations between a range of demographic and socio-economic indicators and childhood nutritional status.

This paper uses regression modelling to examine the weight for age z-scores of children under the age of four years in the three Indian states of Maharashtra, Tamil Nadu and Uttar Pradesh using the NFHS data. Previous research has shown that there are marked differences in mortality and health outcomes between the north and the south of the country (Dyson & Moore, 1983; Arnold, Choe, & Roy, 1996; Agnihotri, 1997; Basu, 1990; and Florencio (1993), Kishor (1995)). The states of Uttar Pradesh in the northeast, Maharashtra in the southwest zone of India, and Tamil Nadu in the southeast were chosen to provide a sample that takes into account regional diversities. Florencio, 1980 suggests that because very young children rely on other family members for food, their nutritional status should be studied within the context of the household. We therefore examine the weight for age z-scores of children with particular reference to the clustering of underweight children in certain familial types. This analysis aims to highlight any differences that may be found between children living in joint families with mothers-in-law and those living in other types of family structure. A number of demographic and socio-economic explanatory variables that are applicable to the child at the family and the individual level will be explored. A random effects model is used to control for the fact that some children in the sample belong to the same family and therefore share the same family-level characteristics. In addition the existence of sex differences in nutritional status is examined.

The regional differences in marital systems and family formation identified by Dyson and Moore (1983) have been carefully considered when selecting states for analysis. The states of Maharashtra, Tamil Nadu and Uttar Pradesh (Fig. 1) include a range of cultural settings for examining the influence of family structure, clustering of weight for age z-scores within families, and gender disparities in weight for age z-scores. Table 1 gives some basic demographic indicators for each state. Uttar Pradesh, in the north of India, is less demographically developed and urbanised than the other two states. The disparity between the demographic and socio-economic conditions of men and women in Uttar Pradesh is greater than that in either Maharashtra or Tamil Nadu.