Trends in the prevalence and social determinants of stunting in India, 2005-2021: findings from three rounds of the National Family Health Survey

Nirmala Rao; Manya Bala; Namita Ranganathan; Utkarsh Anand; Sunaina Dhingra; Janaina Calu Costa; Ann M Weber

doi:10.1136/bmjnph-2023-000648

Trends in the prevalence and social determinants of stunting in India, 2005-2021: findings from three rounds of the National Family Health Survey

BMJ Nutr Prev Health. 2023 Dec 6;6(2):357-366. doi: 10.1136/bmjnph-2023-000648. eCollection 2023.

Authors

Nirmala Rao¹, Manya Bala¹, Namita Ranganathan², Utkarsh Anand³, Sunaina Dhingra⁴, Janaina Calu Costa⁵, Ann M Weber⁶

Affiliations

¹ Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong.
² Department of Education, University of Delhi, New Delhi, Delhi, India.
³ School of Economic Sciences, Washington State University, Pullman, Washington, USA.
⁴ OP Jindal Global University, Sonipat, Haryana, India.
⁵ International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.
⁶ University of Nevada Reno, Reno, Nevada, USA.

Abstract

Objectives: To assess social determinants of stunting and the shifts in contributions of socio-demographic factors to national prevalence trends in India between 2005 and 2021.

Methods: We leveraged data from three rounds of the National Family Health Survey (NFHS-3: 2005-2006, NFHS-4: 2015-2016, NFHS-5: 2019-2021) for 443 038 children under 5 years. Adjusted logistic regression models and a Kitigawa-Oaxaca-Blinder decomposition were deployed to examine how wealth, residence, belonging to a marginalised social group, maternal education and child sex contributed to changes in stunting prevalence.

Results: The decrease in stunting prevalence was notably slower between NFHS-4 and NFHS-5 (annual average rate of reduction (AARR): 1.33%) than between NFHS-3 and NFHS-4 (AARR: 2.20%). The protective effect of high wealth diminished from 2015 onwards but persisted for high maternal education. However, an intersection of higher household wealth and maternal education mitigated stunting to a greater extent than either factor in isolation. Residence only predicted stunting in 2005-2006 with an urban disadvantage (adjusted OR: 1.18; 95% CI: 1.07 to 1.29). Children from marginalised social groups displayed increased likelihoods of stunting, from 6-16% in 2005-2006 to 11-21% in 2015-2016 and 2020-2021. Being male was associated with 6% and 7% increased odds of stunting in 2015-2016 and 2019-2021, respectively. Increased household wealth (45%) and maternal education (14%) contributed to decreased stunting prevalence between 2005 and 2021.

Conclusions: Stunting prevalence in India has decreased across social groups. However, social disparities in stunting persist and are exacerbated by intersections of low household wealth, maternal education and being from a marginalised social group. Increased survival must be accompanied by needs-based interventions to support children and mitigate mutually reinforcing sources of inequality.

Keywords: Malnutrition.