Changes in Child Undernutrition and Overweight in India From 2006 to 2021: An Ecological Analysis of 36 States

Jithin Sam Varghese; Aashish Gupta; Rukshan Mehta; Aryeh D. Stein; Shivani A. Patel

doi:10.9745/GHSP-D-21-00569

Key Messages

Historically, India has displayed high levels of child stunting and low levels of child overweight. Between 2006 and 2016, improvements in the reduction of child stunting and stability of overweight were observed, but, between 2016 and 2021, those trends have slowed or stagnated and the increase in child overweight has accelerated.
The slowing progress in child growth indicators occurred despite improvements from 2006 to 2021 in human development indicators—including literacy, sanitation, and households with electricity—that predicted large reductions in stunting and underweight.

Key Implication

Policy makers and national stakeholders should focus on inter-ministerial efforts to improve human development indicators, while avoiding reversal of gains made in reducing undernutrition and monitoring the simultaneous rise in child overnutrition.

ABSTRACT

Objectives:

We evaluated changes in priority indicators of child growth from 2006 to 2021 and examined the role of human development measures in these changes.

Methods:

We estimated cumulative and annualized changes in state- and district-level child growth indicators using 3 rounds of National Family Health Surveys (2005–2006, 2015–2016, 2019–2021) in 36 states. Outcomes included stunting, underweight, wasting, and overweight. Human development was measured using a principal components analysis of 9 ecological indicators. We contrasted expected versus observed changes in district-level growth outcomes between 2016 and 2021 based on changes in development indicators using 2-way Blinder Oaxaca decomposition.

Results:

From 2006 to 2021, the prevalence of stunting, underweight, and wasting decreased by 12.3, 10.3, and 0.7 percentage points, respectively, while the prevalence of overweight increased by 1.9 percentage points. The annualized rate of within-state change for stunting was lower from 2016 to 2021 compared with the 2006 to 2016 period, while the rate of change in overweight was higher. Simultaneously, all 9 human development indicators improved between 2006 and 2021. A unit increase between 2016 and 2021 in the human development score predicted a −5.1 percentage point (95% confidence interval=−5.8, −4.4) change in stunting, yet observed stunting declined by just -2.5 percentage points.

Conclusions:

From 2016 to 2021, population-level reduction in child stunting has slowed and the rise in child overweight has accelerated, relative to the 10 years preceding this period.

Received: August 11, 2021.
Accepted: August 16, 2022.
Published: October 31, 2022.

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