Child Malnutrition and Chronic Poverty

Child malnutrition is a major cause of poverty (Dasgupta 1993) and is treated here as a major transmission mechanism for the persistence of chronic poverty⁵⁹. Malnourished children are likely to achieve lower levels of physical and cognitive development, have more health shocks and have more health problems in later life.

The “Insecurity” Dimension of Chronic Poverty

87 6.2.1 Nutritional Status of the Children in Bangladesh: A Bi-variate Analysis

The percentage of children underweight or stunted are considered here as dependent variables and a set of demographic, nutritional, labour force, asset, services, empowerment, income, occupation and district level indicators are considered as the independent variables (Table 6.2).

Demography of the Household

As it is found in the present analysis, nutritional status is better for boy child than that of girl child though the difference is very small. Children aged 13 to 24 months exhibit highest level of malnutrition compare to any other age groups. Ages less than 13 months exhibit lowest level of malnutrition among all age groups. The level of malnutrition increases along with the birth order of child's mother's life.

Children born in the lower order are prone to higher malnutrition.

If the child is taken care of by someone else other than mother, then the nutritional status of the child is likely to deteriorate though the difference is not large. Age at mother's first marriage also has a significant influence on a child's nutrition. Children of women married before 15 years of age suffer worst in this regard. As the mother's marital age increases child nutritional status improves. Children of women married after 24 years exhibit better nutritional status compared to the children of those married at 24 or less. As one would expect, a similar pattern is also observed for mother's age at first pregnancy.

Both the 'number of pregnancy' and the 'number of born alive children' also show that as the number of pregnancy and the number of born alive children increases, children's nutritional status deteriorates.

The gender of the household head also has some influence on child nutrition. As in most of the socio-economic aspects, female-headed households are lagging behind than that of male-headed households in this regard. Contrary to popular belief, household size doesn't indicate any significant impact on child nutrition. With regard to religion, nutritional status is better among ‘other religions’ than that of Muslims.

Awareness on Nutrition

Children's first food after birth has significant influence on child nutrition. While over 50% of the children who were given other than colostrums as the first food are underweight, this figure is 34.5% for those given colostrums. The same is also true for stunting. Hand washing material after defecation also is associated with better child nutrition. Using soap for hand wash after defecation significantly improves the status of child nutrition. Similarly, using iodized salt in cooking also improves child nutrition status. Vegetable garden in the homestead however do not present any noticeable difference in child nutrition in the present analysis.

Access to Services

Mother's education has strong influence on the nutritional status of the child. As the level of mother's education increases, child nutritional status also improves. If mother uses contraceptives (meaning birth control), nutritional status of already born child improves. Access to safe water is also positively related with child nutritional status. Similarly, access to sanitary toilet is also positively related with child nutrition. It is important to note here that sanitation has greater influence on child nutrition. While only

Chronic Poverty in Bangladesh

28.4% of the children are underweight with access to sanitation, it is 53.7 for others without having access to sanitary facilities.

Asset and Income of the Household

Household's total land holding has a relationship with child nutrition. Children of households who own more land are better nourished than the children of the households who own less land. Likewise, per capita income of the household also has strong influence on the child nutritional status of the household.

Infrastructure and Public Investment in Social Sectors

Infrastructure has a great influence on child nutrition. Households in districts that have higher proportion of paved road exhibit better child nutrition as compared with the households of other districts. No relationship is however observed between public investment in social sectors in the district and household's child nutrition.

6.2.2 Nutritional Status of the Children: A Rural-Urban and Income-Class Differentiation An attempt has been made here to present the disparities exist between rural and urban (among different income groups as well) with regard to the nutritional status of children (Table 6.3). The status of child nutrition is better in urban areas than that of rural areas. What is observed here is that although it is true for all income groups in both rural and urban areas, the difference is smaller for the extreme poor households. This implies that the extreme poor households in urban areas are worse off than the extreme poor households in rural as compared with their well-off counterparts.

6.2.3 Determinants of Child Malnutrition: A Logistic Approach

Three alternate models have been estimated for each of the three nutritional indicators using a logistic approach. In the first model, only income has been taken into consideration as the explanatory variable.

In the second model, income along with selected household and district level indicators has been considered. In the third model, a complete set of child, mother, household and district level indicators have been considered as explanatory variables.

The results present a significant inverse relationship between per capita expenditure and underweight children in the households (Model-1 of Table 6.4). This implies that as per capita household expenditure increases, child nutritional status improves. The same relationship is also observed in the other two specifications (Model 2 and 3). This indicates that rising incomes and economic growth factor has a significant bearing on child nutrition.

Several other observations are also noteworthy. First, women’s empowerment acts as an important factor.

Thus, ability of the mother to take decision for child’s treatment tends to lead to better nutritional outcomes. Second, assets also matter. The prevalence of child malnutrition drops with increase in land ownership. In terms of quantitative effects on child nutrition, the greatest influence is associated with health

The “Insecurity” Dimension of Chronic Poverty

89 specification.⁶⁰ Similar pattern is also observed for other measures of malnutrition (i.e., stunted, as given in Table 6.5). The additional results influencing child nutrition that emerge from the analysis of stunting suggest the importance of age at first marriage.