Social Discrimination Key Factor In Stunting Among Children: Study
Caste practices and other kinds of social exclusion reduce communities' access to maternal and child health, leading to more cases of stunting, says a new study
New Delhi: Vulnerable to social discrimination, children from Scheduled Castes (SCs), Scheduled Tribes (ST) and Muslim families are more likely to experience stunting--a condition where the body height is less than the accepted range at a given age--says a new study. Even socio-economic advantages do not not change the correlation between stunting and exclusion.
'The Missing Piece of the Puzzle: Caste Discrimination and Stunting', a July 2021 study by Ashwini Deshpande of Ashoka University's Center for Economic Data and Analysis (CEDA) and Rajesh Ramachandran of the University of Heidelberg, was aimed at understanding the impact of caste and socio-economic factors on stunting among children. It found that marginalised castes--SCs, STs and Other Backward Classes (OBCs)--reported a higher prevalence of the condition because of the widespread and entrenched, though illegal, practice of untouchability. Among Muslim families too, stunting was common, regardless of social status.
The study is significant because so far the emphasis has been on researching the links between child malnutrition and poverty and the lack of access to resources. "While stunting in India is high overall, there is a great deal of difference by social identity and we need to focus on that and ask why rates of stunting differ by social identity," says Desphande.
Nearly one-third of all stunted children in the world are in India. This condition causes adverse outcomes later in life, especially impaired brain development, which leads to lower cognitive and socio-emotional skills and lower levels of educational attainment, IndiaSpend reported in August 2018. The lack of these skills has led to 66% of the workforce earning less than it would otherwise have, as per a 2018 World Bank report.
Children in India are much shorter than those in 30 countries in Sub-Saharan Africa, the CEDA report pointed out. This dichotomy, wherein development does not necessarily result in better social indicators, is referred to as the "Indian enigma", comparable to the idea of the "south Asian enigma". India's average rate of stunting is 36% while that of Sub-Saharan Africa is 31%, the study pointed out.
Role of social identity
The CEDA study laid out five critical factors that lead to stunting:
Lack of access to sanitation
Mother's human capital, that is, her ability to read as well as the number of years of schooling
Mother's anthropometric status that is, her height and weight
Intra-household resource allocation
Child stunting has long been associated with poverty because its roots lie in chronic malnutrition, as we said earlier. However, the CEDA study categorised child stunting data into four social categories--'Upper Caste' Hindus, 'Upper Caste' Muslims, SCs and STs, and OBCs. (While caste is traditionally a Hindu practice, other communities in India too subscribe to similar social hierarchies.)
The findings make it clear that social class has a critical bearing on stunting.
Children from dominant Hindu castes reported a lower average rate of stunting (26%) and better height for their age than their counterparts in Sub-Saharan Africa (31%). But this was not the case with any other of the four categories studied--the numbers stand at 40%, 36% and 35%, respectively, for SC-ST, OBCs and 'Upper Caste' Muslim children.
The practice of untouchability plays a big role in stunting, said the study, explaining why even among the disadvantaged groups, Dalit children are more stunted. Why does this happen? Untouchability leads to poor access to healthcare and sanitation, among other facilities, said the study. Dalit mothers and children are also less likely to be able to access essential prenatal and antenatal care and this affects the delivery of services to pregnant and nursing mothers and consequently, the health outcomes among their children.
The CEDA report also observed that the highest rates of stunting across all religious and economic factors are to be seen in Bihar, Jharkhand, Madhya Pradesh, Rajasthan and Uttar Pradesh--earlier referred to in government documents as the 'BIMARU' belt--and Chhattisgarh. The data from these states reflect their poor socio-economic development, said Deshpande.
In this belt, the prevalence of stunting is more than 40% in 38% of the districts for the dominant castes. For the OBCs and 'upper caste' Muslims, it is greater than 40% in 61% and 71% of the districts, respectively.
The situation in the southern and northern regions of India is quite different from the BIMARU states, as per the study. While child stunting remains a problem in these regions, it is less prevalent and less extreme.
However, in the 'BIMARU' belt, the CEDA scholars also examined the links between stunting and socio-economic factors vis-a-vis purely social ones. They did this by comparing the data on Dalit and dominant caste children who were "matched" in terms of socio-economic factors. They found that even with similar socio-economic advantages, children from marginalised castes were shorter than those from dominant castes.
Stunting rates in richer states such as Gujarat, Kerala, and Goa, among others, have actually increased over the last five years, as IndiaSpend reported in December 2020. This reverses the trends reported five years earlier when economic well-being ensured better health among children, said the report.
Social anthropologist A.R. Vasavi, who has also traced the links between caste and class, has a different interpretation of the study's findings. "There are several factors that account for child stunting, malnutrition and nutrition deficiency among the disadvantaged and 'low-ranked' caste groups. However, I would not link it to 'caste discrimination' per se. Instead, the coinciding of caste with class accounts for the multiple disadvantages in which these caste groups are located and for the fact that they face several challenges in meeting their food and nutrition security," she said.
Dominant caste households earned 47% more than the average household income and the top 10% of these households owned 60% of its total wealth, IndiaSpend reported in January 2019. SC, ST, and OBC households earned 21%, 34%, and 8% less, respectively, than the average household.
Disadvantaged communities face other kinds of nutrition issues too. "For migrant communities, the inability of lactating but working mothers to breastfeed their children accounts for the onset of childhood based under-nutrition," said Vasavi. She also pointed to the cultural factors that impact marginalised castes--they are often forced to give up traditional foods such as meats, especially beef, in the course of 'Sanskritisation', a process where marginalised castes emulate the rituals and practices of dominant castes.
"New fads and convenience foods such as bread, Maggi noodles, etc. have spread into rural areas and many families and children are also victims to such food fads," said Vasavi.
The Global Hunger Index, which calculates the percentage of wasting, stunting and mortality among children under five, ranked India 94th in a list of 107 countries. India is also seeing an increase in child undernutrition, reversing decades of gain according to the 2020 National Family Health Survey (NFHS), reported IndiaSpend in December 2020.
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