Are Indian girls really better nourished than Indian boys? Evidence from Indian National Family Health Survey 1992–2016

• Main Authors: Ashish Kumar Upadhyay, Abhishek Singh
• Format: Article
• Language: English
• Published: Elsevier 2021-01-01
• Series: Clinical Epidemiology and Global Health
• Subjects: Height-for-age z-score; Simulation; Imputation; Mortality selection; National family health survey; India
• Online Access: http://www.sciencedirect.com/science/article/pii/S2213398420302153

Objective: Studies on child malnutrition find no evidence of gender difference in childhood stunting (48% for both boys and girls) in India. Several States show a better nutritional status of girls than boys. Therefore, we argued that in an environment of high mortality among girls, the surviving girls are highly wanted and thus are healthier. Therefore, child nutritional status cannot be studied independent of mortality. Methods: We used three rounds of data from the National Family Health Survey 1992-93,1998-99,2015-16 to examine whether Indian girls are really better nourished than boys. Height for age z-score (HAZ), as defined by the World Health Organization was used to measure the health of children. We first imputed the HAZ for dead boys and girls using multiple imputation techniques. Second, these imputed HAZ for dead boys and girls were combined with HAZ of surviving boys and girls to provide a simulated HAZ separately for boys and girls. Results: Results show that relative reduction in average HAZ was slightly higher for girls than boys in each of three rounds of NFHS. Although the relative decline in average HAZ was higher for girls than boys, the simulated z-scores after incorporating the average HAZ for dead children suggest no significant difference between the overall HAZ of boys and girls in any of the three surveys. Conclusion: We do not find enough evidence to establish the effect of mortality selection in explaining the better nutritional status of girls compared with boys in India. Our findings are consistent across the three rounds of NFHS and at different levels of mortality.