Intra-Urban Disparities In Childhood Stunting in Three Urbanizing South Asian Countries

Introduction: 195 million children <5 in developing world are chronically undernourished (stunted). Of these, 40% stunted children live in Asia; 31.2% in India, 3.7% in Bangladesh, 1% in Nepal. By 2030, Asia accounts for more than half of world’s urban population. India, Bangladesh, Nepal together house 400 million urban population. Urban – rural comparisons mask deprivation of urban poor. Country-level DHS data provides adequate sample to unravel unjustified in equity within urban areas.

Objective: Assess extent of and disparities in stunting among urban under-five children in three urbanizing South Asian countries -India, Nepal and Bangladesh.

Methods: Using official country estimates of urban-poverty to determine cut-offs, most recent Demographic Health Survey urban-nutrition data was disaggregated by wealth quartiles for Bangladesh and India and deciles for Nepal.

Results: One-third urban children <5years in these countries were stunted and 12-17% severely stunted. Compared to top wealth-quartile/decile, in lowest wealth-quartile/decile childhood stunting was 2-3 times higher (India: 21% v/s 54%, Bangladesh: 15% v/s 48%, Nepal 15% v/s 55%). Similarly, severe stunting was 3-4 times higher in India (7% v/s 28%) and Nepal (9% v/s 25%) and 6times higher in Bangladesh (3% v/s 19%).Stunting in quartile/decile next to the lowest was also high at 40-50%.

Conclusion: There is an urgent need for disaggregating urban data for policy focus on addressing high-levels of stunting in this deprived and rapidly increasing population segment. Stunting in quartile/deciles next to lowest is equally high, which official poverty estimates do not capture. Disaggregated urban data has helped bring policy focus at national-level and in several States in India towards improving health and well-being of urban poor.

Key Words: stunting, slums, south Asia